Health care reforms nailed to the door

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Comprehensive health care reform in Colorado is one step closer to reality.
Four proposals to overhaul the system are being evaluated, including creating a single, publicly-financed program; creating a core limited-benefit plan that all carriers would offer; creating a purchasing pool to replace individual, small group and large group plans; and creating a voluntary purchasing pool for small businesses and individuals receiving government subsidies.

Colorado Health Services Program

  • Creates a single, publicly-financed program designed for finance, delivery and administration integration. Will be governed and administered like a public utility
  • Creates a governing board to set budgets, determine provider rates and establish standards of care
  • Creates Colorado Health Trust, insulated from the general fund
  • Charges premiums through income tax or payroll deductions, or implements new payroll taxes or income taxes

Solutions for a Healthy Colorado

  • Requires all Coloradoans to have health insurance
  • Creates Core Limited Benefit Plan that all carriers would offer with guarantee issue and modified community rating
  • Ties all provider reimbursement levels to one common basis adjusted for performance on quality benchmarks.

A Plan for Covering Coloradoans

  • Requires all Coloradoans to have health insurance
  • Require employers to contribute to employee coverage or pay reasonable assessment
  • Creates purchasing pool to replace existing individual, small group and large group markets, except ERISA, Medicaid and CHP+
  • Provides subsidy for purchasing coverage in pool up to 400 percent of the federal poverty level.
  • Expands public programs for disabled, elderly, medically needy, children and parents (up to 300 percent of the federal poverty level) and childless adults up to 100 percent of the federal poverty level.
  • Scored high for access, coverage, affordability benefits, quality, efficiency, consumer choice and empowerment and comprehensiveness.

Better Health Care for Colorado

  • Subsidizes purchase of private insurance up to 300 percent of the federal poverty level through Medicaid expansion
  • Creates voluntary purchasing pool for individuals receiving subsidies and small business
  • Reforms Medicaid managed care and long-term care programs.

(Source: 208 Commission)

“We’re at a watershed point,” said Marcy Morrison, state commissioner of insurance. “Whatever comes out of this discussion will be worked into a model. It could change everything.”
The proposals were culled from 30 considered by the 208 Commission, which was created by the Legislature in 2006. The Lewin Group, an independent consultant, will evaluate the finalists. The group will explain the costs and attributes of each proposal, leaving the commission to decide how to proceed.
“They may come up with their own ideas, or create an amalgamation from pieces of the four,” said Jeff Thompson, director of government and corporate relations for the University of Colorado Hospital in Denver. “And people are going to be looking at these four, to see how each would fit in their particular institution.”
The proposals offer different political and public interpretations to solve the problem, Morrison said.
“Some create a single payer system, others rely on more government,” she said.
But the solution should be “global,” with a statewide focus, Thompson said.
“770,000 — that’s the number we’re dealing with,” he said. “That’s how many people don’t have insurance in this state. And as the second-largest provider of indigent care in the state, it’s definitely something we’re interested in.”
B.J. Scott, executive director of Peak Vista Community Health Center in Colorado Springs, helped develop one of the 11 proposals that made the semi-final list. Hers didn’t make the final four.
“And while we’re disappointed, we’re still going to be offering insight and safety net expertise as the process goes forward,” she said
Cost will be important. One proposal requires new income or payroll taxes, while others rely on businesses to pay a share of the premiums or an assessment to the state.
“One thing is obvious — these plans are going to cost money,” Thompson said. “And if they plan to raise this money through taxes, it’s going to have to go before the voters. That could be a hard sell.”
Money is going to be the issue, Morrison said, noting that proposals to eliminate Medicaid could mean the elimination of federal dollars.
Thompson said his group is interested in a plan that offers comprehensive coverage.
“We haven’t really done a strict analysis yet. But we’re really looking at a plan that will provide universal coverage for all Coloradoans — continuous coverage that you can take with you when you leave work. It has to be affordable to employers, individuals and families.”
Those are some of the goals of Healthcare Reform for a Stronger Colorado, a coalition of safety net providers who created a list of topics that should be included in any final legislative proposal, such as health and wellness, as well as prevention.
The group has defined quality health care as “effective, meaning that it encourages evidence-based care/interventions where appropriate … accountable, meaning it utilizes meaningful data, research, technology and best practices … efficient, meaning that care is coordinated and proactively managed … patient and family centered.”
Efficiency also is important, said Sheila Carlon, an associate professor of health services administration at Regis University.
“When we looked through these plans, I tried to look at good coverage that’s efficiently driven,” she said. “That’s what will make or break these plans — how well it will be run, how it will be paid for. There are a couple of plans that would set costs and quality standards and oversee budgets.”
That kind of oversight is impossible today. Hospitals and providers are too far behind in updating their systems to include electronic medical records and other kinds of information technology systems, she said. That makes gathering data nearly impossible.
“I knew people who were on the Clinton commission to overhaul health care,” Carlon said. “And that’s what made them give up — the realization that there’s no national health care information technology. Ways to gather quality data hadn’t been developed yet.”
Those technology needs are why states are better equipped at handling the health care crisis,” she said. It’s easier to create a statewide program to gather data than it is to develop a national one.
“I like the plans that include oversight and are sustainable,” Carlon said. “Some of them are controversial and will provide coverage to non-English speakers, migrant workers. Some clinics already exist that provide health care to them. These clinics can be efficiently folded into the new system, which would address the access part of the problem.”
The new plan should be separate from Medicaid, she said. Many doctors are not taking new Medicaid patients because of the reimbursement rate.
Scott said the real effort is still ahead — when the Legislature begins debate in January. She believes that the organizations involved will work together to develop a solution.
“There are so many moving parts,” she said. “We have to put our heads together to come up with the right thing for everyone. It will be easy to come up with a solution that has adverse consequences on some populations down the road. We’ll have to watch for that — come up with something that improves access across the state, and something that will control costs for businesses.”
Compromises will have to be made, Morrison said.
“Any way you look at it, no one will get everything they want,” she said. “Everyone’s going to have to give a little — providers, patients, the insurance industry. We’re all going to have to give up something to make it workable.”
Amy.Gillentine@csbj.com