With thousands of jobs at stake, Medicare for All is a complicated issue for Democrats in Hartford, the 'Insurance Capital of the World'

Aug. 1--Elizabeth Warren drew enthusiastic applause at Tuesday night's Democratic presidential debate when she launched into an extended attack on the health insurance industry.

"These insurance companies do not have a God-given right to make $23 billion in profits and suck it out of our health care system," said the Massachusetts senator, who backs replacing private health insurance with a government-run program known as Medicare for All. "The basic profit model of an insurance company is taking as much money as you can in premiums and pay out as little as possible in health care coverage. That is not working for Americans across this country."

During Wednesday night's debate, the insurance industry also endured strong criticism from Califronia Sen. Kamala Harris, who accused the companies of "jacking up the prices for far too long" while hurting "American families [who are] held down by deductibles and co-pays and premiums that can cause them bankruptcy."

Criticism of the insurance industry plays well with the party's progressive base. But for Democrats in Connecticut, which is home to several large insurance companies, the picture is more complicated. They generally see Medicare for All as too extreme and support scaled-back health care reform that would maintain the insurance industry jobs that are vital to the state's economy.

"Hey, Medicare for All, that's a laudable goal, it's something people can wrap their arms around," said Rep. John Larson, whose district includes Hartford, a city long known as the "Insurance Capital of the World." "But like anything else there's a lot of detail that goes with that."

Aetna, Anthem, Cigna, ConnectiCare, Harvard Pilgrim and United HealthCare employ more than 17,000 people directly and support another 31,000 indirectly in Connecticut, according to a recent study by the Connecticut Economic Resource Center.

Larson is among the Connecticut Democrats who reject any health care overhaul that eliminates private insurance companies from the marketplace. Millions of Americans get their insurance through the private market, and, he said, "they're very reluctant to give that up."

Rep. Rosa DeLauro, a liberal firebrand from New Haven, is also wary of the Medicare-for-All proposal put forth by Sen. Bernie Sanders of Vermont and endorsed by Warren.

"One hundred and sixty five million people get their insurance through their employer," DeLauro said. "You can't say sorry" and get rid of it.

"If you're looking ... to get everyone in [and expand coverage], you don't do that by taking people's health care away," she added. "You give [them] the option of saying 'I'll keep what I have.' "

The debate over health insurance reflects a deep divide among the Democratic presidential candidates between progressives such as Warren and Sanders and those who take a more conservative view. Among them is former U.S. Rep. John Delaney of Maryland, who is currently polling at below 1 percent. He blasted Medicare-for-All as "fairy tale economics" in Tuesday's debate.

In the middle are moderates such as former Congressman Beto O'Rourke of Texas, former Vice President Joe Biden and South Bend, Ind. Mayor Pete Buttigieg, who have all expressed support for the concept of allowing individuals and perhaps businesses as well to buy into the Medicare program, but preserving private insurance.

That's similar to a proposal put forth by DeLauro and her Democratic colleague from Illinois, Jan Schakowsky. Their plan would let small employers buy in to the Medicare program but those who work at large firms would be excluded.

DeLauro does not support a single-payer insurance system similar to those in some European countries. "I'm not talking about a government-run program, [like in] Ireland and England and so forth," she said.

Larson is sponsoring a bill that would also allow individuals to opt in to Medicare, but would also preserve private insurance for well-off consumers seeking additional coverage. Larson is in the top 20 among congressional recipients of insurance company campaign donations; he received nearly $261,000 from the industry in 2018, according to the Center for Responsive Politics.

"Our insurance industry has done a very good job of providing the wraparounds," Larson said. "They would sell the programs that people with means and ability could purchase for expanded coverage."

Sen. Chris Murphy likewise supports legislation allowing individuals and businesses to purchase Medicare plans while preserving private insurance.

"I favor putting the choice in the hands of the consumer," he said earlier this year when Sanders released his health care plan. "Sen. Sanders' legislation makes that choice for them."

The one exception on the issue of Medicare for All among the Connecticut congressional delegation is Sen. Richard Blumenthal, who co-sponsored the Sanders plan. He noted in a recent interview that the bill is just one of several health care reforms he's endorsed.

"My goal is universal health insurance," Blumenthal said recently. "And that's why I've endorsed a variety of different solutions. Any one of them will be tremendous progress toward that goal. I am not in favor of abolishing or eliminating private insurance for its own sake."

The insurance industry has been wary of any significant overhauls. Connecticut companies referred comment to America's Health Insurance Plans, a trade group. In a statement submitted at a congressional hearing this spring on Medicare for All, AHIP said the legislation would do nothing to address health care affordability.

"These proposals will mean higher taxes on all Americans, higher total premiums and costs for the hundreds of millions of people enrolled in private coverage, longer wait times, and lower quality of care," the group wrote. "To put it simply, patients would pay more to wait longer for worse care. ... We should improve what we already have, rather than starting from scratch or moving in a completely different direction."

In addition to its impact on the insurance industry, which employs about 16,000 people in Connecticut, Medicare for All poses another dilemma for Connecticut Democrats, who have traditionally been staunch allies of organized labor. A mandate for government-run health insurance could alienate unionized workers reluctant to give up the private insurance benefits they achieved through negotiations.

"This plan that's being offered by Sen. Warren and Sen. Sanders will tell those union members who gave away wages in order to get good health care that they're going to lose their health care because Washington's going to come in and tell them they got a better plan," Rep. Tim Ryan of Ohio said during Tuesday's debate.

Sanders dismissed those concerns, saying unionized employees, like the workforce as a whole, will be better off under a government-run system.

Among those watching the debate play out among the large and ideologically diverse Democratic presidential field are Sean Scanlon and Matt Lesser. The two co-chairs of the Connecticut legislature's insurance committee pressed for a modified "public option" plan earlier this year.

The proposal, known as "the Connecticut Option," aimed to create a state-subsidized health insurance program. It would have offered coverage that met or exceeded existing health plan offerings and provided state-financed subsidies for those who do not qualify for federal health care subsidies.

The legislation would have established an individual mandate with a penalty for not having health insurance, authorized the state comptroller to establish rates for a new provider network to support a health care program and would have imposed surcharges on individual and group health insurance policies.

But even that limited measure failed to win passage in the legislature after the insurance industry, led by Bloomfield-based Cigna, lobbied hard against the bill.

"The Connecticut Option that we unveiled was far more modest than the reforms proposed by any of the Democrats running for president," said Lesser, a Democratic state senator from Middletown. But, he added, the insurance industry nevertheless "saw our modest tweaks as radical."

State Comptroller Kevin Lembo, a Democrat who has long backed a public option, said the public is growing impatient with the slow pace of reform and the power of the insurance industry to block it.

"Those of us who have been pushing for reformative health care for some time are accustomed to picking ourselves up, dusting off and continuing the fight -- but we are headed to a breaking point," he said.

"If the dynamics don't change, if the influence of industry isn't moderated in some way, then the people will hold their elected officials accountable. Something will change. It's just question of when government finally gets in sync with the needs of the people over the needs of a powerful few."

Lembo said he is seeking "boldness over Band-Aids" on health care reform. "There is no better promise on the horizon, whether in Connecticut or at the national level, to effectively disrupt the spiral of rate increases and people losing coverage than by introducing a new affordable health care option," he added.

Lesser and Scanlon said they are pressing ahead with state level reforms, even as they expressed hope for a broader health care solution on the federal level.

"Health care is hard," said Scanlon, a Democratic state representative from Guilford. "It took seven different presidents from Harry Truman to Barack Obama to pass a national health care bill. We tried to do something big this year ... change takes time."

But Scanlon and other advocates for change say they are encouraged by the outsize role the health care debate is playing in the Democratic presidential campaign.

"Health care is the single biggest issue I hear about from people, whether you're a Trump supporter or a Bernie supporter, the concern is the same: the costs are going up while the quality is going down," he said. "I think people are going to be making decisions in 2020, from president to state rep, based on what that person's position on health care is."

Courant staff writer Christopher Keating contributed to this report.

Daniela Altimari can be reached at dnaltimari@courant.com.

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