While it is encouraging that the SIM planners are now seeking
consumer and advocate input for new committees, there are many challenges. Advocates pointed out that we have key
unanswered questions
about the plan, this administration’s intentions, and how it could affect
people if implemented. Many advocates have not yet decided whether to support
or oppose the state’s application for a federal grant to implement the final
SIM plan and the answers to those questions are key. Advocates also await their
commitment to, and degree of, genuine consumer involvement in decision-making
going forward.
Advocates expressed concerns about SIM planner’s
over-attentiveness to the interests of insurers – arguing that consumers should
be SIM’s key constituency as both
the ultimate payers and ultimate consumers of health care. Advocates made it
clear that just listening to advocates is not sufficient – it is critical that they
be in decision-making roles and that their input from a variety of means is
incorporated into policy. Advocates repeatedly objected to SIM staff plans to
have only a few consumers or advocates on each committee, placing them in a
minority position. Advocates repeatedly urged SIM to focus less on getting a
few “perfect” consumer representatives for their committees, as consumers are
not organized into trade associations like other stakeholders, but to open the
decision-making process to include and incorporate public input. Advocates gave
SIM numerous examples of successful and respectful past policy decision-making
models. Advocates urged SIM to ensure that consumers and advocates make up a
majority of members of all committees, as in many of those successful models. Advocates
also expressed concern that membership would be at the sole discretion of the
administration, unlike successful models like the Medicaid Oversight Council
whose membership is set in statute. SIM staff resisted that recommendation
concerned about sustaining that effort and making enough space for other
stakeholders, specifically insurers.
Points I wasn’t given the opportunity to make during the
meeting include a concern that these committees, even if they include consumer
voices, will still be three levels below where decisions are made on the SIM
organizational chart. There is a
history in CT of overruling consumer committee input at higher level
boards. It is also critical that in any online communications about public input,
that consumers be allowed to check whether their input was included or not. Too
often policymakers incorrectly believe they have faithfully included consumers’
input but have missed critical points. It is also critical that meetings,
especially those with insurers about payment models, be public and transparent
rather than private. It is important to note that no advocate asked to be
included in secret meetings, we have repeatedly asked that there not be secret
meetings. Nothing was decided at the meeting; we await answers to our questions
about the plan’s impact on the Medicaid program, CT’s public health system, and
promising medical home programs as well as responses to advocates’ strong recommendations
for consumer/advocate majority representation on all committees and for
transparency and meaningful public input in decision making beyond the
committee structure. We look forward to a constructive process that works to foster
successful, responsible reforms of CT’s health care system.
