The Connecticut Health Care Insurance Act
December 30, 1998 revision

The Connecticut Health Care Insurance Act establishes the Connecticut Health Care System, a health insurance program to provide all Connecticut residents with all medically necessary services by a provider of their choice. The Connecticut Health Care System replaces the current mixture of public and private health insurance plans with a publicly financed health care plan with a single administrative and payment mechanism. 

The Act is organized into four sections. The first section, Findings and Declarations, establishes why the Connecticut Health Care System should be enacted. The second section, Intent and Purpose of the Connecticut Health Care System, articulates the intentions and purposes of the Connecticut Health Care Insurance Act. The third section, Principles of the Connecticut Health Care System, articulates the guiding principles to be utilized in establishing and administering the Connecticut Health Care System. The fourth section, Governance and Administration of the Connecticut Health Care System, creates an Connecticut Health Care Trust charged with a) defining the benefits of the Connecticut Health Care System, b) defining the payments for the procedures covered by the Connecticut Health Care System, c) establishing funding for the Connecticut Health Care System, and d) administering the Connecticut Health Care system including enrolling eligible Connecticut residents, quality assurance, capital development, cost containment, consumer education, and certification of providers.

Section One of the Act:
Findings and Declarations 

The Connecticut Health Care Insurance Act finds and declares:

That the over 12% of Connecticut residents without health insurance constitute a threat to the public health which will be resolved by this Act. As reported in the January, 1999 American Journal of Public Health, the number of uninsured in the State of Connecticut has increased by over 50% since 1987 to more than 12% of the population, with the largest increases being among middle-income families. Of the uninsured, 80% are working individuals and their families, whose numbers in the State of Connecticut will continue to rise if universal coverage is not enacted in the State of Connecticut. This ever-increasing percentage of Connecticut residents without health insurance constitute a threat to the public health of the State because the lack of insurance a) inhibits access to adequate health care, and b) delays preventive care and appropriate treatment. As reported by Donelan et al. in the Journal of the American Medical Association in 1995, 75% of the uninsured in “poor” health report problems in accessing health care. As a result, the uninsured are more seriously ill when they seek treatment, are more difficult to treat, and have increased costs of treatment. These increased costs are commonly passed on to the state because the State of Connecticut is the payer of last resort when residents of Connecticut are impoverished or bankrupted by medical expenses. Universal coverage, especially when combined with an integrated system of preventive health care, will decrease total health care expenditures over the course of a person’s life time and significantly improve public health.
That the current patchwork of private and public health insurance programs is administratively inefficient compared to publicly administered insurance programs with a single payer. Under the current health care system, private, for-profit, managed health care insurance corporations spend 20-30% of the health care dollar on administrative expenses. In addition, such corporations increase the administrative costs of health care providers by forcing them to relate to hundreds of health insurance programs and multiple systems of micromanagement involving multiple methods of certification, approval, and reimbursement. By comparison, the Federal Medicare program spends approximately 3% on health care administration. Similarly, the national health insurance programs which exist in every other industrialized nation, spend between 8 and 10% of the health care dollar on administrative costs. 
That the current patchwork of private and public health insurance programs is inconsistent with the wishes of the residents of the State of Connecticut. A 1990 Hartford Courant poll indicated that 60% of Connecticut residents support a tax-financed government health plan. Several national polls taken at that time indicated that from 62-72% of Americans surveyed supported a tax-financed national health plan. A 1996 national poll of the National Coalition of Health Care reported in the Journal of Health Care Finance in 1997 revealed that the vast majority of Americans (69%) feel “the federal government can play an important role in making health care better” and “more affordable” (72%). This same study revealed that, overall, Americans covered by public insurance programs were more satisfied with the their health care than people covered by private insurance. In Canada, 96% of Canadians polled prefer their single payer, universal health care system, to the previous US style system, and would be opposed to a return to a US style system. Most recently, in the November 3, 1998 elections, when Cambridge, MA voters were asked “Shall the state representative from this district be instructed to vote in favor of legislation for universal, affordable, comprehensive health insurance for all residents of Massachusetts, and providing for a Health Care Bill of Rights for all residents of Massachusetts?”, they voted “yes” by a margin of 8 to 1.
That for-profit, micro-managed health care, characteristic of our current health care system, has resulted in the denial of necessary medical treatment. The 1996 Coalition for Health Care poll found that eight in 10 Americans believe that the quality of medical care is being compromised in the interest of profit. Similarly, a 1996 poll of over 1,000 physicians conducted by the Black Corporation for the American Medical Association found that 71% of physicians believe managed care has negatively affected quality of care through the denial of necessary treatment. Furthermore, the vast majority of Americans are opposed to having decisions about health care being taken out of their providers’ hands and requiring the approval of their insurance company.
That the current patchwork of public and private health care insurance disrupts the continuity of patient care and restricts the ability of consumers to choose their own health care providers causing poor medical care, inefficiency, and frustration. Under the current system approximately 25% of consumers with employer based insurance programs are forced to change one or more of their health care providers each year as a result of changes in their insurance programs. Such 
changes result in poor patient care by disrupting the provider-patient relationship, result in incalculable wasted hours on enrolling, transferring patient records, and learning a new health care insurance system, and creates unnecessary frustration and uncertainty in consumers and providers. The universal coverage system initiated with this act insures total continuity of patient care.
That the current patchwork of public and private health care insurance precludes the participation of consumers and providers in determining the benefit package offered to consumers and the rates paid to providers for offering these services. The only choice that consumers and providers have in relationship to private insurers is to accept or reject the packages offered to them in toto. Furthermore, many consumers have a poor understanding of the insurance packages offered to them and make uneducated and misguided choices in selecting them. The publicly financed, universal coverage system instituted with the act, provides consumers and providers a meaningful role in determining the benefit package offered to consumers and the rates paid to providers for these services.
That the micromanaged dimensions of our current health care system represent a serious threat to patient confidentiality and privacy. That the establishment of a universal health care system which macromanages’ providers patterns of utilization with reference to established treatment and prevention guidelines will ensure patient confidentiality and privacy. 
That the establishment of universal coverage through the administrative efficiency of a single payer health care system would reduce the total health care expenses while increasing utilization by the currently uninsured portion of the population. This conclusion was reached by studies of the Congressional Budget Office at the federal level, and by the State of Connecticut Office of Health Care Access Report (1995) to the Connecticut General Assembly, where they concluded “total spending would decline because savings from reduced administrative costs and lower provider payment rates would more than offset increased spending due to increases in insurance coverage and the more generous benefit package.”
That the incremental legislative reform of managed care abuses cannot address the fundamental problems of lack of access, cost, quality and accountability.
That the establishment of universal coverage through a single payer in the State of Connecticut would reduce the cost of medical expenses for the average resident in the state of Connecticut and contain health care costs overall.