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Welcome to Prescription for Healthcare, a podcast collaboration between the WFHB Local News and Medicare for All Indiana, broadcasting the second Thursday of every month as part of the Local News at 5:15 PM.
This month we interview attorney Sheldon Toubman, the litigation attorney with Disabilities Rights, Connecticut, which serves individuals with a broad range of disabilities throughout the state of Connecticut.
Sheldon focuses on healthcare and protecting civil rights, including rights under the Americans with Disabilities Act. Sheldon has been an attorney for 43 years. He practices in Hartford, Connecticut.
When he was an attorney with the New Haven Legal Assistance Association, Sheldon co-led a coalition that successfully changed the Medicaid delivery system from being run by profit driven insurance companies to a state run system accountable to taxpayers saving the state of Connecticut, literally billions of dollars since the conversion in 2012.
From the podcast: “Karen Green Stone – In February of 2025 while testifying before a Senate hearing in Connecticut, you said that in 2011 Governor Daniel Malloy made a bold decision to move away from being dependent on risk-based insurance companies called Managed Care organizations or MCOs [In Indiana, these are usually referred to as MCEs, Managed Care Entities] to run the state’s Medicaid program, even though most other states then contracted with them and still do today. And I’ll add here that Indiana continues to contract with Big Insurance. The decision was really not that hard because Medicaid run through insurance companies was a source of major access problems for Medicaid enrollees statewide and major headaches for their providers who spent huge amounts of time trying to get approvals of care they prescribed, and even though it was approved, actually getting paid. And I’ll add here that Indiana’s solution is to reduce the size of Medicaid rather than expand services. So Sheldon, we’ve always thought of Connecticut as the Insurance State, and we were surprised to hear that you achieved the conversion to a state based finance system for Medicaid. Will you please tell us about the history of the movement to change the way Connecticut finances its Medicaid program?
Sheldon Toubman – “It’s true that most people would say that Hartford is the insurance capital of the country. Aetna is headquartered there and Aetna was at the time, one of the three MCOs, and another for-profit in the system was UnitedHealthcare, which of course is the largest insurance company, and has a major presence in Connecticut as well. So it was formidable to take on the industry. The campaign was literally over 10 years, really 12 years.
“It was an education campaign. There were a lot of other pieces to it, but mostly it was an education campaign to just educate the legislators, the state agency people, and the public at large about what was lost by having turned the keys to the program over to these capitated insurance companies, capitated for-profit insurance companies, and capitation simply means that there is a per-member per-month payment that goes to the insurance company, and so every dollar paid to a healthcare provider comes out of the insurance company’s pocket. It was a direct financial incentive to deny care. It was an education campaign about what that really means. And what it meant is that access was significantly restricted to healthcare for low income people who have no other option. The two main ways that access was restricted was through, a limited provider network and extensive, burdensome prior authorization…”
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Medicare for All Indiana is the Indiana Chapter of Physicians for a National Health Program
“If Not Now, Tell Me When” by Carrie Newcomer is used with permission.
