Tuesday, January 20, 2009

Local election 2009

2009 is here. And another local election is on its way.

The terms of all Council members are done... and many others will be up for election.

In the First District, I recall seeing comments (just last month) about Councilman Sheldon Dill running again.

In the Second District, Tom Ruocco is in his second term and is doing a good job. I really appreciate all of his efforts in offering alternative budgets. And just think... if the Council had agreed to his alternatives... the town would have saved over $1,000,000 in the past year alone.

In the Third District, Laura Decaprio is a freshman. And she seems to enjoy it. So it seems that she'd run again.

In the Fourth District... umm... well... I'm planning to run again. And according to one person I trust, at least one person (Bob Moran) has been telling people of his intention to run against me. Which is good. Though with comments like this,* I'm uncertain he'll get widespread support in his party. Such unsubstantiated comments usually don't sit well with anyone.

As for the at-large Council members, I'm pretty sure that Jimmy Sima and Tim Slocum both intend to run again. And about a year ago, Matt Hall stated that he wouldn't be on the Council during the next term. I'm not sure about Mike Ecke or Matt Altieri. And yes, during the Turf discussion Ecke made it clear how unhappy he is on the Council... but I'd put money on him running again. And as for Councilman Altieri... I don't know if he'll run again... but I know at least one person for whom I won't cast a vote.

Board of Ed has terms expiring for Mrowka, Behrer and Hellreich. That means a one seat pick up by the GOP flips the majority. Or a win by a non D or R could make things interesting.

I'm not sure about PZC. Best I can figure, there are three R seats with terms expiring - EJ Kurtz, Sean Strollo and Dave Veleber. So with a 6-3 majority, the Dems would need to pick up two of those seats. But I may have PZC wrong. I'm not sure when Marty and Lou Todisco's terms expire.

Anyone care to speculate?

Tim White

* The message is from November 25, 2008. And the click thru website is 4shared.com. I didn't notice any problems when I used their website for the audio sharing service.


Anonymous said...

I wonder what the "disturbing things" are about Rep. Nardello which Bob Moran refers to on that tape?

I'm glad to see that he's not blindly loyal to the Dem party, but as a good citizen, he should make this information public.

Anonymous said...

What about Dave Schrumm running again? Hope DeCaprio doesn't run and/or isn't asked to again. Being "nice" and "competent" are two entirely different virtues...

Anonymous said...

All democrats must be defeated!

Anonymous said...

Hopefully the republican town committee is going out to each district and looking for good canidates. I am sure they can find ones that are popular enough in their districts to defeat the incumbants. They can't wait for volunteers. Recruiting is essential at this time.

Anonymous said...


tim white said...

10:08 PM


tim white said...

I wonder what the "disturbing things" are about Rep. Nardello which Bob Moran refers to on that tape?

I have no idea. But I will say that while I've heard of "disturbing things" about Tom Gaffey... I firmly believe that Reps. Nardello, Esty and Sen Caligiuri are all good people who always try to play by the rules.

Sure, I disagree with Vickie and Elizabeth on policy issues... but they're good peeps.

bob moran said...

the disturbing things are that on business and healthcare reform issues i believe vickie nardello is too far to the left in my party the democratic party. i am a moderate democrat. i was a member of the energy commission in cheshire and allowed vickie to use my name supporting her on energy issues against you. at that time and now vickie and i know we have a different view on business and healthcare reform issues. i am still waiting for your return phone call from my phone call regarding our state rep's job performance on issues she does or doesn't support affecting working families in our district and state from the tape you place on this blog if you would like we could have a sit down with vickie.

Bill said...

What is concerning is the fact that Tim attached a personal phone call to him from Bob Moran on a web site. This shows me that Tim, you can not be trusted, your creditability is gone. How can you and what gives you the right to take a recorded message and make it public? What are the reasons for doing so? The people in your district should take a serious look at your ability to be a member of the Town Council or any other elected body. At least Bob Moran has the backbone to reply.

Anonymous said...

To Bob Moran:
If no new information has come to light, why support Vickie then and Tim now?

tim white said...

hey Bob... good to see you here! And good luck with the campaign (though not too much!)

Now about your comments...

i am still waiting for your return phone call

Correct me if I'm wrong, but I recall one day since the election when you called me. Actually you called me a few times and when I checked my voicemail, I just listened to the first message. Then called you back... figuring you'd explain all of your concerns. In case you don't recall, we were discussing your election results and your conclusion that a non-major party candidate cannot win. To which I commented that winning as a non-major party candidate is extremely unlikely. Not that it's right... it's just a reality.

if you would like we could have a sit down with vickie

Do you want to? Because I didn't ask for that. The "issue" differences between Vickie and me is pretty big. That's why I ran against her... and speaking of...

thank you for encouraging me to run against her again. But I'm not interested.

tim white said...

How can you and what gives you the right to take a recorded message and make it public?

Bill, Bob is a political figure. I wouldn't do that with a non-political figure, but that's not the case here. It's similar to Amann. Most people presume Amann will be declaring his run for office next week Jan 29. But he's not a candidate now... and he's no longer speaker. He's just a regular citizen at this moment. But he intends to run. That's why he took so much heat for that job. Cappiello got a job for $103k, but he didn't take the heat Amann took... because he's not known to be a candidate for office.

What are the reasons for doing so?

I encourage you to read the front page post. I commented on the upcoming election. I think it's self-explanatory.

tim white said...

correction from:

you called me a few times and when I checked my voicemail


you called me a few times that day and when I checked my voicemail

also, I now recall the v-mail that you left me that day that I heard. It convinced me that I should call you asap.

You questioned me about my vote on the teachers' union contract... saying that I was "grandstanding," unlike the Rs on the BOE. You suggested that all Council Rs should have voted the same as BOE Rs because we are the same party.

Anyway, I called you right back and explained my vote was directly related to the economy. I didn't think it was grandstanding. I thought it was very appropriate.

You disagreed, suggesting the main concern was the insurance plan offered in the contract.

In retrospect, I still firmly believe that voting to reject the contract was the right thing to do.

Anonymous said...

I like this....Sounds like a debate is in the future.

I also wonder why Bob Moran won't run against Nardello if he feels she is too far "left" for his party. Why run against Tim?

It sure seems like the issues he wants to address sound more like state level issues, not town issues.Plus, this council really doen't seem to care about energy issues or they would open up a discussion about performance based contracts. The only one who seems to care is Tim.

bob moran said...

the problem with todays politics is that the election season ( silly season never ends ) it is not the time to focus on who is running for local or state office. the cheshire town budget and the state money we receive has alot to due with our taxes and spending at the local level. my phone call to tim was because he represent me as my council person and i am concerned about the positions our current state rep has on business ( job creation ) and healthcare reform. Tim you still have not called me back on these issues. The reason the state might cut back state funding to cheshire is because people are out of work and not paying taxes at the state level. When Tim ran for state rep verus state rep nardello education, environment , and energy were the issues he debated state rep nardello on . I supported her not as an active democratic political figure ) but as a citizen. i felt she deseved to be reelected. tim you did't not debate her on healthcare and business ( job creation ). i would say that i am a moderate on these issues and you are more to right of me. she won reelection and even won cheshire because you challenge her on issues she was doing in my opinion a great job. I agree with State rep Nardello . the business climate and healthcare were not a the top of the list. tim seem to be a one issue guy. Energy. I dont feel state rep nardello or anybody else disagrees with you on energy. We need to put partisan and liberal conservative beliefs aside and try and work together on business ( jobs creation ) and healthcare just like our new president is trying to do with the left wing of my democratic party in washington. the people are tired of partisan debate. they want action, solutions, and results.

Anonymous said...

"tim seem to be a one issue guy."

Obviously you have not followed Tim that well.
He is the lone voice of reason on the council. He tries to fight the rubber stamp that the majority uses way too much. His focus is not only on energy, but also the economy, which in these tough times go hand in hand

Anonymous said...


I wouldn’t worry about Bob Moran running against you, or even having a debate. Last time he ran for office he chickened out and didn’t even show-up for the debate.

bob moran said...

nice comment i didnt chicken out i had a prior business meeting that could not be moved and i was given very little advance notice of the debate. it was a last minute thing done for the first time to include the registrar of voters. Bob moran

bob moran said...

this is what my phone call was about. tim could you please find out what the republicans plan and or business ( cbia ) etc. As active citizens I feel you and I need to work together on healthcare reform and business ( job creations ) issues. Getting medical inflation even with current inflation would go a long way in helping connecticut kept and creat jobs with taxpaying citizens and then all us democrats and republicans can get back to regular debate on spending and taxing issues of government. i feel we have to put all the rest on hold until we get medical inflation down . that 10% difference verus normal inflation since the late 90"s is killing connectictut's economy. sincerely bob. ps i got your phone will call back asap to see if you have any questions regarding this email
----- Original Message -----
From: Bob & Tracy
To: Rep. Nardello, Vickie
Sent: Sunday, January 25, 2009 8:29 AM
Subject: Emailing: 1699302576496f8a3846d5e7.46290486

Hi Vickie

I have been put on a business advisory group that James Stirling and others are on by the universal healthcare foundation. I am meeting with James next week on the 4th. to be introduce on what this group is doing to support the universal healthcare foundation's attached healthcare reform proposal backed by business , labor , and several other group. With fully insured medical insurance inflation running at 13% still we can not have job creation ( taxpaying citizens ) without getting some real reform on healthcare in hartford. This is a state issue because fullyinsured is regulated by state laws not federal. business under 500 employees and indiviuals buy fully insured. i know this is a much more complex issue then this email . I have been told that with have speaker chris d plan, this plan attached , and i believe 2 more which i would guess are from business and one from the republican party. Can you tell me before i meet with James Stirling if you are still open on which of the major 4 plans you support before i meet with jim on the 4th . ps james is a owner of stirling benefits in milford, he lives in our state rep district in bethany, and he is a d member of the bethany bd of ed . sincerely Bob Moran 203 -439-0361 office cell 203-623-4607 i try to attach my email on 1/25/09

bob moran said...

A P1roposal for Health Care Reform by Universal Health Care Foundation of Connecticut
Universal Health Care Foundation of Connecticut presents to the people of the state a
public policy proposal for how, working together, we can:
• Guarantee all Connecticut residents access to their choice of high quality health
coverage and health care.
• Control costs so that health care is affordable and sustainable for individuals,
families, businesses, and taxpayers.
• End residents’ worries about losing access to care when they change jobs, finish school,
start a business, experience other life-changing events or have pre-existing conditions.
• Prevent illness and disease where possible and improve health.
• Eliminate racial and ethnic disparities in health care and health outcomes.
There is widespread agreement among Connecticut residents statewide, policy makers,
business, health care, labor and elected leaders, clergy and consumer advocates that the
health care system as we know it is unsustainable.
With ideas and feedback from all of these perspectives, the foundation developed this
policy proposal. We call it SustiNet, the Latin word for sustains, adopted from the
Connecticut state motto to reflect the proposal’s commitment to health and sustainability.
The proposal offers a vision and a blueprint from which to start on the road to a high
performance health system.
SustiNet rebuilds health care delivery in Connecticut.
Under the SustiNet proposal, every patient has a “medical home.” The medical home
promotes healthy behaviors and management of chronic illness. Care coordination, patient
empowerment and timely access to care are the essential elements of the medical home.
Physicians and other health care providers are paid for these services.
SustiNet sets high standards for health care quality through quality improvement
measures and recognizes providers of the highest quality of care. Clinicians play a central
role in determining standards of care.
Provider and patient communication improves, costs associated with duplicative tests
decline and medical errors are prevented through widespread implementation of electronic
medical records. Technology experts, health care providers and the state of Connecticut
collaborate to ensure that the systems that are adopted are effective; and that financing
and technical support is available and patient privacy is protected.
Health care delivery improvements are supplemented by investment in public health
programs to promote healthy behaviors, prevent the development of chronic illness, and
ensure an adequate health care work force supply.
Copyright © 2009 by Universal Health Care Foundation of Connecticut
Executive Summary
Doris Coleman of Old Lyme
works hard but still cannot
afford to provide health care
security for herself and her
college age children. She prays
they don’t get sick.
SustiNet provides a new health coverage option.
People satisfied with their existing private coverage can keep it. SustiNet builds a new plan
from health coverage already funded by Connecticut taxpayers. It merges state employees
and retirees with HUSKY and SAGA1 participants into a self-insured2 pool. Three other
groups can enter the pool:
• people without access to employer sponsored insurance, including sole proprietors
and other self employed individuals;
• people offered employer sponsored insurance that does not provide affordable
access to essential care; and
• and employers, starting with small businesses, nonprofits and municipalities, but
ultimately including any employer in the state.
SustiNet is distinguished by key coverage features:
• Comprehensive health benefits give SustiNet participants the care they need when
they need it. Along with benefits typically included in large employer sponsored
coverage, SustiNet will also cover medical home services, mental health and dental care.
• All applicants are accepted, regardless of pre-existing conditions.
• Income limits for HUSKY eligibility increase. Those not offered coverage through their
employers and others whose employer sponsored insurance does not adequately meet
their needs can enroll in SustiNet.
• Premiums and co-pays are subsidized based on income.
• Providers receive fair compensation for the care they provide to those eligible
for HUSKY. This reduces unreimbursed costs and increases access to care for lower
income people.
• Automatic enrollment, adequate affordability subsidies and informed consent are
used as mechanisms to achieve universal coverage.
1 HUSKY, Healthcare for Uninsured Kids and Youth, is the portion of the Medicaid program that provides health insurance for
children and their parents. Currently, HUSKY A serves lower-income families: those below 185 percent of poverty. HUSKY B
covers children in families between 185 percent and 300 percent of poverty. SAGA is the state’s general assistance program for
low-income adults. Adults currently enrolled in the Medicaid program that covers the elderly, blind, and disabled will remain in
that program and would not be covered by SustiNet.
2 Companies such as Pratt and Whitney and Pitney Bowes are self-insured; that is, they pay their employees’ health claims
directly, negotiate rates with health care providers and implement health enhancement and cost-control initiatives of their
choice. Insurance companies may serve as the third-party administrators of these benefits, but they do not assume risk in
covering these employees. The state will convert its employees’ and retirees’ coverage program to a self-insured plan and will
contract with an insurer or other third-party administrator to manage claims processing and provider and customer relations.
SustiNet brings much-needed transparency
to the health care system.
It makes informed health care purchasing decisions possible for employers, families,
and individuals by making cost and quality of care transparent through an independent
information clearinghouse.
SustiNet is governed by a specially appointed public-private board to represent
Connecticut residents, the health care professions, hospitals, small and large businesses,
and organized labor. The SustiNet board will:
• set policy goals and ensure they are achieved;
• spearhead required reforms to the health care delivery system;
• identify health care workforce challenges and ensure they are addressed;
• select and monitor the administrator of the SustiNet self-insured pool; and
• report quality and cost outcomes to the public.
Health care spending declines and employers
and households save money.
The foundation worked with The Urban Institute and Dr. Jonathan Gruber, a prominent
health economist at the Massachusetts Institute of Technology, to identify the coverage
and economic impact of the SustiNet proposal.
Delivery system innovations and coverage enrollment will be phased in over 5 years,
from 2011 to 2016. Coverage expansion begins January 2011. By 2014, 98 percent of the
population is insured.
Employers and households will see significant savings in premiums and out-of-pocket
costs because:
• Employers will pay more affordable premiums for their workers’ coverage.
• Cost-effective health care delivery measures and the leverage and efficiencies possible
with hundreds of thousands of covered lives will bring premiums down.
• Fewer uninsured people and higher payment rates to providers will reduce the cost
shift to private insurers, which is today reflected in higher premiums charged to employers.
• Households will have lower personal health care costs and more discretionary income.
We can do this in Connecticut.
Our proposal addresses the root causes of the problems with our health system – poor
health outcomes, out of control costs, inadequate access to care and uneven quality of care.
SustiNet is also designed to make the marketplace better, not to reduce competition or
replace private options for coverage. With measures to improve health and reduce costs,
plus hundreds of thousands of covered lives, it leverages the purchasing power of the state
to deliver a better health care system to all Connecticut residents.
Executive Summary
Sole proprietors, who cannot
afford coverage like Gaylordsville
business owners Caroline
and Richard Mrozinski paying
“our share of taxes …” and
trying to cope with mounting
medical debt, want an affordable
SustiNet: Health care we can count on.
Connecticut’s health care system is on life support. The need to address our state’s health
care crisis has never been more urgent. The economic downturn serves to make health
care reform an even greater challenge for Connecticut. Our success as a state depends on
the health of our residents and the ability of our businesses to compete in the national
and global marketplace. Improving our health care system and ensuring the health care
security of state residents is vital to Connecticut’s future.
Overhauling our health care system to cover everyone and reduce cost is an economic
imperative for our state. High health care costs put Connecticut businesses at a disadvantage
to their foreign competitors and leads to lower wages and fewer jobs. Our system also
threatens families’ health and financial security.
Universal Health Care Foundation of Connecticut believes Connecticut’s families and businesses
not only deserve, but also need a health care system we can count on. That means a
system in which costs are controlled, quality is improved, and access is available to all.
The foundation has been working with a team of America’s leading health economists and
policy experts, headed by The Urban Institute, to present to the people of Connecticut a
public policy proposal for quality, affordable health care for all.
From 2006 to the present, the foundation listened to input from residents from all walks of
life across the state, physicians and other health care providers, health policy experts, policymakers,
consumer advocates, small and large business, organized labor, and faith leaders.
We are grateful to the Connecticut State Medical Society, the Interfaith Fellowship for
Universal Health Care, the Business Advisory Council, Small Business for Health Care Reform,
Labor for Universal Health Care, our partner organizations in the healthcare4every1
Campaign, and the many individuals and organizations who contributed their ideas and
feedback. Their voices and concerns have shaped this proposal. The result is a forward-looking
strategy for how, working together, we in Connecticut can achieve the following goals:
• Guarantee all Connecticut residents access to their choice of high quality
health coverage and health care.
• Control costs so that health care is affordable and sustainable for individuals,
families, businesses, and taxpayers.
• End residents’ worries about losing access to care when they change jobs,
finish school, start a business, experience other life-changing events or have
pre-existing conditions.
• Prevent illness and disease where possible and improve health.
• Eliminate racial and ethnic disparities in health care and health outcomes.
A system of
coordinated and
services would
make the right
amount of
health care
available at the
right time.
The proposal’s name, “SustiNet,” is Latin for sustains and reflects the policy proposal’s inherent
commitment to health and economic sustainability. The name is adopted from the
Connecticut state motto.
At heart, SustiNet is a far broader strategy than just health insurance coverage. This public
policy proposal addresses the root causes of our health care system – spiraling cost growth,
disturbing health trends, uneven quality and inadequate access to care.
Economic downturns cause elected and appointed officials to adopt more conservative
spending policies. The possibility of federal health care reform in 2009 may lead some to
the conclusion that Connecticut should postpone reform efforts. However, investments
in state reform over the next few years promise to lower costs, reduce the percentage of
health care spending in the state budget and improve health outcomes. Health care reform
is an opportunity for Connecticut to bring costs under control, stimulate the economy and
serve as a model for the country.
Universal Health Care Foundation of Connecticut respectfully presents SustiNet to the
Connecticut General Assembly, Governor M. Jodi Rell, and members of the Connecticut
congressional delegation as a blueprint for enacting health care reform in 2009 and implementing
it in the years to come.
Rebuilding Health Care Delivery in Connecticut
To expand access to health care, improve the quality of care and reduce costs, SustiNet
emphasizes and invests in disease prevention and chronic disease management. To meet
these objectives, three initial measures are necessary:
• establishment of patient-centered medical homes;
• adherence to quality standards and a system of measuring health outcomes; and
• widespread use of electronic medical records.
Medical Homes for Everyone
Under SustiNet, every patient has a medical home. A medical home is a regular source of
care. An emphasis on primary preventive care is a strong underpinning of this approach.
Early screenings and detection, and other preventive measures are more likely when patients
have a steady source of care.
Physicians, nurses, physician assistants, health educators, and other providers in a medical
home use a coordinated team approach to care for their patients. Medical homes ensure
that patients have timely and appropriate access to care and the tools and knowledge to
manage their own health. They are highly effective and efficient, particularly in managing
the care of chronically ill patients.
Policy Brief
Medical home services fall broadly into three categories:
1. Care coordination. Providers routinely exchange patient information and pursue
integrated care for patients, including those with complex conditions. The medical home
serves as the communication hub. Care coordination professionals make nonmedical
referrals to services such as as nutrition, domestic violence, and other programs. Active
monitoring ensures that patients receive all recommended primary and preventive care
services, such as immunizations, screenings, and diagnostic tests.
To ensure their effectiveness in reducing health disparities, medical homes demonstrate
cultural competency in communication skills with patients from different ethnic and
racial backgrounds.
2. Patient empowerment. Patients, including those with chronic illnesses, learn how
to monitor and manage their conditions and accomplish health-related goals, such as
improved nutrition and smoking cessation.
3. Timely access to care. To reduce unnecessary and costly emergency room visits,
same-day, next-day, evening, and weekend appointments are available. Patients have
telephone and secure e-mail access to health care providers. In-person medical visits
following hospital emergency room discharges help reduce costly rehospitalizations.
Medical practices participating in SustiNet have the option of directly providing all
medical home services or contracting for some with care management/care coordination
providers. In the SustiNet medical home model, providers are reimbursed not only
for diagnosis and treatment but also for ongoing care coordination, care management,
and patient education.
Commitment to Quality Standards and A System of Measuring Outcomes
Best practices for the care of many diseases and for ensuring patient safety and reduction
of medical errors have been well documented. Yet, how care is delivered varies greatly. To
ensure high-quality, efficient, and effective health care delivery, SustiNet health provider
advisory groups agree on guidelines for clinicians and hospitals. SustiNet providers develop
quality standards and goals for health improvement.
Providers that meet or exceed quality of care standards for particular medical conditions
receive public recognition through SustiNet. Health care providers also receive confidential
performance reports, comparing them with their peers. Providers have access to continuing
education programs for honing and continuously improving their clinical skills.
To remove barriers that can discourage physicians from adhering to care guidelines, a nofault
compensation system is established to compensate patients who are harmed even if
an approved guideline was followed.
Changes in the state’s public
health system are necessary
to meet the goals of improving
health, eliminating health
disparities, and reducing health
care costs. In the long run,
investments in public health
prevention and health promotion
programs reduce the
cost of caring for people with
chronic disease. Effective public
health programs will benefit
all state residents, far beyond
just participants in the SustiNet
health plan.
Electronic Medical Records
Effectively designed, electronic medical records systems allow clinicians to access the
medical information they need to make good clinical decisions, to avoid medical errors,
and to prevent costly testing duplication. To improve health care delivery under SustiNet,
widespread adoption of electronic health records systems is essential. They allow SustiNet
access to necessary data to track progress in meeting health goals and quality standards
and to measure, monitor, and report on the extent to which care guidelines are followed.
SustiNet requires participating providers to upgrade to an electronic medical records
system. A group of technology experts, in conjunction with physicians, hospitals and other
providers, is appointed to determine which systems SustiNet providers use.
Cost can be a barrier to provider adoption of electronic medical records. A potential funding
mechanism for the new electronic infrastructure is issuance by the state of a tax-exempt
bond to finance the acquisition of software and hardware. Participating providers would pay
back their proportionate share of the bond. They would be entitled to free or reduced-cost
training, technical support and conversion of paper records into electronic form.
SustiNet’s systems would be linked with existing state efforts to develop a health
information exchange that allows communication across different electronic health record
systems, including lab and radiology information.
Providing a New Health Coverage Option
SustiNet offers an innovative coverage choice that builds on existing risk pools already
funded by Connecticut taxpayers. Initial members are state employees and retirees, and
HUSKY and SAGA1 participants. Like health coverage plans offered by most large employers,
the coverage component of SustiNet is a self- insured2 plan , essential to the hands-on, datadriven
management necessary to improve the delivery of health care and reduce costs.
Families and businesses satisfied with their existing health care plans may keep their coverage.
Three additional groups can choose to purchase coverage through SustiNet, if they wish:
• People without access to employer sponsored insurance, including sole
proprietors and other self employed individuals;
• People offered employer sponsored insurance that does not provide affordable
access to essential care; and
• Employers, starting with small businesses, nonprofits and municipalities, but
ultimately including any employer in the state.
Policy Brief
Maurice Williams of New Haven
has diabetes. He has health
insurance through his employer.
It’s crucial to controlling
his condition. He wants quality,
affordable health care for all
diabetics so they can get the
care they need to stay healthy.
Membership Groups and Coverage Assumptions
People Not Offered Health Coverage by Their Employers
People not offered insurance by their employers may now purchase health coverage. All
applicants are accepted, regardless of pre-existing conditions. Premiums do not increase
for people with health problems as long as they enroll promptly when coverage through
SustiNet becomes available and retain continuous coverage.
Premiums are subsidized on a sliding scale for residents whose incomes fall between 300
percent and 400 percent of federal poverty levels. Those whose income is below 300 percent
are eligible to receive HUSKY coverage through SustiNet.
Today, a Connecticut family of four with an annual, pre-tax income of $85,000 (too high for
subsidies) can pay $1,550 for comprehensive health insurance with $500 individual deductibles,
20 percent coinsurance, and 3 tiers of prescription drug co-pays. When SustiNet
is fully implemented, such a family would pay approximately $1,010 (in today’s dollars) for
more comprehensive benefits that include preventive and dental care.
SustiNet coverage plans offer comprehensive benefits that include medical home services,
inpatient and outpatient hospital care, and dental and mental health care. Programs to
prevent and treat obesity and tobacco use are also covered.
Co-pays of $15 per office visit, a tiered prescription drug benefit that charges lower co-pays
for generic drugs and an annual $400 deductible are anticipated. Cost sharing is designed
to promote patient compliance with needed treatment. For example, certain chronic
disease medications needed to maintain health and life, such as diabetes medications, may
have little or no cost sharing. In these and other ways, the benefits package design complements
the overall goal of keeping people healthy.
Other benefits include:
• office visits
• immunizations, screenings,
checkups, and well-child visits
• generic and name-brand
prescription drugs
• home health care
• vision care
• family planning
• identification and treatment
of developmental delays from
birth to three
• emergency transportation
• lab and radiology services
• durable medical equipment
• short-term rehabilitation
• speech, physical, and
occupational therapy
• hospice
• prosthetics
• chiropractic and naturopathic care
Dr. Bruce Gould, the director of
a Hartford medical clinic regularly
sees the failings of typical
health insurance in the health
crisis of his patients.
People Without Affordable Access to Essential Health Care
People with inadequate coverage, even though they may have access to employer-sponsored
insurance, can join SustiNet. Coverage is considered inadequate if the level of benefits
is (a) less than 80 percent of the average for employer-sponsored insurance purchased
by large employers in Connecticut or (b) the employees’ share of premiums is excessive in
proportion to income.
Coverage is also deemed inadequate, regardless of income, if out-of-pocket health care
costs are at least 7.5 percent of adjusted gross income. This ensures that seriously ill residents
are not denied access to decent, comprehensive health care coverage.
If any transfers from employer-sponsored insurance to the self-insured plan occur because
of inadequate coverage, the employer pays the amount the employer would have paid if
the employee stayed in the employer’s health plan. Such payments are capped to prevent
them from increasing the percentage of workers for whom employers assume financial
SustiNet’s self-insured plan is not designed to replace private coverage options, but to
stimulate competition. With hundreds of thousands of covered lives and cost effectiveness
measures, it leverages Connecticut’s purchasing power to offer the highest quality benefits
to all Connecticut residents.
As SustiNet reduces costs through delivery system improvements, it can be purchased by
small businesses, nonprofits, and municipalities. Eventually it will become available to all,
with multi-year contracts to increase the predictability of health care costs. SustiNet offers
employers new options designed from the start to reduce costs, improve health care quality
and deliver savings to members.
At the same time, an independent information clearinghouse requires all insurers, public
and private, to provide comprehensive anonymous information showing quality of care,
services rendered, outcomes and customer satisfaction. This helps the health insurance
market function more efficiently. Combined with affordable options available through the
SustiNet self-insured plan, this approach lowers business costs while helping businesses
attract and keep good employees and gain a competitive edge in the local, regional and
global economy.
Employers offering coverage are encouraged to continue to do so by two factors. First,
even if federal health care reform is enacted, powerful federal tax incentives are likely to
remain in place favoring employer payment of health insurance premiums. Second, mediumsized
and large employers that do not cover their workers are required by SustiNet to make
modest “shared responsibility” payments to help cover the cost of their employees’ health
care. This is expected to lessen the extent to which firms shed costs by dropping coverage.
To compete effectively, SustiNet markets to employers through existing channels, including
brokers, agents and purchasing pools.
Policy Brief
Access to
quality health
care for all is
a giant step
racial and
ethnic health
State Employees and Retirees
State employees and retirees retain the covered services and limits on out-of-pocket cost
sharing that they now have. Existing collective bargaining agreements are honored.
Lower Income State Residents
Husky A and HUSKY B recipients retain all currently covered services. Limits on premiums
and out-of-pocket cost sharing remain the same. However, low income residents all receive
care through the reformed health delivery system that is the foundation of SustiNet.
Under SustiNet, all adults, regardless of whether they have children, are eligible for HUSKY
A if their incomes fall below 185 percent of poverty (currently $19,400 for an individual and
$39,220 for a family of four). Adults with incomes between 185 percent and 300 percent
of poverty join children in qualifying for HUSKY B for which they are charged modest
amounts for premiums and co-pays.
SustiNet provider payment rates for all HUSKY beneficiaries gradually increase to the same
levels as fees paid by insurance offered by large employers. Fair payment to health care
providers increases the number of physicians who can afford to care for HUSKY participants.
Lower income people also achieve greater access to physician care.
Regardless of income or employment status, all SustiNet enrollees present the same insurance
card to health care providers.
Automatic Enrollment
SustiNet relies on automatic enrollment mechanisms, adequate subsidies to make insurance
affordable and informed consent to achieve universal coverage. People lacking insurance
will be automatically enrolled in coverage according to their ability to pay, when they:
Individuals can opt out of health insurance coverage but must do so by affirmatively indicating
they do not want to remain in SustiNet.
Extensive media marketing and targeted community based outreach is employed to reach
state residents not offered employer-sponsored insurance. Automatic enrollment mechanisms
are implemented in various settings and through diverse channels listed above.
• begin or end employment • request unemployment coverage
• children begin school • file state income tax forms
• seek health care
Under SustiNet,
families and
satisfied with
their existing
health care
plans may keep
their coverage.
SustiNet Boosts the Connecticut Economy
Universal Health Care Foundation of Connecticut engaged the services of Dr. Jonathan
Gruber of the Massachusetts Institute of Technology, one of the country’s leading health
economists, to develop cost and coverage estimates for SustiNet. The model employed
uses Connecticut-specific population and cost data to predict the response of households,
employers and government to policy assumptions underlying SustiNet.
The figures in this report are based on modeling completed in early December 2008 and
may change as the foundation’s researchers continue to refine the economic model and
update the data and assumptions on which it is based. This information, however, provides
a useful starting point for understanding the potential costs and benefits of implementing
the proposal.
Coverage Improvements
In Fiscal Year (FY) 2010, planning and infrastructure development lays the groundwork for
SustiNet implementation, which begins in FY 2011 and is phased in over 5 years. Coverage
expansion begins January 2011. By FY 2013, with automatic enrollment well underway
but not fully implemented, the number of uninsured in the state is predicted to drop from
more than 350,000 in the middle of the current decade to 100,000 people. By FY 2014, only
2 percent of the population, approximately 50,000 people, are uninsured, largely consisting
of those who opt out of coverage with incomes too high to qualify for HUSKY.
Economic Costs and Benefits
Connecticut Reduces Health Care Spending
At the current rate, in the absence of SustiNet, total health care spending by all stakeholders
on all Connecticut residents is expected to rise to $20.2 billion in 2012, reaching $26.48
billion by 2016. With SustiNet , total health care spending in Connecticut is expected to fall
below projected levels, with the drop ranging from 0.2 percent to 3.2 percent, depending
on the year.
Beginning in 2012, the cost of insuring each resident in Connecticut is reduced by an average
of $730, a decline of 9.2 percent over current trends. By 2014, with costs further under control,
Connecticut residents save an average of $875 on premiums and out of pocket costs.
Policy Brief
West Hartford small business
man Kevin Galvin would like
to buy health insurance for his
employees. But with current
costs at $600 to $1000 per
month per employee, it would
be difficult to pay those costs
and still make a profit.
Employers Save Money
Employers who currently provide health insurance see savings for several reasons:
• With cost-effective health care delivery measures and the leverage and efficiencies
that are possible with hundreds of thousands of covered lives, SustiNet offers more
affordable premiums.
• Fewer uninsured people and higher payment rates for HUSKY mean less cost
shifting from hospitals to private insurers, which in turn is reflected in lower
premiums charged to employers.
• Public health investments in combating obesity and tobacco use, together with
transparency measures to disclose and ultimately prevent problematic actions by
clinicians and prescription drug companies, slow cost growth for all payors,
including employers.
As a result, employers who currently offer coverage save $1.35 billion in total health care
costs by FY 2014. At the same time, some medium-sized and larger employers that do not
provide insurance today are asked to contribute toward the cost of their workers’ coverage.
These payments total $90 million by FY 2014.
Households Save Money
Households save money under SustiNet. With lower spending for premiums and out-ofpocket
costs, total personal health care costs decline by $540 million in FY 2014, compared
to what they would be in the absence of policy change.
The model predicts that Connecticut households will see their after-tax income rise above
projected levels by $930 million in FY 2014. Between lower health care costs and higher
post-tax wages, state residents have $1.47 billion of net increases in income to spend on
expenses other than health care.
Adalberto Rodriguez, the owner
of a New Haven convenience
store and an only child, buys
health insurance for his mom
– in the Dominican Republic,
where it’s one-quarter the cost
of insurance here.
Policy Brief
Marie Santiago of New Haven, a
former nurse, can’t get affordable
insurance on her own due
to her pre-existing conditions,
including diabetes and high
cholesterol. She stays awake at
night worrying that everything
she has worked for may be
taken away.
How Connecticut Can Pay for SustiNet
The discussion to this point shows that SustiNet saves $1.7 billion for Connecticut’s
households and employers as of 2014. At the same time, state spending increases by
$950 million, for two reasons: the previously uninsured receive subsidies that help them
afford coverage; and Medicaid and HUSKY provider payments rise to market rates.
Premiums and revenues collected to finance coverage are paid into a separately
established fund to ensure that revenues are used for their intended purpose, and that
they are not counted against the state spending cap.
Role of Federal and State Governments
Through SustiNet, federal funding increases by $800 million as of FY 2014. This results
from (1) automatic enrollment bringing into coverage increased numbers of state
residents who qualify for HUSKY and premium subsidies, which the federal government
helps pay; and (2) the cost of increasing provider payment rates is shared by the
federal government.
Household Payments
When individuals choose to enroll in SustiNet, they are charged premiums on a sliding
scale, based on their ability to pay. By FY 2014, individual premium payments are projected
to total $570 million, with the state collecting an additional $50 million in income taxes attributable
to rising Connecticut incomes.
Employer Sources
Medium sized and larger employers that do not provide coverage contribute to help offset
costs to the state of adding their uncovered employees to SustiNet. The proposed contribution
is 4 percent of any payroll costs that exceed the average for a Connecticut company
with 10 employees ($318,000 in 2008 dollars). The 4 percent payment constitutes 3 percent
from the employer and 1 percent from the employees. Companies with smaller annual payrolls
below $318,000 in 2008 dollars are exempt from this requirement. In FY 2014, shared
responsibility payments are estimated to generate $80 million in revenue.
If employees join SustiNet because their current employer-provided health insurance is
inadequate, the employer pays the same amount the employer would have spent on the
employees’ health coverage. Such payments are expected to total $240 million by FY 2014.
Finally, employers that do not currently cover their employees and decide to purchase SustiNet
pay premiums to cover the resulting costs, as they would to any health insurer.
Managed by a Public-Private Partnership
Roles and Responsibilities
A public-private governance board outside of current state government, but accountable
to the Connecticut General Assembly, is established to oversee SustiNet. Its major responsibilities
are to:
• Establish policy goals and monitor progress progress toward meeting them.
• Spearhead required reforms to the health care delivery system.
• Identify health care workforce challenges and ensure they are addressed.
• Select and monitor the SustiNet administrator.
• Report quality and cost outcomes to the public.
The SustiNet board conducts regular surveys to assess health status, health coverage, and
health care delivery in Connecticut. It makes adjustments to policy based on these findings
and other new information. Major reallocation of state resources and large changes
in policy require legislative approval. The board submits annual reports to the Connecticut
General Assembly and to the governor on SustiNet’s impact on cost, quality, and access.
Board Expertise and Appointment Process
Members of the SustiNet governance board have expertise in health care delivery, public
health, health care policy, and insurance. Physician, nursing, and hospital representation is
essential. Membership includes consumers, both small and large employers, and state of
Connecticut employees and management. Racial and ethnic diversity as well as geographic
diversity is ensured.
Board appointments are made through a combination of:
• Appointments to the board by elected leaders, including the governor, the speaker
of the house, the president pro tempore of the senate, and the minority leaders
of the house and senate.
• A confirmation process, similar to how Connecticut currently appoints members
to state university boards or appoints judges.
As appropriate to each agency’s charge, existing state agencies are required to work with
the board.
Under the SustiNet umbrella, existing oversight structures of the Health Care Cost Containment
Committee and the Medicaid Managed Care Council continue to carry out their responsibilities
for the state employee health care plans and the Medicaid/HUSKY programs.
SustiNet is run according to the highest ethical standards. Board meetings are open
to the public and rotate around the state. A portion of every meeting is reserved for
public comment.
1 Connecticut has a precedent for establishment of a public-private entity in the Connecticut Housing and Educational Financing Authority (CHEFA).
Improving our
health care
system and
ensuring the
health care
security of state
residents is vital
to Connecticut’s
Policy Brief
Health Care We Can Count On
The SustiNet policy proposal presented here applies the country’s best
thinking about prevention and patient care, moving towards a rational
health care system focused on positive health outcomes. SustiNet’s reforms
are designed to change the way we pay for medical care to make the health
of Connecticut’s residents the driving force behind key public and private
Building on existing health coverage that Connecticut taxpayers are already
funding, SustiNet streamlines an out-of-control and costly health care
system. The new policy uses a focus on patient well-being, fair payments to
health care providers, risk control, and innovative technologies for claims
filing. It builds on best practices from other states and other innovative
health plans. It drives down costs and saves the employers and households
of Connecticut money.
SustiNet is compatible with national reform plans, and its strategies dovetail
with health care reform proposals coming from Washington. As Connecticut
stands at the forefront of states addressing their health care crises, we
are confronted with a rare historic opportunity to be a leader in America’s
health reform movement.
We already have some of the building blocks in place: a program piloting
a model of medical homes in the HUSKY program, Primary Care Case Management;
a regional electronic health records collaborative, eHealthConnecticut,
that has examined Connecticut’s health information needs; and a
groundswell of public support for change.
Connecticut needs health care we can count on. SustiNet was developed
with the input of the people to show the way.
Improving our health care
system and ensuring the health
care security of state residents
is vital to Connecticut’s future.
Maggie Adair, Connecticut Association for Human Services
Ellen Andrews, Connecticut Health Policy Project
Rev. Edwin Ayala, Christian Activities Council
Patricia Baker, Connecticut Health Foundation
Lucy Baney, Access Technologies Group
David Benfer, St. Raphael’s Hospital
Beverly Brakeman, Citizens for Economic Opportunity
Rev. Lydell Brown, Conference of Churches
Christopher Bruhl, Business Council of Fairfield County
Richard Brvenik, Windham Hospital
Leo Canty, American Federation of Teachers
Angelo Carrabba, MD, Connecticut State Medical Society
Rev. Shelley Copeland, Conference of Churches
Everett Corey, International Association of Machinists
Tanya Court, Business Council of Fairfield County
James Cox-Chapman, MD ProHealth Physicians
Will Crimi, Connecticut Health Foundation
Michael Critelli, Pitney Bowes
Bruce Cummings, Lawrence and Memorial Hospital
Joni Czajkowski, American Heart Association
Susan Davis, St. Vincent’s Medical Center
Michael Deren, MD Connecticut State Medical Society
Ken Esposito, Christian Activities Council
Clodomiro Falcon, La Guia Hispana de Connecticut
John Farrell, JJ Farrell & Associates
Ken Ferucci, Connecticut State Medical Society
Paul Filson, Service Employees International Union
Margaret Flinter, Community Health Services, Inc.
Rabbi Stephen Fuchs, Congregation Beth Israel
Kevin Galvin, Connecticut Commercial Maintenance
Lynne Garner, Donaghue Foundation
Shelley Geballe, Connecticut Voices for Children
Paul Grady, Mercer
Rev. Bonita Grubbs, Christian Community Action
Douglas Hall, Connecticut Voices for Children
Nancy Heaton, Foundation for Community Health
Rev. Emilio Hernandez, Christian Coalition for Social Change
Lisa Honigfeld, Child Health and Development Institute
Charles Huntington, University of Connecticut School
of Medicine
Jennifer Jaff, Advocacy for Patients with Chronic Illness
Bryte Johnson, American Cancer Society
Matthew Katz, Connecticut State Medical Society
Brenda Kelley, AARP
Katharine Kranz Lewis, University of Hartford
Ned Lamont, Lamont Digital Systems
Shawn Lang, Connecticut AIDS Resource Coalition
Sharon Langer, Connecticut Voices for Children
Kevin Lembo, Office of the Health Care Advocate
Sal Luciano, American Federation of State County
and Municipal Employees
Robert Madore, United Auto Workers
Linda Masci, Anthem Blue Cross and Blue Shield of Connecticut
Fred McKinney, Connecticut Minority Supplier
Development Council
Jane McNichol, Legal Assistance Resource Center
of Connecticut
Judith Meyers, Child Health and Development Institute
Sharon Mierzwa, Connecticut Association of Directors of Health
Marty Milkovic, Connecticut Oral Health Initiative
Leslie Mills, Griswold Special Care
Jack Mimnaugh, United Action for Connecticut’s
Sean Moore, Greater Meriden Chamber of Commerce
Amy O’Connor, NAMI-CT
John Olsen, American Federation of Labor and Congress
of Industrial Organizations
James Parent, International Association of Machinists
Rev. Joshua Pawelek, Unitarian Universalist Society: East
Brian Petronella, United Food and Commercial Workers
Ann Pratt, Connecticut Parent Power
Cheri Quickmire, Connecticut Association for Human Services
Susan Raimondo, National Multiple Sclerosis Society
Renae Reese, Connecticut Center for a New Economy
Anthony Rescigno, Greater New Haven Chamber of Commerce
Lisa Reynolds, Senior Resources Agency on Aging
Deacon David Reynolds, Connecticut Catholic Conference
Robert Rinker, Connecticut State Employees Association
Ed Rodriguez, Sandoval Associates
Joanne Ryan, Northwest Chamber of Commerce
Baker Salsbury, Connecticut Association of Directors of Health
Steven Sasala, Waterbury Regional Chamber of Commerce
Lisa Sementilli, Permanent Commission on the Status
of Women
Arvind Shaw, Generations Health Center
Tony Sheridan, Chamber of Commerce of Eastern CT
Bill Shortell, International Association of Machinists
John Smith, Bristol Chamber of Commerce
Todd Staub, MD ProHealth Physicians
James Stirling, Stirling Benefits
Paul Storiale, St. Raphael’s Hospital
Tom Swan, Connecticut Citizen Action Group
Robert Tessier, Connecticut Coalition of Taft-Hartley
Health Funds
Peter Thor, American Federation of State County and
Municipal Employees
Dominique Thornton, Mental Health Association
of Connecticut
Sheldon Toubman, New Haven Legal Services
Robert Trefry, Bridgeport Hospital
Victoria Veltri, Office of the Health Care Advocate
Alicia Woodsby, NAMI-CT
Cornell Wright, Parker Wright Group Inc
Nancy Yedlin, Donaghue Foundation
We wish to express our profound thanks to the following individuals and organizations,
whose questions, critiques, and ideas greatly influenced our thinking in developing our
SustiNet proposal. We apologize in advance if we’ve left anyone out.
Thanks also to the following
Connecticut Association of
Directors of Health
Community Health Centers
Association of Connecticut
ProHealth Physicians
American College of Physicians,
Connecticut Chapter
American Academy of Pediatrics,
Connecticut Chapter
AFL-CIO Executive Committee
Business Council of
Fairfield County
Connecticut Realtors
Business Advisory Council
Interfaith Fellowship for
Universal Health Care
Labor for Universal Health Care
healthcare4every1 organizing
and advocacy partner
Stan Dorn, J.D. is a senior research associate at The Urban Institute. He is an expert
on Medicaid, SCHIP, auto-enrollment strategies for providing health coverage,
health coverage tax credits, and the uninsured. The Urban Institute is a nonprofit,
nonpartisan policy and educational organization in Washington, D.C. More information
is available at www.urban.org.
Jonathan Gruber, Ph.D. is a professor of health economics at the Massachusetts
Institute of Technology. He is also the Director of the Program on Children at the
National Bureau of Economic Research, where he is a Research Associate. He is a
co-editor of the Journal of Public Economics, and an associate editor of the Journal
of Health Economics. He serves as a board member of the Massachusetts Health
Insurance Connector Authority. More information is available at http://econ-www.
Universal Health Care Foundation of Connecticut
290 Pratt Street Meriden, CT 06450 universalhealthct.org
Universal Health Care Foundation of Connecticut is an independent, nonpartisan
activist foundation dedicated to making quality affordable available to everyone
in the state. Its mission is to serve as a catalyst that engages people and communities
in shaping a health system that provides access to quality, affordable
health care and promotes health in Connecticut. To learn more about the foundation,
visit www.universalhealthct.org. To learn more about SustiNet and the
foundation’s statewide campaign, visit www.healthcare4every1.org.

Anonymous said...

In all due respect Bob, you said yourself, "This is a state issue because fullyinsured is regulated by state laws not federal."
What can you accomplish as a member of the "Cheshire Town Council"? You keep talking about the big picture.
I haven't heard you say 1 thing about the ridiculous use of town owned vehicles, what you can do about the bubble, what is your stance on turf, shoud the Board o Ed get the increase they are asking for???
These are town issues that need to be addressed. It sounds like you have 1 issue--Healthcare.
Run against Nardello if you feel so strongly about changing these "State" issues.
Or, give us your opinions on the local issues.

John said...

I like and support the idea this blog should have an ongoing section specific to Town issues. All politics is local and we as residents need to address, participate, provide ideas, criticism; both positive and negative and become more involved in what happens in Town. I'll give Bob credit for providing specific information about the issues he has concerns with and maybe healthcare does not directly affect our Council and local govt but at least he is open with his comments and signs his name.

Don said...

To John (if that is your real name)
Signing your name when you are a politician is just one more way of getting your point across.
Look and see all that info he provided, although it may be good (for some), it is not going to be something the town council will be discussing or voting on.
If you want to run for Cheshire Town Council, you should addrss the town problems and how you will fix them. This is what Tim does.

John said...

Yes Don, if that is your real name I agree. All politics is local and we should stick to discussions about local issues.

bob moran said...

yes all politics is local as my great uncle thomas tip O'neil once said. here you go for a local healthcare issue.

line item 201 cheshire 09/10 budget for medical benefits is 7.3 million right now . a 1.2 million increase over last year. greg florio has stated in his budget book that the 2 million dollars that the employees contribute has been taken out to get to the needed 7.3 million to budget at 100% of needed cost. one problem the blue cross renewal which i have and the entire board of education was given states 7.6 million is needed to cover 100% of cost for 09/10. the blue cross sheet handed out doesnt take out the 2 million dollars the employees pay toward the total cost of line item 201 . why does greg need 7.3 million + 2 million from the employees out of their paychecks or a total of 9.5 million dollars , when blue cross states very clearly that to cover the total cost of line item 201 medical benefits you need 7.6 million. it would make more sense that 7.6 million - the 2 million share the employees have to pay by contract be subtracted resulting the taxpayer having to pay 5.6 million not 7.3 million. why is greg florio asking for 1.7 more than he needs per blue cross proposal. also if you can figure this one out then you will know how in the year the schools receive 0 dollars no services were cut. sincerely bob moran

Anonymous said...

"as my great uncle thomas tip O'neil"
Name dropper....may be a great Irishman, but I didn't think to highly of his politics. That Irish-Catholic Boston machine were an arrogant bunch of bullies. But, save that for another day.

You do have a valid point, but how would you vote if the rest of the majority decided (which I bet they will)to give Florio what he wants?
Who pushed for the 0% increase in the past?
I don't think Tim would be much differnt on that point than you are. He is all about saving the town money, unlike the turf heads.

Anonymous said...

tim if we kept all town and school services the same with the increase in cost coverd by our towns budget surplus allowing a 0 increase in taxes , as long as the remaing surplus was still at the fiscal prudent level to have a good bond rating . ( borrowing rating ) if i have heard correctly our surplus is target for around 11% . the schools need 1.2 for teachers contract . they saved 250,000 on health insurance per contract and the town will need to cover their contract increases what ever they are . cheshire has had a tax collection rate of 99% for several years and budgeted for 98% . that has been close to a million dollars in surplus building up. lets not play politics with our schools and town services. lets use our surplus that does not effect our reserves needed to kept a good bond ( borrowing rating ) and support a o tax increase , not a o budget increase. then we should move forward and elect leaders in the fall who have long term solutions . the taxpayers have pay their taxes so we should use it to avoid teacher, police , etc layoffs. what do you think tim

jacker said...