The future of the UCONN Health Center - What's in the Public's Interest?

The UCONN Health Center is in tough financial straits and has an old, small hospital. Prior to 1997, the federal government funded teaching hospitals like John Dempsey so well that the Health Center used the extra revenue to fund its academic & research programs. Since the federal Balanced Budget Act of that year, the Health Center's finances have been precarious. There was a bailout of the Health Center in the early 2000s, but no systematic increased state support for its academic and research programs.

As a result, the Health Center last year came up with the idea of building a much bigger hospital whose revenues would be used to subsidize the academic and research activities. This caused, understandably, strong opposition among the non-profit hospitals in the Greater Hartford area. Most of these hospitals are in precarious financial circumstances themselves and they viewed a bigger John Dempsey Hospital as draining more of their profitable, private pay patients from the wealthier suburbs.

There are several options offered by the CT Academy of Science and Engineering (CASE) to address the Health Center's need for a replacement hospital. But the CASE report also stressed the continuing need of state support for the Health Center's academic & research programs. I believe that the Executive Branch whether OPM, DSS, the Office of Health Care Access should be directly involved in the recommended negotiations between the Health Center and the Greater Hartford non-profit hospitals on how a replacement hospital on the grounds of the UCONN Health Center should be set up and administered.

The UCONN Health Center and the John Dempsey Hospital have really not significantly assisted the state in solving its health care problems - whether smoking cessation, the need for more doctors & dentists to take HUSKY patients, child obesity, etc. Partly, this is the fault of the General Assembly. Most of the oversight of the Health Center has been by the Higher Education Committee and the Higher Education Subcommittee of Appropriations - not the Public Health or Human Services Committee (the latter handles the DSS administered HUSKY program). We need to put the Health Center & Hospital on solid financial footing, but in doing so we must see whether their missions need to be more focused on addressing the state's public health needs.

For example, we could stabilize the UCONN Health Center's finances by directing a portion of the annual Tobacco Settlement money there. In exchange, the Health Center could provide smoking cessation and other smoking related health services to Medicaid recipients (the reason CT got the Tobacco Settlement $ was the costs to the Medicaid program caused by smoking).

UCONN Health Center and John Dempsey Hospital are public assets. In whatever the state does to address their finances, the need to protect and advance the interests of the public must be the utmost priority.

Funding Non-Profits Smarter

There is no doubt that the Executive Branch and the Legislature have seriously underfunded the non-profits organizations which provide so many social and other services to CT residents.

The increases they have received in the last decade or more are below the inflation rate and far below the increases in health insurance and energy costs. They are in dire shape. But to really address this issue in a thoughtful, long-term way we need to do much more than just give them money. As a practical matter, given the state's spending cap and the other demands on state dollars, CT can not give the non-profits the kind of increases in funding they need to stabilize their operations. We need to fund them smarter. We need to assist them with their cost drivers such as health care and energy and incentivize them into working together/consolidating back-room operations/expenses whenever possible.

For example, the state subsidizes a big variation among the non-profits concerning health insurance. Some non-profit employees are on the state's HUSKY program because their non-profit can not provide affordable, comprehensive health insurance. Many are simply too small to get private health insurance at a reasonable cost. Other non-profits provide decent health insurance, but are hard-pressed. They must ask employees for higher co-pays and premiums or little to no wage increases in order to do so.

Instead, since many of these non-profits mostly/exclusively provide state services with state funding we should find a way to bring them into the state employee health care pool. Candidly, this is easier said then done because of the diversity of the non-profit community and the variation in health insurance they provide and how much it costs them. But if we can find a way to do so, we can provide them with decent health insurance at an affordable price. The state employee plan (actually, there are several plans provided by several private health insurance companies) is comprehensive and has not had the huge annual increases that non-profits have faced. If the non-profits which can not afford health insurance for their workers, this will allow them to attract and keep good employees. For those which already provide decent health insurance going into the state health insurance pool should allow them to do so at a lower cost and/or with lower annual increases.

The State should also use its purchasing power to assist non-profits with their energy costs. Again, since these non-profits are providing state services with state dollars, the State is already, albeit indirectly, paying for their energy costs - just very inefficiently.

However, before we assist them with the capital costs of weatherization, getting more efficient lighting and heating infrastructures, etc. we need to get more information on the non-profits. Are there too many stand-alone buildings? Are they in the right locations? Can multiple non-profits be co-located to save money and provide better services to the state resident they serve? We don't know the answers right now. The Departments of Developmental Services, Mental Health & Addiction Services & Social Services should assess all the non-profits they fund and share the information among them to figure out the best way to proceed.

Finally, we should incentivize non-profits to combine non-direct care services whenever possible.
Personnel, Legal, Custodial, Repair and even Executive Director services may be able to be shared among non-profits especially if we can get them to co-locate. We are subsidizing a lot of costly inefficiency.

Does that mean every non-profit can be co-located have all its back office operations shared with other non-profits? Of course NOT. For some services provided for some state residents this may be inappropriate, inefficient or unacceptable. But, we won't know until we ask the questions and challenge the non-profit community.

Just like we must incentivize municipalities and boards of education to share services between and among them to achieve economies of scale whenever possible and appropriate, we must do so with the non-profit community. We can not afford to do otherwise.