Insurance and Real Estate Committee
JOINT FAVORABLE REPORT
Bill No.: HB-5042
Title: AN ACT CONCERNING HEALTH CARE COST GROWTH.
Vote Date: 3/10/2022
Vote Action: Joint Favorable
PH Date: 3/1/2022
File No.: 56
Disclaimer: The following JOINT FAVORABLE Report is prepared for the benefit of the
members of the General Assembly, solely for purposes of information, summarization and
explanation and does not represent the intent of the General Assembly or either chamber
thereof for any purpose.
SPONSORS OF BILL:
Request of the Governor pursuant to Joint Rule 9
REASONS FOR BILL:
This bill codifies Governor Lamonts Executive Order No. 5 signed in January 2020, to address the health
inequities that have been exasperated by the COVID-19 pandemic. This bill aims to prioritize primary
care and improve the quality and affordability of health care in our state.
RESPONSE FROM ADMINISTRATION/AGENCY:
Natalie Braswell, State Comptroller supports this bill, and notes that it does not impose hard
caps, but rather sets goals for all stakeholders, including the state as a whole, to try to
achieve. HB 5042 also sets targets for primary care investment in Connecticut.
Joshua Hershman, Deputy Commissioner, Connecticut Insurance Department is proud to
stand with Governor Lamont and Executive Director Veltri on this important initiative given the
unsustainable rate of growth we continue to see in health insurance rates filed with the
Department annually.
Ted Doolittle, Healthcare Advocate, Office of the Healthcare Advocate encourages the
adoption of the bill but suggests that the bill incorporate the 25th percentile of family income,
in addition to median income, as an additional factor in calculating the periodical cost growth
benchmark. This simple change could put Connecticut at the forefront of all benchmarking
states and manifest an important first step in fulfilling another goal of recent legislation,
namely, to recognize and address the consequent racial and other health disparities linked to
growing income inequality. Accordingly, OHA encourages this committee to revise the
language in this bill slightly in order to emphasize the acute financial needs of working lower-
and middle-class families in establishing a cost growth benchmark.
NATURE AND SOURCES OF SUPPORT:
Milbank Memorial Fund believes that the bill will strengthen transparency and accountability
for health care costs, formalize the process for setting the benchmark and monitoring cost
growth, and provide a predictable basis for sustained resources to administer these
programs.
Bristol Health suggests multiple amendments. Namely, requirements for: Reauthorization of
benchmarks and targets beyond 2025; OHS to consider other factors like the adequacy of
public payer provider reimbursement rates, labor costs, medical inflation, etc; The OHS
executive director to hold a public hearing on benchmark values and report publicly on why
such values are maintained/changed; the annual report by OHS to include information on
payer and provider input costs, including pharmaceutical costs, the adequacy of Medicare
and Medicaid payment rates as they relate to the cost of care, Page 4 of 4 the impact of the
rate of inflation and rate of medical inflation, impacts on access to care, medical service
expansion, and pursuit of medical innovation, the effect of patient acuity, and any impact on
the response to a public health crisis.
Connecticut Childrens Medical Center appreciates the goals of the bill but asks that
legislators consider the following amendments to the proposed legislation. Namely,
requirements for: Reauthorization of benchmarks and targets beyond 2025; OHS to consider
other factors like the adequacy of public payer provider reimbursement rates, labor costs,
medical inflation, etc; The OHS executive director to hold a public hearing on benchmark
values and report publicly on why such values are maintained/changed; the annual report by
OHS to include information on payer and provider input costs, including pharmaceutical
costs, the adequacy of Medicare and Medicaid payment rates as they relate to the cost of
care, Page 4 of 4 the impact of the rate of inflation and rate of medical inflation, impacts on
access to care, medical service expansion, and pursuit of medical innovation, the effect of
patient acuity, and any impact on the response to a public health crisis.
Connecticut Hospital Association suggests the legislation should authorize the benchmarks
and targets through 2025 and require their reauthorization by the legislature for
implementation beyond that date, and multiple language changes in sections 1, 3, 4, 5, 6.
Connecticut Association of Health Plans supports the bill, which continues the hard work
already begun of addressing the underlying cost of care components that drive the cost of
health insurance coverage, and looks forward to continuing the existing dialogue and
partnering with OHS and other stakeholders in achieving the objectives outlined.
Connecticut State Medical Society has some concerns, questions and recommendations
regarding the proposals set forth in this bill. At the forefront of their concerns are the
enforcement mechanisms that may be enacted for payers that exceed the benchmarking
standards. Requiring a health payer to reduce medical spend will undoubtably come on the
backs of the physicians providing medical services to Connecticuts residents. CSMS urges
the Committee to consider the potential negative impact to patients as an unintended
consequence of the benchmarking proposal. Lastly, they implore this Committee to add into
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this bill a mechanism to ensure that insurers are not simply cutting out medically necessary
care in order to reduce health care spend as a whole and meet a set spending benchmark.
Liz Dupont-Diehl, Special Projects Coordinator, CT Citizen Action Group is pleased that it at
least mentions profits as a factor to be considered, but urges you to maintain a focus on the
grossly excessive profits and salaries, and to be mindful of the likelihood that capitated
payments will result in limiting care, especially to people who are on or eligible for Medicaid.
Hartford Healthcare suggests multiple amendments. Namely, requirements for:
Reauthorization of benchmarks and targets beyond 2025; OHS to consider other factors like
the adequacy of public payer provider reimbursement rates, labor costs, medical inflation,
etc; The OHS executive director to hold a public hearing on benchmark values and report
publicly on why such values are maintained/changed; the annual report by OHS to include
information on payer and provider input costs, including pharmaceutical costs, the adequacy
of Medicare and Medicaid payment rates as they relate to the cost of care, Page 4 of 4 the
impact of the rate of inflation and rate of medical inflation, impacts on access to care, medical
service expansion, and pursuit of medical innovation, the effect of patient acuity, and any
impact on the response to a public health crisis.
Karen Siegel, Health Equity Solutions recommends regularly reviewing and updating HUSKY
provider rates and payment models to evaluate their impact on provider network adequacy,
health outcomes overall, and equity in health outcomes. Health Equity Solutions supports
increased investment in primary care. Health Equity Solutions supports equity-focused
systems reform and recommends requiring equity be a central focus of payment reform
efforts. Health Equity Solutions recommends requiring all future value-based payment efforts
to explicitly target and evaluate health equity. Health Equity Solutions recommends granting
the Office of Health Strategy the authority to require entities in violation of the benchmark to
engage in equity-focused performance improvement plans.
Yale New Haven Health suggests multiple amendments. Namely, requirements for:
Reauthorization of benchmarks and targets beyond 2025; OHS to consider other factors like
the adequacy of public payer provider reimbursement rates, labor costs, medical inflation,
etc; The OHS executive director to hold a public hearing on benchmark values and report
publicly on why such values are maintained/changed; the annual report by OHS to include
information on payer and provider input costs, including pharmaceutical costs, the adequacy
of Medicare and Medicaid payment rates as they relate to the cost of care, Page 4 of 4 the
impact of the rate of inflation and rate of medical inflation, impacts on access to care, medical
service expansion, and pursuit of medical innovation, the effect of patient acuity, and any
impact on the response to a public health crisis.
Daniel F. Keenan, Vice President Advocacy and Government Relations, Trinity Health of New
England suggests multiple amendments. Namely, requirements for: Reauthorization of
benchmarks and targets beyond 2025; OHS to consider other factors like the adequacy of
public payer provider reimbursement rates, labor costs, medical inflation, etc; The OHS
executive director to hold a public hearing on benchmark values and report publicly on why
such values are maintained/changed; the annual report by OHS to include information on
payer and provider input costs, including pharmaceutical costs, the adequacy of Medicare
and Medicaid payment rates as they relate to the cost of care, the impact of the rate of
inflation and rate of medical inflation, impacts on access to care, medical service expansion,
Page 3 of 6 HB-5042
and pursuit of medical innovation, the effect of patient acuity, and any impact on the response
to a public health crisis.
Middlesex Health suggests multiple amendments. Namely, requirements for: Reauthorization
of benchmarks and targets beyond 2025; OHS to consider other factors like the adequacy of
public payer provider reimbursement rates, labor costs, medical inflation, etc; The OHS
executive director to hold a public hearing on benchmark values and report publicly on why
such values are maintained/changed; the annual report by OHS to include information on
payer and provider input costs, including pharmaceutical costs, the adequacy of Medicare
and Medicaid payment rates as they relate to the cost of care, Page 4 of 4 the impact of the
rate of inflation and rate of medical inflation, impacts on access to care, medical service
expansion, and pursuit of medical innovation, the effect of patient acuity, and any impact on
the response to a public health crisis.
Kathleen Silard, Stamford Health suggests multiple amendments. Namely, requirements for:
Reauthorization of benchmarks and targets beyond 2025; OHS to consider other factors like
the adequacy of public payer provider reimbursement rates, labor costs, medical inflation,
etc; The OHS executive director to hold a public hearing on benchmark values and report
publicly on why such values are maintained/changed; the annual report by OHS to include
information on payer and provider input costs, including pharmaceutical costs, the adequacy
of Medicare and Medicaid payment rates as they relate to the cost of care, Page 4 of 4 the
impact of the rate of inflation and rate of medical inflation, impacts on access to care, medical
service expansion, and pursuit of medical innovation, the effect of patient acuity, and any
impact on the response to a public health crisis.
Universal Health Care Foundation of Connecticut supports codifying the Cost Growth
Benchmark initiative into law and shares some views about how the effort could be improved.
Victoria Veltri, Executive Director, Office of Health Strategy supports this bill because it is
necessary to ensure a sustainable benchmark initiative program, guarantee access to data
necessary to drive accountability, hold entities publicly accountable for meeting set
benchmarks, and identify discrete, additional policy initiatives.
NATURE AND SOURCES OF OPPOSITION:
Connecticut Health Policy Project opposes OHS's Roadmap for Strengthening and
Sustaining Primary Care, and has concerns regarding OHS's Cost Cap/Benchmarking Plan.
They strongly support efforts to control healthcare costs that do not sacrifice the quality of
care, but say the Cost Cap plan is likely to create unintended harm. The arbitrary cap does
not consider the healthcare needs of residents, and jeopardizing their critical needs.
Linda Bronstein opposes the bill because she believes it would reduce the ability of CT
residents to access needed medical care. Capping total annual health expenditures while
simultaneously diverting large amounts of funding exclusively to primary care would logically
result in a significant decrease in funding for types of health care such as behavioral health,
adult dental care, and the home care services that can enable elderly and disabled people to
stay with their families instead of becoming institutionalized.
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Thomas Burr shares the concerns of the Medicare for All Coalition and the CT Cross
Disability Lifespan Alliance in that these bills in that these bills will not make health care more
affordable/accessible, and encourages the committee to listen closely to their concerns and
incorporate suggestions they might provide.
Kerri Colombo opposes the bill and asks legislators to vote on on the Primary Care
Roadmap Capitation Plan, work to ensure insurance companies cover their fair share of the
cost of mental health services for all ages, substance abuse intervention and dental care, and
vote to continue and expand access to HUSKY healthcare for families like mine who became
eligible for enrollment during the federal health emergency declaration and are relying on CT
HUSKY Medicaid as our secondary insurance to address ongoing health struggles.
Social Welfare Action Alliance CT suggests that the bill not be passed, and believe that it will
negatively affect equitable access to health care for all CT primary care patients particularly
people with disabilities, elderly, those of limited income, and the BIPOC community all of
whom suffer from health disparities already. HB 5042 seems to mistakenly empower OHS
(Office of Health Care Strategies) to direct and monitor adoption of alternative payment
method for health services such as capitated payment for primary care instead of the
current consumer empowering fee for service payment model. This proposal while
introduced by the governor and OHS to allegedly increase equity in health care, will not in
SWAA CTs opinion.
Jordan Fairchild, Coordinator and Community Organizer, Keep the Promise Coalition
believes that the bill, if passed would have a profound negative impact on their members. The
consequences of these bills will be to exacerbate the problems of systemic racism and
ableism in our health care system, and worsen health care access in our state.
Kathleen Flaherty, Executive Director, CT Legal Rights Project says it is not clear to her that
the proposal will achieve their stated goals without risking further harm to our low-income
clients and without risking an exacerbation Connecticut Legal Rights Project, Inc. P.O. Box
351, Silver Street, Middletown, CT 06457 (860) 262-5030 2 of already-existing health
disparities for people with disabilities, the elderly, and populations of color. She urges you to
beware of claims of innovation regarding recycled ideas that have already been considered
and rejected, and says there is insufficient transparency in the development of the primary
care roadmap.
Tim Gabriele opposes the bill and hopes that our legislators will re-evaluate the healthcare
roadmap and remove primary care capitation from the Roadmap language in upcoming
healthcare bills.
Maggie Goodwin urges the committee to vote against the bill, because it could create a mess
in primary care going forward, and urges you to get more information. The main concerns
appear to be the redefining of Primary Care, and the trapping of patients and care providers
until the time period paid for by the truncated rate is over.
Eileen M. Healy, Independence Northwest objects to the entire Primary Care Roadmap and
Cost Growth Caps because of its harmful impact on people with disabilities, elders and
people in the Black, Brown, Asian and Indigenous communities. The Roadmap states it will
apply to all payers, but the state can only control Medicaid; therefore, Medicaid enrollees will
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most likely be the Roadmaps experiment group. The experiment will be conducted on
patients with the least resources.
Karen Healy is worried that primary care capitation would make it much more difficult for
people with mental health conditions, disabilities, and other complicated health conditions to
be seen by their primary care doctors, since no matter how many times I need to be seen, my
primary care provider will be paid the same flat rate, and is also concerned how this would
affect her as a HUSKY patient, especially if capitation is hard to enforce on other plans which
arent controlled by DSS.
Connecticut Orthopaedic Society urges this Legislature to oppose the provisions in HB 5042
that call for benchmarking for health care cost growth and quality of care and the significant
authority the OHS will be allowed to have if this bill is enacted as written.
Eileen O'Donnell is against the OHS Primary Care Roadmap because it will move away
large sums of money to primary care and away from other areas of health care, including
areas that need more money.
Rose Reyes is against HB 5042 because it constrains the reach of funding and can act as a
disincentive to provide sufficient services.
Carol Scully, Director of Advocacy, The Arc of Connecticut opposes the bill because it will
likely harm access to health care for all patients but particularly people with disabilities,
elderly individuals and Black and brown people who already suffer health disparities.
Ronna Stuller opposes the bill as it is current proposed. This bill, along with SB 15, may in
practice cause harm to vulnerable members of our population, especially through the
enabling of alternative payment methodologies.
Sheldon Toubman, Litigation Attorney, Disability Rights Connecticut opposes the bill
because the roadmap includes a radical proposal to pay all primary care providers under all