One of our favorite bloggers, Maggie Mahar, hosts the latest Health Wonk Review, and it’s an excellent edition with lots of thought-provoking posts. One of the most interesting comes from Sonya Schwartz at Health Affairs. Sonya writes about the impact of several potential Supreme Court rulings regarding the ACA, from the perspective of states that are currently active in implementing reform. To get an “active” rating, the states must have a score of at least five on this chart. Colorado scores a four, so it’s not one of the states that the article considers. But Colorado has made a lot of progress over the last few years in terms of healthcare reform, and Governor Hickenlooper has indicated that the state remains very committed to continuing the process, regardless of the fate of the reform law on a national level.
Sonya’s article rates potential rulings on a Richter Scale, with magnitudes ranging from 2.0 (entire ACA upheld) to 8.0 (entire ACA struck down). I think her analysis is pretty much spot-on, and I would say that the impacts she describes would also apply here in Colorado, even though we’re not quite “active” according to the criteria on the State Reforum chart. The three criteria on the chart that Colorado has not officially met are areas where the state has been making progress already, so I would say that we’re not too far off from getting a score of five or more. (For example, Medicaid expansion has been a priority here for a few years, and the Colorado Division of Insurance has made changes to bring more transparency and accountability to the health insurance rate increase review process. Those two issues are part of the criteria on the chart that Colorado has not yet fulfilled). And given the Governor’s commitment to expanding health insurance coverage to as much of the state’s population as possible, I would say that Colorado will continue to take steps to reform healthcare over the next few years, even if there ends up being little or no federal framework for reform. But as Sonya pointed out, if the entire ACA is struck down, the state will have to start from scratch on a lot of issues. In some regards, however, Colorado has already passed laws that address various individual aspects of healthcare reform – things likegender-neutral premiums and maternity care, for example. Those will not be impacted by a ruling on the ACA, since they are independent of federal law and apply only to health insurance policies sold here in Colorado.
If you’re curious about how your state is doing on healthcare reform, the chart that Sonya links to is very interesting. The states at the bottom of the list have their work cut out for them if the ACA is upheld, and the states that have been making a lot of progress might find that some of it has to be scrapped if the Supreme Court rules against the ACA.