The 2010 legislative session in Colorado got underway this week, and included the introduction of a few bills aimed at health insurance reform on a state level. HB 1008 would make it illegal for gender to be used in the determination of health insurance premiums, HB 1021 would require reproductive services to be covered by health insurance, and HB 1004 would implement standardized explanation of benefit (EOB) forms for insureds. All of these measures are included in some form in the federal House and/or Senate bills that are being merged at the White House this week, but Colorado lawmakers are taking steps to try to implement these changes here at home without waiting for federal reform. In addition, the Colorado bills would all take effect in 2010 or 2011, as opposed to federal changes which are mostly delayed until 2013.
All three of these changes sound good at first glance, but the first two are not as cut and dried as they sound. Ending gender-based pricing in the individual market would likely result in lower premiums for women, but higher premiums for men. In Colorado, men are more likely than women to be uninsured, and raising their prices would almost certainly mean that more of them would drop their coverage.
Adding reproductive services also sounds like a good idea, but it depends on how much it would increase premiums, as many people already struggle to afford their health insurance. For people like me, who choose to have homebirths with midwives, would we be paying for maternity coverage and still paying out of pocket for our midwives? Would people who choose to adopt or not have children be forced to pay for maternity coverage? Would people who would rather have a high-deductible, HSA qualified policy still have to pay for maternity coverage? There are a lot of questions around this topic, and I still haven’t seen any solid data indicating how much health insurance premiums would increase if reproductive services were included on all policies. Group policies in Colorado are required to cover maternity care, and the premiums are far higher than individual policy prices. But group policies are also guaranteed issue, and it’s hard to tell how much of the premium difference has to do with underwriting and how much has to do with things like maternity care being covered on group plans and not on individual policies. Currently there are only a handful of individual carriers in Colorado that offer maternity coverage (Rocky Mountain Health Plans, Assurant, and United Health One), and with all of these carriers, the addition of maternity coverage makes the policy significantly more expensive. Obviously the premium difference wouldn’t be as dramatic if the coverage price were spread across the whole population via a mandate, but I am concerned that it might not be a small rate increase.
The bill that would require standardized EOBs does have my support, as does any legislation that would make health insurance benefits and claims information easier to understand and compare. Anything that can reduce the amount of time that medical offices and consumers spend trying to figure out benefits and claim information will ultimately make our health care system more transparent and efficient.
If you have an opinion one way or another on these or any of the other bills that were introduced this week, now is the time to contact your representative.