State House debates health coverage for undocumented children, immigrant mothers after other reforms fail

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A proposal to expand health care access to undocumented children under age 9 and immigrant mothers — a crucial piece of legislative Democrats’ health care reform plan — is expected to be the first order of business in the House Tuesday.

About 1,900 children would be eligibile for HUSKY Medicaid coverage under the bill before the House, according to the Office of Fiscal Analysis. To qualify, children would have to be living in households earning up to 323 percent of the federal poverty level — a far higher threshold than typical HUSKY coverage.

If passed by the House, the bill would still need approval from the Senate. It’s one of few remaining health reform measures still in play with less than two days to go in the legislative session — a session that started with ambitious reform plans by Democrats.

The other surviving part of the health reform plan would provide more subsidies for Connecticut residents to sign up for health care coverage on the state’s insurance exchange. That is part of the budget that the House and Senate will adopt by Wednesday night, but Gov. Ned Lamont’s push to tax health insurers by $50 million a year to help pay for the subsidies is no longer on the table.

House members were debating the start date of the added Medicaid coverage midday Tuesday.

Any child born in the country is a citizen and therefore could be eligible for HUSKY coverage depending on his or her family’s income. the bill would expand eligibility for those children and cover non-citizen children whose families move into the state.

The estimated cost to the state is $700,000 in the first year of the biennium budget, growing to $4.1 million in the second year, with the anticipation that more will join the program, according to the bill’s fiscal note.

Mothers, regardless of their immigration status, would be able to qualify for prenatal care through HUSKY if living in households earning up to 263 percent of the federal poverty level. Up to 1,400 women would qualify for the coverage.

The cost to the state is estimated at $11 million a year after the program ramps up.

Another 1,400 or so women would have access to up to a year of postnatal care as long as they are living in households where incomes do not exceed 263 percent of the federal poverty level. The estimated cost is $750,000 in the first year and $5 million during the second year.

In February, Lamont presented a health care reform package that he saw as key to expanding medical coverage and lowering costs, as he crafted Connecticut’s response to a pandemic that killed more than 8,000 state residents and laid bare, in glaring terms, disparities in access to care.

And Democrats in the General Assembly reevived their plan from 2019 to create a so-called public option health plan that they said would help lower insurance costs.

But Lamont’s plan — including the $50 million tax on health insurance companies to subsidize expanded coverage and his proposal to cap drug price hikes — failed to gain traction. And the public option plan, which Lamont opposed, also died.

Under the state budget plan that will roll out Tuesday, federal stimulus money would be complemented by state-sponsored subsidies that would cover the costs of copays, deductibles and premiums for about 40,000 residents.

With the state’s improved fiscal outlook, the Lamont administration believes it can absorb that cost within the general fund, instead of through levying the health insurance tax, the governor’s budget director Melissa McCaw said last week.

But the state subsidies would take several years to fully implement as Connecticut would need to secure a waiver from the federal government before they could be put in place. Massachusetts, Vermont, and California currently provide state-funded subsidies for exchange coverage and New Jersey plans to implement a program this year.

Connecticut already has one of the lowest uninsured rates in the nation. Still, thousands of residents with incomes just above the poverty level, who are ineligible for HUSKY Medicaid coverage, struggle to find affordable care, according to the Connecticut Health Foundation. That was an issue even before the pandemic and by all accounts it got worse as many people lost their jobs and their employer-sponsored health insurance plans.

James Michel, chief executive officer of Access Health CT, the state’s Obamacare health exchange, has estimated that through the new federal subsidies as many as 210,000 uninsured and under-insured state residents will be eligible to join the program, which had 105,000 registrants as of the end of April.

These residents could save hundreds or thousands of dollars a month compared to what they are currently paying, Michel said. But there is concern about what happens when the federal money runs out.

The public option health insurance plan, aimed at small businesses and nonprofits, failed for the third year in a row, under intense opposition from the health insurance industry. State Sen. Matt Lesser, D-Middletown, the major backer of the proposal, has pushed reforms in other ways.

The increased state and federal subsidies included in the two-year budget plan would provide for a “big expansion of health care affordability” Lesser said Monday. In the out years, he wants plans to “build on this .... to turn it into more of a middle-class benefit.”

But, he said, “this is a huge first step and it’s a proof of concept.”

Part of the Democrats’ proposal to expand health care access to more people includes lowering costs for undocumented immigrant residents — an idea that’s still alive.

The House on Tuesday is expected to take up a bill to provide Medicaid coverage to undocumented children under age 9, and to women, regardless of their immigration status, for pre-natal and post-natal care, for certain income levels. This added coverage would cost the state $11.9 million in fiscal year 2023, according to the Office of Fiscal Analysis.

In the Senate, Lesser led bipartisan passage of a bill that would limit the circumstances under which health insurance companies can make drugs more expensive or discontinue them during a plan year — an effort to curb rising prescription drug costs. The bill, previously passed by the House, now goes to Gov. Lamont.

A Republican plan unveiled earlier this year, which would use medical cost benchmarking to save consumers money, also did not gain support this legislative session. That proposal, similar to what Massachusetts implemented in 2012, is based on the idea that transparency lowers prices.

julia.bergman@hearstmediact.com