For several years now – starting well before the ACA became the law of the land – Colorado has been working to improve access to health insurance and health care for the people here. For three years in a row, Colorado has received large Medicaid grants because of the progress the state has made in expanding Medicaid coverage. Maternity coverage has been mandatory on individual health insurance plans here for two years, and gender-based premiums disappeared two years ago as well. Colorado is making good progress with a health information exchange system that links hospitals and providers throughout the state. And in terms of making healthcare more affordable, the Colorado Hospital Payment Assistance Act went into effect last summer and requires that hospitals charge uninsured patients (with incomes up to 250% of FPL) no more than the lowest negotiated price the hospital has with a private health insurance carrier. In addition, the state has been been making good progress in setting up a health insurance exchange that should be open for business next fall, with policy effective dates starting a year from now.
One of the most tireless crusaders for health care access in Colorado is State Senator Irene Aguilar, who is also a physician. The Hospital Payment Assistance Act was her bill, and she’s introduced numerous other healthcare-related pieces of legislation over the last several years. Her most recent one is another attempt to create a universal healthcare system in Colorado. This would be independent of anything created by the ACA, although the idea is that it might work in tandem with the fledgling health insurance exchange by directing per-member fees to private insurers when members choose to stay with them instead of joining the public group plan. Aguilar’s plan would involve new payroll taxes combined with Medicare and Medicaid funds that would allow the state to create a basic plan that would cover everyone.
I would say this is a long shot, just based on how contentious the debate was regarding Senate Bill 200, which passed in the 2011 legislative session to allow for the creation of Colorado’s health insurance exchange. The exchange is a state-run board but the products it will sell are private health insurance plans – and even that was seen by a lot of people as too much government involvement in health care.
Senator Aguilar’s plan for universal healthcare in Colorado is based on a genuine need: even with current and planned state and federal healthcare reforms, there will still be a lot people in Colorado without health insurance. The CBO estimates that on a national level, we’ll have 30 million uninsured people in the US a decade from now. That’s taking into account the fact that SCOTUS struck down a provision in the ACA that would have required states to expand their Medicaid programs. States have flexibility with that now, and some will likely choose not to expand. Colorado, however, is expected to expand its Medicaid program (not surprising, given how much work the state has already done on that front). The uninsured population in Colorado hovers somewhere in the 600,000+ range, depending on how and when the samples are studied. If the ACA is expected to reduce the national uninsured population from 53 million to 30 million, and taking into account the fact that Colorado will likely be one of the states that opts for Medicaid expansion, I would say it’s reasonable to expect that the uninsured population here will be reduced by at least 50% once the ACA is fully implemented. But that still potentially leaves a few hundred thousand people – not an insignificant number by any stretch – with no health insurance. Those are the people Senator Aguilar is trying to help.
I’m sure some will say that Senator Aguilar is beating a dead horse with this newest bill, given that the ACA has cleared many hurdles over the past three years and continues to move forward. But even with all of the changes that the ACA will bring, and even with all of the work that Colorado has done on a state level over the last few years, there could still be hundreds of thousands of people in Colorado with no health insurance ten years from now, unless we add additional reforms and/or make changes to the ones we’re currently implementing.
I don’t know what the answer is. I can see both sides of the debate here, and I recognize that there are some significant cost barriers to insuring 100% of the population. But I commend Senator Aguilar for her continued efforts to address the needs of citizens who are without health insurance and might remain that way without additional interventions.