With the health care of 345,000 vulnerable children and their parents at stake, Gov. M. Jodi Rell is engaged in an extraordinary showdown with legislators and health care advocates.
The Rell administration took a hard slap a week ago at critics of her Charter Oak Health Plan for uninsured adults, demanding the critics turn over e-mails and correspondence.
The demand came in an unprecedented freedom-of-information request Rell aimed at key legislators, Attorney General Richard Blumenthal and one of her own appointees — the state's health care advocate, Kevin P. Lembo.
"The letters were intended to bring transparency as to why there has been a monthslong effort to undermine the Charter Oak program — a program that is helping thousands of Connecticut residents who previously did not have health care coverage," said Chris Cooper, a Rell spokesman.
By demanding their e-mails and correspondence, Rell made clear that she distrusted the motives of the many critics of Charter Oak, a relatively tiny new program she has linked to the much larger HUSKY.
Yet her follow-up to the FOI request was to invite the same critics to a meeting Tuesday.
"I believe it is time — indeed, past time — for all of us to turn our energies toward ensuring this much-needed program achieves its full potential to benefit the citizens of Connecticut," Rell said.
Rell has required that health care providers who participate in HUSKY, a Medicaid program that serves 345,000 poor children, also sign up for Charter Oak, whose lower reimbursement rates have dissuaded most doctors from joining.
Legal aid lawyers such as Sheldon V. Toubman, who represent the poor, said Rell has jeopardized HUSKY to prop up the far smaller Charter Oak, which has only 2,300 clients now and is not expected to ever grow beyond 19,000.
"It's the ultimate in the tail wagging the dog," Toubman said. "We wish her luck in moving Charter Oak forward, but it's coming at the expense of a far larger, vulnerable population who had access to health care."
Toubman, Lembo and others say their only motive is to protect HUSKY. If Rell discounts their opinions, they point to concerns raised by a wide range of doctors and health providers.
William A. Handelman, president of the State Medical Society, warned last week that care will be compromised unless Rell uncouples Charter Oak from HUSKY.
"Children and adults face losing access to medical care if the state of Connecticut does not agree to let physicians separately opt into one program or the other," Handelman said.
Rell seemed to relent recently, saying that participation in one program did not require simultaneously signing up for the other. But it appears that the state still is requiring a commitment to both programs.
A Political Boost
Charter Oak is seen as important to Rell, either as a re-election issue should she run in 2010 or as a political legacy should she step down.
Rell has pointed to Charter Oak as a potential model to serve the uninsured, although it is geared to mainly covering healthy residents. Its high co-pays and deductibles, plus an annual cap of $100,000 in coverage, renders it of limited use to the chronically ill.
The state began marketing Charter Oak in July without networks of providers.
An e-mail exchange June 4 between Lisa Moody, the governor's chief of staff, and Social Services Commissioner Michael P. Starkowski, showed that Starkowski was reluctant to begin the marketing effort.
"Lisa, I am pushing as fast as I can on this but I am sure you agree that the last thing we want is for us to start the program and the managed care companies do not have their network of providers signed up," Starkowski wrote.
Starting without providers would invite a lawsuit from Toubman, Starkowski wrote.
"I know we want to open as soon as possible with a splash and press coverage, but all the pieces have to be in place," he wrote. "I don't want to open a program that [embarrasses] the governor, doesn't meet her commitments, has fatal flaws at the start or gets shut down due to inadequacies."
The e-mail was made public in response to an FOI request by the Day of New London.
On Nov. 14, Starkowski turned the FOI law against critics of Charter Oak, demanding documents from Lembo, Blumenthal and Sen. Toni Harp, D- New Haven, Sen. Jonathan Harris, D- West Hartford, Rep. Peter Villano, D- Hamden, and Rep. Christopher Donovan, D- Meriden, the incoming speaker of the House.
Donovan has played no obvious role in the dispute, but he is an advocate of a broader universal health care program. His inclusion seemed to reflect a suspicion that opposition to Charter Oak was linked to a feeling that anything less than universal care should be blocked.
"If there was evidence of that, I think it would be very damaging and expose a motive," said House Minority Leader Lawrence F. Cafero, R-Norwalk.
Several days later, the administration withdrew the request for documents from Donovan, who could not be reached for comment. David Dearborn, a spokesman for Starkowski, said Donovan did not seek the withdrawal.
Cooper, the top spokesman for Rell, acknowledged that the decision to file the FOI requests was the administration's, not just Starkowski.
"The governor, her staff, the DSS commissioner, and his staff did discuss the FOI requests prior to the letters being sent," Cooper said.
The FOI request demanded copies of all communication related to HUSKY and Charter Oak, plus any communication with Toubman and Anthem Blue Cross/Blue Shield. Anthem is a HUSKY managed-care provider that did not bid to continue in the combined program.
As the largest provider, it has been continuing on a month-to-month basis. Three other managed-care companies eventually will take over HUSKY and Charter Oak. Two of them are building networks from scratch.
The FOI request puzzled legislators.
"I think a spirit of cooperation would go a lot further than intergovern- mental warfare," said Senate President Pro Tem Donald E. Williams Jr., D-Brooklyn.
It is the second time this year that the Rell administration has played hardball with critics of Charter Oak. In February, Starkowski threatened to sue legal-aid lawyers, saying they were interfering with the state's efforts to establish the new program.
He backed down after Blumenthal said the lawyers were exercising their free-speech rights
Reprinted with permission of the Hartford Courant.
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