Advocacy in Action: A Focus On Process for a State Basic Health Program

April 24, 2012

Last year, CT Health awarded four organizations grants to promote the generation of health policy / advocacy research that would be used to:

  • advance the policy agenda or advocacy strategy of the grantee organization
  • inform CT Health’s policy agenda and programmatic objectives 
  • inform state or local advocates and decision makers working on related issues

This is the first in an ongoing series to highlight each of these grants and demonstrate the impact public policy has on how health is valued in CT.

The State Basic Health Program

Advocates play a key role in helping policy-makers make good decisions: they can supply policy-makers with data and research that enable them to understand issues in a more complete way. This year, the Legal Assistance Resource Center of Connecticut (LARCC), with a grant from CT Health, funded research into the impact of a State Basic Health Program (SBHP).

One piece of the Patient Protection and Affordable Care Act (ACA) is the SBHP, an option for states to cover non-Medicaid eligible adults between 138 percent and 200 percent of the federal poverty level, through a state-run program rather than through  the Health Insurance Exchanges.  Monette Goodrich previously blogged about the SBHP and its feasibility for CT here (a great overview). This legislative session features two  bills on the SBHP that have been approved by the Human Services and Public Health Committees and are awaiting further action. .

LARCC contracted with the University of Massachusetts Medical School, Center for Health Law and Economics, to produce, “Evaluating the State Basic Health Program in Connecticut.” What’s interesting is that the brief, rather than propose a specific structure for a SBHP, recommends instead that the state conduct further analysis and design a program that meets the needs of low income individuals and the state.

I spoke with Katharine London, one of the principal researchers on the brief, and Jane McNichol, Executive Director of LARCC. (Robert W. Seifert was the other researcher on the brief).

A Focus on Process, Not Outcome

Jenn: How did this research brief elevate the conversation on the SBHP?

Katharine: There’s a lot of confusion around the SBHP – but why? The brief helped stakeholders to understand why there was so much confusion – it’s complicated and there are many unknowns. Everyone was coming at the SBHP from different assumptions, which led to different conclusions about the impact it would have on the state’s resources.

Jane McNichol

Jane: Instead of proposing the end result we want – a SBHP that mirrors CT’s Medicaid program – we proposed that:

  • the legislature authorize a SBHP
  • the Administration be charged with developing the details of the SBHP within certain guidelines specified in the legislation by October 1, and
  • the key committees of the legislature be authorized to approve, modify, or reject this proposal.

We wanted to propose a process that didn’t end with the legislative session, but one that enabled policy-makers to be a part of a continuing conversation to devise a program that really works. This process is modeled on the process used to approve waivers to the federal Medicaid plan.

To date, the brief has been successful in helping legislators to understand that there are no simple answers right now but that the BHP has potential for Connecticut. We’re working on engaging the administration itself.

Jenn: Is the SBHP a good direction for CT to go?

Katharine London

Katharine: First of all, low income individuals could have much lower out-of-pocket costs through a SBHP than through the Exchange.  Because of the lower out-of-pocket cost we would expect that there would be fewer uninsured if there was a SBHP. The study done on the issue by Mercer Health and Benefits  for the Health Insurance Exchange Board estimates 17,000 fewer uninsured with a SBHP in place. Depending on the design, there’s potential savings of state budget dollars; the state could use surplus funds to pay higher rates to providers. Lastly, the population remaining in the Exchange would have a lower health risk profile.

But, we are still waiting for federal guidance on how they’ll implement the program. Once we have that guidance, we’ll be able to do a true cost-benefit analysis.

Jane: The SBHP seems like an intelligent way to move towards universal coverage. Otherwise, people between 138% and 200% poverty level would be in a tough spot.

To better understand the SBHP, I recommend looking through slides Katharine presented to CT Health’s Public Policy Committee in March – they made a complex issue very clear.

The Basic Health Program What would it mean for Connecticut?

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