Business Plan Work Group Presentation to the Health Care Cabinet January 10, 2012

Background Long history of health care reform 2010 SustiNet Partnership board recommendations Public Health Plan to drive delivery system innovation, improve health, and lower costs Economic and political obstacles PA11-53 creates Cabinet & charges it with developing a business plan for alternatives to private insurance to achieve same goals

Connecticut Health Insurance Exchange Marketplace of health insurance products – Affordability and quality to uninsured, under- insured and small businesses – Data presented so far requires analysis, raises more questions – Who is still left out? Small businesses with low wage workers? Basic Health Program for those up to 200% FPL? Are subsidies enough for high-cost state like CT? Immigration status?

Health Care Cabinet: Business Plan Work Group PA11-58 Sect. 13h and Sect. 14(c)(5)(A) Charge: The charge to the Business Plan work group of the Cabinet is to propose one or more business models that could effectively offer quality health benefits affordable to small businesses and individuals. It will compile and analyze market, feasibility and risk assessment data in order to identify gaps in coverage, quality and affordability. The work group will develop multiple scenarios for addressing such gaps including public, nonprofit and private approaches, and it will make recommendations for alternative approaches. The Cabinet is responsible for transmitting recommendations to the Governor and legislature by October 1, 2012.

Timeline Assessment Phase (through March): gather and analyze data – Mercer, Milliman, Census ACS, Medical Assistance Program Oversight Council, other sources Analysis & Recommendations Phase(through May): analyse, discuss findings from assessment, develop recommendations, refine, present draft recommendations to Cabinet Writing Phase (through Sept.): provide drafts for review & feedback, seek public comment, obtain Cabinet vote and transmit final report

So far… 1.Affordable small group coverage may continue to be a problem. 2.The uninsured is comprised of different sub-groups. 3.The undocumented immigrant population and immigrant population with less than 5 years residency will be left out of other options 4.Mercer data show that a large percentage of the insured receive benefits below what may be considered “bronze” level. 5.Populations left out will likely represent the most unattractive risk.

Discussion Cabinet’s guiding principles: – Commitment to impact – Equity in health care delivery & access – Leverage – Accountability – Inclusion – Action