Maria Horn

Just before the snow arrived last weekend, I put the wreaths up on my house, but somehow forgot to remove the pumpkins.  They all grew from a single compost-sprouted vine this summer, so I guess I was reluctant to return them to the heap. Now they are covered in snow, and possibly getting washed away by the rain.  I hope you are all doing better in the swap out of holiday decorating!
 
These pre-holiday weeks are busy ones.  For me, they’re dominated by my efforts to have as many meetings in person as possible, so I’ve been on the road a lot.  There is a whole new crew of people I will be working with regularly, and it makes a difference if we can start off meeting face-to-face.  I also haven’t figured out a way to pack up my office virtually, and move into another one (even when it’s just down the hall), so I’ve had to spend some time in Hartford anyway.  I find that you pick up a lot of information just being around, though, so it’s time well-spent.
 
The week has also included on-site, in-person, meetings in the region.  One was Legislative Night at the Litchfield County Regional Fire School, where we had a great bipartisan, bicameral conversation about how to increase the chances that a piece of legislation makes it over the finish line.   The same group of legislators reconvened the next morning at Connecticut Junior Republic in Litchfield, which for over one hundred years has helped children, youth and families make positive changes in their lives with a variety of support systems on a beautiful campus.
 
We also marked the 10th anniversary of the tragedy in Sandy Hook with a vigil on the White Hart green on a chilly evening.  The murders of 20 children and six adults galvanized action in CT, which now has among the strongest gun safety laws in the country, thanks in large part to the activism from families and first responders hit hardest by the trauma.  There is much work to do, but we all drew strength from gathering together that evening.  My thanks to Sophia and Lee Deboer for their continued organization of this yearly event and the advocacy that accompanies it, and to the many others who provided music, lights, and banners that kept us all inspired to continue the work ahead.

• COVID-19 weekly update. Click here
• New Laws Taking Effect in the New Year. Click here. 
• Career ConneCT expands intake portal. Click here. 
• Message from the Office of the Healthcare Advocate. Click here. 
• Connecticut’s contributions to NASA’s Artemis Moon Exploration Program. Click here.
• Department of Labor launches new tax page to guide employers on unemployment tax. Click here.

• Specified Connecticut residents convicted of cannabis possession will have their records automatically cleared and other specified charges can be petitioned for erasure at the start of the new year
  • Click here and scroll to the bottom of page 29 for a breakdown table on qualifying erasures
  • Announced Delay: The Governor's Office recently announced that some erasures would be delayed until, "…the second half of 2023." Click here to learn more
• Numerous state agencies must also provide recommendations by January 1^ston how to prevent cannabis use by individuals under 21and address the impacts of cannabis legalization on youth
• These provisions were included in PA 21-1 – Passed in 2021 – that legalized the recreational adult-use of cannabis

Clean Slate Law:

• Nearly 280,000 more people will be eligible to have their criminal records erased on January 1^st, and the Board of Pardons and Paroles must provide written documentation if they deny an application for a person's qualified pardon
  • Announced Delay: As shared above, the Governor's announced delay will also affect this law's provisions
• These provisions were included in PA 21-32 – Passed in 2021 – known as the Clean Slate Law

The Bottle Bill:

• Will expand the types of bottles and cans accepted in the 5-cent return program to now include:
  • Teas
  • Hard Seltzers
  • Ciders
  • Energy Drinks
  • Coffee

• This provision was included in PA 21-58 – Passed in 2021 – which makes tiered adjustments to the state's bottle redemption program through January 2024

Lead Poisoning Safety:

• Will take a tiered approach strengthening Connecticut's lead poisoning testing standards to align with federal standards and will lower the threshold for youth testing levels that trigger parental notification or home inspection
  • The Governor's Office reported that in 2020, over 1,000 Connecticut Children tested at high enough lead levels to trigger the federal standard for a home inspection
• These provisions were included in PA 22-49 – Passed in 2022 – and will incrementally lower the qualifying testing levels through January 2025

Breast & Ovarian Cancer Screening Coverage:

• Certain commercial health insurance policies will be required to cover:
  • Mammograms
  • Ultrasounds
  • MRIs for breast screenings
  • Breast biopsies
  • Certain prophylactic mastectomies
  • Breast reconstruction surgery
  • BRCA 1 and 2 testing
  • Routine ovarian cancer screenings 
• These provisions were included in PA 22-90 – Passed in 2022 – which expanded required insurance coverage from previous legislative efforts

These are just a few of the laws and provisions going into effect when we celebrate the new year. The full list of laws taking effect on January 1^st can be accessed by clicking the button below: 

• Value Pricing: Carriers are singularly focused on value pricing, in part due to their diminished ability to negotiate with large hospital system, which itself stems from hospital consolidation. But after a decade of concerted efforts to get value-based models off the ground, the approach has had limited effect. Value-based models involve systemic intervention in pricing, including moving away from straight fee-for-service payment system, and instead adopting payment structures that ostensibly incentivize high quality care, while discouraging waste, redundancy, excess spending and growth in all cost drivers. This makes intuitive sense, and is worth continuing to explore, but due to the approach’s failure to deliver significant spending reductions thus far, it shouldn’t be the only strategy we try.  Moreover, the idea that over-spending is inherent in fee-for-service models is demonstrably wrong, as a number of our overseas competitors (such as Japan) deliver quality healthcare at half the price using fee-for-service payments exclusively.  It’s more a matter of managing the fee-for-service system appropriately.
• Price Justification: There must be a private - public price justification and transparency processes. This could enhance the negotiating position of insurance carriers, even with giant healthcare systems that we are left with after decades of unmanaged hospital consolidation.  Literally every one of our international economic competitors use some sort of periodic price justification (not price-setting) mechanism to review, and such systems always have some level of government involvement or partnership.  The lesson of the past 40 years of internationally abnormal medical spending inflation in the U.S. private insurance markets is that commercial carriers acting in private and one their own are not able to deliver the internationally competitive medical prices that Connecticut families and businesses need – and deserve.
• Partnership: Carriers can partner with the state in several ways to have powerful providers justify extremely high fees for service medical prices, including a more probing review during the annual insurance premium rate hearings.  Another promising proposal just advanced by the non-partisan National Academy for State Health Policy involves limits on the out-of-network prices that hospitals and other providers can charge commercial health plans.  One attraction of justifying out-of-network prices is that it is light-hand regulation, which, does not involve any changes whatsoever to existing contracts between carriers and providers.  There is also room to develop entirely new or enhanced coverage options for small businesses in the state – the key again will be to ensure that these new options include some public-private price justification process, because history has shown that carriers and small employers cannot achieve internationally normal medical prices without some degree of partnership and support from the state.
• Direct Pay:  Reward both providers & carriers for what we want, not just for better health outcomes but also for lower prices (unit cost, not volume). Perhaps cash bonuses for hospital & carrier C-Suite & staff who hold the line on unit cost.

Between 1970 and 2019, total US health spending grew from 6.9 percent of gross domestic product (GDP) to 17.7 percent of GDP, and according to the Centers for Medicare and Medicaid Services, health spending rose to almost 20% of GDP during the pandemic. We weren't projected to reach these levels until 2028. It is not clear how much if at all, the easing of the pandemic will affect these numbers. Under any scenario, this is unsustainable.

We pay abnormally high rates for quality healthcare. Other nations pay far less for healthcare of equal or better quality. It's time to do some radical surgery and interventions right here in Connecticut on these pricing models. The families we represent desperately need it, and if we can bring our abnormally high medical spending under control, Connecticut businesses both small and large will become more competitive both within the U.S. and internationally.