Insurance legislation both friend and foe to consumers

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Transparency, standardization and efficiency.

That’s what legislation this session would require insurance companies to include when writing policies.

Here are some of the health care bills:

House Bill 1038 seeks to establish a database of claims throughout the state to better understand how Colorado is spending its health care dollars. The information from the database will be used to create more efficient health care.

“Our only concern about this bill is to make sure everyone is reporting the information the same way,” said John Suits, vice president of legislative affairs at Memorial Health System. “We want to make sure we’re comparing apples to apples, and there are so many ways to report the information. You could report actual costs, Medicare reimbursement, payer reimbursement.”

For health care analysts, the bill is a chance to gather a greater amount of information about the costs of chronic illnesses — as well as where Colorado is spending most of its money — in a single place.

“This is important,” said Kelly Shanahan, policy director for the Colorado Consumer Health Initiative. “We don’t know, except for using the Medicare database, what illnesses are getting the most money in Colorado. This information is needed to set policy.”

House Bill 1166 would require insurance policies to be written without industry jargon. This bill would require policies to be written at a tenth grade level, despite the complexities of insurance information.

House Bill 1242 would require a single form for every insurance carrier in the individual market. Its goal is to allow consumers to compare insurance products more easily.

“It’s really going to allow an apples-to-apples approach,” Shanahan said. “That’s the reason we’re supporting it. Right now, it’s really difficult to compare insurance products, every company is using  a different application.”

House Bill 1004 is another bill designed to make the claims process easier for consumers. The bill seeks to standardize policy forms and clarify benefits explanations.

House Bill 1252 is in a response to government studies released this summer that recommended women get fewer mammograms. This bill seeks to ensure that breast cancer screenings remain covered by insurance companies at current guidelines.

Legislation threatening?

While The Consumer Health Initiative applauds the bills on Gov. Bill Ritter’s agenda, there are a few health and wellness bills that they fear will result in less coverage and less access for consumers — and leave most of the decisions in the hands of insurance companies.

House Bill 1163, now in committee, would allow insurance carriers outside the state to offer insurance in Colorado — without complying with the state’s consumer protection laws.

“This is not a good bill for consumers,” said DeDe DePercin, executive director of the nonprofit organization. “While it looks like it will allow lower premiums, it could well provide an arena for fraud and mismanagement.”

House Bill 1160 gives the insurance companies the power to set premiums based on participation in health and wellness programs. A bill passed last year that allows certain cash incentives for employees who participate in the program. This bill takes it a step further, and allows the insurance companies to set benchmarks for health in order to receive the discounts.

“This just takes it too far,” Shanahan said. “It doesn’t take people’s life circumstances into consideration. Everybody says wellness is great, and we agree. But leaving the decisions in the hands of the insurance company doesn’t make sense.”

The bill also doesn’t guarantee workers will see the discount, but their employers will.

“That sort of makes your employer “big brother,” DePercin said. “I don’t want to walk around policing what my employees eat just so I can get an insurance discount.”

While watching these health care bills closely, most health care experts and analysts agree that the big “action” is yet to come.

“We are waiting for the Long bill,” Suits said. “That’s the budget bill. We know the legislators are going to be struggling to balance the budget, and we know that means some cuts to reimbursement to Medicaid. We’ll be watching it closely.”

Suits said that the state’s hospitals with large numbers of Medicaid patients are bracing for the cuts they know are coming.

“It’s just hard to predict right now,” he said. “These bills are important — but the big stuff is coming up.”