The demise of the 208 Commission has been widely overstated.
The commission, which was created to evaluate health care reform proposals and make a recommendation to the legislature in January, was reported to be stuck: with neither enough money nor time to complete its job.
That, said Chairman Bill Lindsey, isn’t true.
“We were given a year and $100,000,” Lindsey said. “And we’re working to come up with recommendations to the legislature. We’re still working to do that. We haven’t disbanded or gone home.”
The commission has a specific mission: to suggest ideas for widespread, comprehensive health care reform. But some things are beyond its scope of work, such as solving problems with Medicare. The commission also won’t resolve the problem of 750,000 Colorado residents who do not have health insurance.
“That’s not our charge,” Lindsey said. “We’re looking at the problems of access and reducing costs. Other problems are not in our purview. Our main goal is to look at expense, access, redundancy and costs. Many of these issues are important, but we just can’t get to them.”
The commission is reviewing five plans — four from outside sources and one that it developed. The public will get a chance to hear more about the proposals from 5 to 8 p.m. Oct. 5 at First Presbyterian Church in Colorado Springs. The group is touring the state to get public input about the plans.
Every comment received during the public meetings will be included in the commission’s final report to the legislature.
“This is not a perfunctory meeting,” Lindsey said. “We want people to be heard; their view is very important to us.”
Local health care officials are closely following the 208 Commission’s work.
“This was one of Gov. (Bill) Ritter’s biggest campaign promises,” said John Suits, associate administrator of business and government affairs at Memorial Health System. “I expect something will be implemented in 2009, and I feel sure it will be some sort of hybrid of the programs.”
B.J. Scott, executive director of the Peak Vista Health Clinics, said the public needs to pay close attention to the health care reform proposals.
“If they want to have a voice in what reform looks like, this is the opportunity,” said Scott, who is the vice-chairwoman for the commission’s provider task force. “This is a broad group, a bipartisan group that has literally put in hundreds of hours on this issue. Whatever comes out of it will have significant impact.”
But the commission’s final recommendation won’t please everyone, she said.
“There has to be some compromise,” she said. “Everyone has to give up something, so if it’s a ‘good’ proposal will depend on your perspective. The goal is to cover more people and reduce costs.”
Three of the proposals have a common theme: adding government subsidies to insurance premiums that are tied to the federal poverty level. One proposal deals with a single-payer system and the commission’s proposal is a mix of the others.
“There are major problems with the system,” Suits said. “The collective cost of providing that care is already to a point where it exceeds the state cost — but it’s a matter of where the financial burden is if the state already can’t cover the costs. How will we pay for it?”
Business owners in particular should pay attention to the public meetings about health care reform, said Ralph Pollock, executive director of the Business Health Forum. “We see a need to get business leaders engaged in the process,” he said. “Business leaders don’t have a voice right now; they don’t have dedicated staff to cover these health care issues. And yet, health care is a major concern for them.”
At the top of the list of concerns are rising costs.
“Even if they aren’t paying for it, they’re paying for it,” Pollock said. “The costs shift to higher premiums, higher costs for the employer. It’s a crucial time.”
Most of the proposals would be paid for through additional taxes — such as adding nutrition taxes on junk food or raising cigarette and alcohol taxes.
Efficiency and concerns
In addition to costs, those interested in health care reform should also look at efficiency, 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 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.”
Lindsey said that his biggest concern is that if the proposal selected by the legislature requires additional taxes, it would have to be approved by voters.
“I think there’s a legitimate concern that if something has to be referred to the ballot on a presidential election that will be loaded with other motions, it’s troubling,” he said. “Will voters take the time to digest the important information about the program in the face of a myriad of other ballot issues? I think that’s a real concern.”
|Solutions for a Healthy Colorado
Colorado Association of Health Underwriters
|Expands eligibility for children under Child Health Plus|
|Expands eligibility for Medicaid to their parents|
|Provides a premium subsidy for private coverage|
|Co-pays: $15 to $100|
|Premiums range from $102.89 for individuals 25 or younger to $899.26 for families with members 64 or older|
|Increases alcohol, tobacco taxes and creates a nutrition tax|
|State spending increases 1 percent|
|Payments to providers increase $781 million|
|Better Health Care for Colorado
Service Employees International Union and the Colorado Association of Public Employees
|Expands coverage under Medicaid/SCHIP to cover more children|
|Provides subsidies for private coverage for parents and some childless adults|
|Requires individuals purchase health insurance|
|Benefits cap: $35,000|
|Co-pays: $10 to $100|
|Monthly premiums: $150 to $200|
|Increases alcohol and tobacco tax|
|State spending increases 2 percent|
|Payments to providers increase by $374 million|
|A Plan for Covering Colorado
Committee for Colorado Health Care Solutions
|Employers must provide health insurance for workers or pay a fee|
|Medicaid coverage is expanded to cover all parents and children living below 300 percent of the federal poverty level and childless adults below 100 percent of the federal poverty level|
|Creates purchasing pool with subsidized premiums|
|Mandates health insurance for everyone|
|Co-pays range from $5 to $100|
|Financed through employment assessment, tax on insurers, increases in tobacco and alcohol taxes|
|State spending increases by 4.3 percent|
|Provider payments increase by $805 million|
|Colorado Health Services Plan
Health Care for All Coalition and the Colorado Nurses Association
|Single payer system covering all residents|
|Coverage for Medicare and Medicaid would be folded into the statewide program|
|Employers would no longer cover workers|
|Co-pays from $2 to $15|
|Funded with 6 percent employer payroll tax and an increase of 7.5 percent of individual/family income taxes, increase in tobacco and alcohol tax|
|The Fifth Element
Proposal being formulated by 208 Commission
|Requires health insurance|
|No employer mandate|
|Reforms the individual and small group markets by creating a central program to administer subsidies, determine benefit packages|
|Provide subsidies for private insurance for all legal residents up to 400 percent of the federal poverty level|
|Creates three to four benefits plans that must be offered by all carriers in Colorado|
|Expands use of integrated delivery system|
|Reimburses Medicaid providers at 75 percent of Medicare|
|Creates the Optional Portable Government Plan, a voluntary single payer program|
|(This plan is still in development and has not been evaluated by the Lewin Group)|