SustiNet: Trying Something New in the Nutmeg State

by Tim Foley

categories: Public Plan, State and Local Efforts

Published January 22, 2009 @ 06:25AM PT

Somewhat lost in the long weekend and the coverage of Whatsisname getting inaugurated in Washington D.C., a grassroots group in Connecticut has pushed forward a significant proposal for covering up to 98% of individuals in the state.  The plan, detailed in the video below, would essentially create a public insurance option for individuals and employers to buy into which would compete directly with the private insurance industry.



At first glance, this looks very similar to what President Obama proposed on the campaign trail – create a public program similar to Medicare and have it compete on the merits.  But there are some marked differences.

For one thing, neither Obama nor anyone else proposing the public competitor model (Edwards, Clinton, Baucus, etc) had envisioned the public plan being sold to businesses, only to individuals.  Their system focused on pay or play – employers either provided coverage for their employees and chose their coverage, or employers left their employees free to make their own choices through a National Health Exchange, and instead paid some percentage of their payroll into a common fund to support the Exchange.  SustiNet’s video clearly positions it as a direct help to businesses in the troubled economy.  Clearly they’re not just looking to market to those left behind by the system, as the Massachusetts Health Connector did. They’re looking for businesses fed up with dealing with rising premiums to jump ship as well, and their proposal makes clear that they would market to businesses using the same tools as the private insurance companies.  Because they’re state-based, they also have one advantage over a national public competitor – they don’t start the plan with zero enrollees.  Instead, they would move their state employees and retirees, HUSKY members (the state children’s health insurance program) and SAGA participants (low-income but not elderly, blind or disabled Medicaid recipients).

For another, SustiNet is premised not just on providing comprehensive benefits for those who don’t have it (or supplemental benefits for those whose current coverage is insufficient – a welcome detail, since there are nearly as many underinsured as uninsured!), but changing the quality of care substantially.  Their goal is not just to provide coverage, but to provide the “killer app” in software terms:  the health care model that you have to have.  Electronic medical records are part of it, but so is their idea of the “medical home” and the coordinated care that would be required of participating health care providers.  The proposal is obsessive about stats and health metrics, with a board to review data on treatments for those participating in the plan, and a top-to-bottom commitment on standards for effectiveness.  Imagine that --  a reimbursement scheme based not on fee for service but on coordination, efficiency and data.

At present, this is the brainchild of the grassroots, who triumphantly launched the proposal at a rally last Friday.  Whether it will get picked up in any serious fashion by legislators in Connecticut is a complete unknown, and the proposal is somewhat hazy in how it arrives at its cost savings figures (and what steps it would take to prevent a Massachusetts-like explosion of unintended costs.)  But the fact that serious plans like this are taking center stage in the states means there’s something in the air – and that’s good for the momentum of changing our broken health care system.