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Governor Calling for Major Changes in Providing Health Care

February 11, 2011

NEW HAVEN, Conn. - Up to now, three insurance providers, including two for-profits, have been contracted to provide health care for the state's 400,000 low-income families on the Husky Program. Now, Gov. Dannel Malloy is taking the profit out of the system by having the state contract with a single organization to administer the program.

Ellen Andrews, executive director of the Connecticut Health Policy Project, says often families could not find a doctor, even though they had insurance through one of these providers.

"They got a set amount of money whether you went to the doctor or not, so they had an incentive - an economic incentive - to keep you from getting any health care. Now, the state is going to pay the bills directly, so they have no incentive to keep you from getting any health care."

She believes fears of runaway costs under the new system are unfounded - and that the state stands to save $50 million annually.

Andrews points to a recent experiment that blocked the for-profit providers for a year, and medical costs actually went down slightly.

"We still don't know why, exactly, but we're hoping people could get access to preventive care, and that kept them out of the hospital, which is the way it's supposed to work."

She says the new system promotes an idea that's a cornerstone of health reform.

"The 'medical home' concept is where you have a direct relationship with a doctor, a nurse practitioner, a physician assistant, who is your personal provider. And if you have a problem, you don't run off to the emergency room - you call them."

Andrews adds that the governor's plan goes beyond Husky families to include 200,000 seniors and residents with disabilities on Medicaid.

"People in nursing homes - or even worse, people who are at risk of ending up in a nursing home, but can't get access to a doctor, so they end up in the nursing home because their preventive problems aren't taken care of - may be able to get better care now."

The changes are due to go into effect Jan. 1, 2012.

Melinda Tuhus, Public News Service - CT