Foley, Malloy, Like Late-Season Dragonflies, Lock in Death Spiral Over Health-Care Campaign Turf.

 
 

 Ah yes. We must be past Labor Day, for the gubernatorial race is moving apace, with nearly daily engagements between Democrat Dannel Malloy and Republican Tom Foley.

Here’s Foley’s proposal today for the future of Connecticut health care, followed by Malloy’s reaction:

“Connecticut’s health care system provides excellent health care to most of its citizens and it is an important contributor to our economy. However, the cost of delivering health care in Connecticut is higher than in almost every other state in the country. The high cost of health care puts a strain on our state’s budget and burdens employers and individuals with high health insurance costs. These high costs strain family budgets and drive jobs out of the state. Good health care policy in Connecticut should focus on improving the quality and accessibility of health care services while driving health care costs down.

Health care services collectively account for one-sixth of Connecticut’s economy and one third of Connecticut’s state budget. The state spends nearly $7 billion a year on health care through Medicaid, employee benefits for active and retired state employees, and state sponsored insurance programs. Although Connecticut has extended coverage to over 90 percent of our citizens, we still have basic coverage and insurance affordability issues that need to be addressed. The recently enacted federal bill will largely define how those issues will be handled. State-based plans for expanding coverage need to be tabled until we understand the structure and impact of the federal plan. Our health care focus near term in Connecticut needs to be on lowering costs, improving quality, and improving the health status of our citizens.
As Governor, I will set three broad goals for state action:
1. Become the healthiest state in the country by 2020, as measured by national data.
 
The very best way to lower health care costs and raise quality of life is to help people stay healthy, yet this is rarely a target of public policy. It is estimated that 75% of health spending is on diseases caused at least in part by lifestyle choices. The immediate targets for a state-based wellness initiative should be reducing obesity, smoking, and drug and alcohol abuse while improving fitness. Connecticut is rated in the top ten on health status among the states—we should set our sights on being number 1.
 
2. Reduce the cost of delivering health care services in Connecticut by 10% over five years adjusted for inflation.
 
Health care costs in Connecticut are some of the highest in the country. To solve our budget deficit challenge and keep from driving even more jobs from Connecticut, we must drive down the cost of health care. In addition to promoting better health to lower costs, Connecticut must take the initiative to promote electronic record keeping, transition more consumers from fee for service based care to pay for performance based care, develop more community-based care options for our elderly and disabled populations, give consumers a stake in the economics of their care choices, provide incentives for consumers not to use emergency rooms for non-emergency care, improve the way victims of medical malpractice and medical errors are compensated, and authorize an affordable, ‘core needs’ insurance plan that is exempt from state mandates for those who cannot afford state mandated plans.     
 
3. Improve the quality of care in Connecticut.
 
Although the quality of care in Connecticut is good, it can be improved. The biggest opportunities to improve the quality of care will come from reducing medical errors, encouraging more evidence-based medicine, driving consumers to primary care providers who oversee their overall healthcare needs, and transitioning patients away from fee for services care and toward performance based care. 
 
As Governor, I will take the following early action steps to improve Connecticut’s health care system:
 
1. Place a moratorium on the enactment of new private health insurance benefit mandates.
 
2. Allow small companies which have not previously provided health insurance, and any company whose health insurance costs exceed a defined percent of payroll, to elect coverage under a ‘core needs’ plan to be set by the Insurance Commissioner which is focused on basic care needs and is exempt from state mandates.
 
3. Place the current state Medicaid program for the aged, blind and disabled into a modern managed care framework. 
 
4. Adopt a three-year goal and program to orient state Medicaid for the elderly away from nursing home care to more cost effective home and community-based care. The state should use some of the savings to raise Medicaid reimbursement rates for nursing homes so that nursing homes can provide a higher level of care and invest more in their facilities. 
 
5. Develop and promote wellness with an emphasis on reducing obesity and smoking while improving fitness. Consider state incentives to school districts to deliver healthy breakfast and lunch programs, and incentives to employers for similar wellness programs. Create an awards program for employers who successfully promote wellness.
 
6. Reform medical malpractice arrangements and lower costs in Connecticut by piloting special health courts, working with providers to establish standards of care which, if followed, provide a ‘safe harbor’ against malpractice suits, and using state muscle to weed out bad actors and repeat offenders. 
 
7. Assist doctors, hospitals and other providers to partner in integrated delivery systems of care that are paid in ways that provide incentives for improved quality, customer service, and cost effectiveness. Promote e-health initiatives. Use state Medicaid and public employee benefit programs to help lead these innovations. Over the long term, the best opportunity to lower costs and improve quality is to reorient the health care delivery system away from its current costly fee-for-service care model.   Numerous initiatives are underway, under terms like Medical Home, Accountable Care Organizations, pay-for-performance, and bundled or full-risk payments. The state must be an advocate and convener across public and private programs to press for these changes, and must use its own programs to accelerate progress.
 
8. Work, where possible, to eliminate market-distorting cost-shifting from public insurance plans such as Medicare and Medicaid to medical service providers and private consumers.
 
Nearly $30 billion a year is spent in Connecticut on health care. This is both a liability and an opportunity. It is a liability because health care services in Connecticut are very expensive which adds to our fiscal problems and costs the state jobs. It is an opportunity because health care services can be exported and be a large contributor to our economy providing jobs and economic growth. As Connecticut’s next Governor, Tom Foley will place a high priority on improving the health of our citizens while lowering the cost and improving the quality of healthcare services in Connecticut.”

 

Malloy Responds to Foley’s Plan:  

“This isn’t a health care plan, it’s a lifeline to the insurance companies and HMOs that got us into this mess in the first place. I have a fundamental belief that health care is something everyone should have – Tom Foley apparently disagrees.

“He proposes a moratorium on benefit mandates to private insurance carriers.  What does this mean?  That the state would no longer be able to ensure coverage for patients with existing conditions.  I suppose taking wigs away from cancer patients undergoing chemotherapy wasn’t far enough – Tom wants to take their insurance too.

“Tom proposes placing ‘the current state Medicaid program for the aged, blind and disabled into a modern managed care framework.’  That’s a nice way of saying that Tom will add one more layer of fee-driven bureaucracy for our seniors and disabled to have to muddle through in their attempt to receive care.

“Of course, none of this should be terribly surprising.  This is a candidate who believes that health reform is a ‘bad deal’ because enough Connecticut residents already have coverage. Tom Foley apparently isn’t concerned about the more than 400,000 Connecticut residents who don’t have health insurance.”

Malloy’s health care plan, which he announced in June, can be read at http://www.danmalloy.com/policy/health_care.