Report on Connecticut’s Forum Addressing Federal Healthcare Cuts and Sustainable Development Goals

Introduction: Aligning with SDG 3 and SDG 10

On September 4th, a forum was convened by the Connecticut Commission on Racial Equity in Public Health and Health Equity Solutions to address impending federal healthcare cuts. The event focused on developing strategies to maintain health coverage for Connecticut residents, directly addressing the principles of Sustainable Development Goal 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities). Ayesha Clarke, executive director of Health Equity Solutions, opened the forum by emphasizing that achieving equitable outcomes requires the inclusion of impacted communities in the solution-making process, a core tenet of SDG 16 (Peace, Justice and Strong Institutions).

Projected Impacts on Health, Poverty, and Inequality

State officials, including representatives from the Department of Social Services (DSS) and Access Health Connecticut, reported that an estimated 300,000 residents will be impacted by the federal cuts. The consequences of these cuts present significant challenges to multiple Sustainable Development Goals.

• Threat to Universal Health Coverage (SDG 3.8): Panelists projected that the cuts will drive up uninsurance rates, leading to residents forgoing or delaying essential medical care.
• Exacerbation of Poverty (SDG 1): As insurance is a primary protection against medical debt, the anticipated loss of coverage is expected to increase financial hardship and medical debt for residents, undermining efforts to eradicate poverty.
• Worsening Health Outcomes (SDG 3): Uninsurance is directly correlated with negative health trends, including worsening clinical outcomes, longer hospital stays, and higher rates of premature death.
• Increased Systemic Inefficiency: Dr. Linda Barry of UConn noted that increased uninsurance would lead to greater reliance on emergency rooms for primary care. This is a more costly and less effective model of care that disrupts the continuity necessary for positive long-term health, placing undue strain on critical infrastructure.
• Healthcare Workforce Strain: The additional stress on hospitals, which are already facing provider shortages, is expected to fuel provider burnout, compromising the stability of the healthcare system.

Institutional Response and the Call for Stronger Systems (SDG 16)

The Department of Social Services (DSS) is proactively addressing the challenge by developing a new workflow and technical system to manage the transition while continuing to serve approximately 980,000 people. This effort to build a resilient and responsive system is critical for ensuring residents maintain insurance coverage and is a direct application of SDG 16, which calls for effective, accountable, and inclusive institutions. Commissioner Andrea Barton Reeves highlighted the importance of community partnerships in this effort, reflecting the collaborative approach of SDG 17 (Partnerships for the Goals).

Expert Panel Recommendations and Call to Action

A panel of experts moderated by Alexander Reger of the Office of Health Strategy culminated in a strategic call to action for the state to uphold its commitment to health and equity. The panel’s key takeaways provide a clear path forward:

1. Act Now: The state must engage in immediate and proactive planning rather than waiting for the negative effects to materialize.
2. States Are Not Powerless: Connecticut has the autonomy and resources to implement policies that can mitigate the deleterious effects of the federal cuts.
3. Build a Better System Together (SDG 17): A collaborative approach involving state agencies, healthcare providers, and community organizations is necessary to construct a more equitable and resilient system.

Pareesa Charmchi Goodwin of the Connecticut Commission on Racial Equity in Public Health concluded the forum by reiterating that hope is not a plan. The state possesses the expertise and resources to formulate a concrete strategy that protects its residents and advances the Sustainable Development Goals.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The article’s central theme is public health, focusing on the consequences of federal healthcare cuts in Connecticut. It directly discusses issues like loss of health insurance, access to care, worsening clinical outcomes, longer hospital stays, and higher rates of premature death, all of which are core components of SDG 3.
2. SDG 10: Reduced Inequalities
   • The article begins by mentioning the “Connecticut Commission on Racial Equity in Public Health” and the involvement of the “UConn Health Disparities Institute.” This framing explicitly connects the healthcare cuts to the potential for increased inequality, suggesting that the impacts will not be felt equally across all populations and that addressing racial and health disparities is a key concern.
3. SDG 1: No Poverty
   • The article highlights the link between health insurance and financial stability. It states that “insurance is the best protection against medical debt” and anticipates “increases in medical debt for residents across the state” due to coverage losses. Since significant medical debt can be a major driver of poverty, this issue connects directly to SDG 1.
4. SDG 16: Peace, Justice and Strong Institutions
   • The article discusses the institutional response to the healthcare cuts. It describes how the Department of Social Services (DSS) is “working to set up an entirely new workflow and technical system” to manage the crisis while continuing to serve residents. The call for the state to “establish a plan” and the emphasis on “community partnerships” relate to the need for effective, accountable, and inclusive institutions to deliver public services.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   • The entire article revolves around the threat to health coverage. The statement that federal cuts will “drive up uninsurance rates” and that an “estimated 300,000 residents will be impacted” shows a direct challenge to achieving universal health coverage. The concern about rising “medical debt” speaks to the erosion of financial risk protection.
2. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard.
   • The forum hosted by the “Commission on Racial Equity in Public Health” aims to find “meaningful solutions” to prevent the cuts from disproportionately harming certain communities. This effort to create a state-level plan to mitigate the effects of federal policy is an action aimed at reducing inequalities of health outcomes.
3. Target 1.3: Implement nationally appropriate social protection systems and measures for all… and by 2030 achieve substantial coverage of the poor and the vulnerable.
   • Publicly funded health insurance is a key social protection system. The article discusses the challenge of keeping “Connecticut residents covered” as this system is cut at the federal level, directly threatening the coverage of vulnerable populations who rely on it.
4. Target 16.6: Develop effective, accountable and transparent institutions at all levels.
   • The article describes the operational challenges faced by the Department of Social Services (DSS), which must adapt its systems to handle the changes effectively. The call for a state plan because “hope is not a plan” underscores the need for a robust and accountable institutional response to the crisis.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Uninsurance Rate:
   • The article explicitly states that cuts will “drive up uninsurance rates.” The number and percentage of residents without health insurance, particularly the “estimated 300,000 residents” who will be impacted, serve as a direct indicator for Target 3.8 (universal health coverage).
2. Prevalence of Medical Debt:
   • The article predicts “increases in medical debt for residents.” Tracking the number of individuals with medical debt and the average amount of that debt would be a key indicator for the financial risk protection component of Target 3.8 and the poverty-related aspects of SDG 1.
3. Rates of Delayed or Forgone Care:
   • The text mentions that “uninsurance results in patients forgoing or delaying care.” Surveys or healthcare system data measuring the percentage of the population that avoids seeking medical care due to cost would be a relevant indicator of access to healthcare services (Target 3.8).
4. Health Outcome Statistics (Disaggregated):
   • The article mentions “worsening clinical outcomes,” “longer hospital stays,” and “higher rates of premature death.” These are direct health outcome indicators for SDG 3. To address Target 10.3, these statistics would need to be disaggregated by race, income, and other demographic factors to measure inequalities.
5. Emergency Room Utilization for Primary Care:
   • The concern that uninsured individuals may end up “relying on the emergency room for care” implies that the rate of non-urgent ER visits can be used as an indicator of a failing primary care system and lack of proper insurance coverage (related to Target 3.8).

Summary of SDGs, Targets, and Indicators

Source: today.uconn.edu