Here’s the Deal with Colorado’s Big Health Care Bill

The bill formerly known as the “Colorado Option” passed out of the House Health and Insurance Committee on a party-line vote on Tuesday. House Bill 1232 now heads to the House Appropriations Committee; it is expected to move along with little trouble to a floor vote and then to the State Senate.  

There has been a bit of confusion about what the current format of the bill does and does not accomplish, due in part to complicated policy, protracted negotiations, and multiple versions of bills over several legislative sessions. Here are some questions and answers to help in that regard:

 

Q: So, what does this bill actually do and why should I care?

A: This is a big deal. While a lot has been written and said about HB21-1232, the impact on Coloradans is fairly straightforward: Health care costs for individuals and small groups will fall by 18% over the next three years. This is a significant savings for Coloradans and should make it easier for more people to get health care coverage. 

 

Q: Did Democrats cave into demands to drop a public option?

A: Sort of…

Creating a quasi-governmental nonprofit entity to oversee a competitive health care plan was one of the “sticks” outlined by lawmakers to hold the healthcare industry to its promise to reduce the cost of premiums by 20% (now 18%). The “public option” dropped in and out of the conversation between last year and the introduction of HB21-1232, and while it got a lot of attention, our understanding is that this was never the end goal here; the point was always to cut the cost of health care for Coloradans, and that will still happen under the current version of the legislation with a “standardized plan” option.

You could perhaps make an argument that Democrats could have pushed the bill through both legislative chambers as it was originally written, but sponsors ultimately felt that they could achieve their overall goal with a revised version. 

 

Q: Why was this bill being marketed as the “Colorado Option”?

A: Presenting this bill as a “Colorado Option” might not have been the best idea because it raised expectations for many supporters on the left that the end goal was a “public option” of some sort. On the other hand, the threat of a “public option” probably did play a significant role in convincing the healthcare industry to seek out a deal.   

 

Q: Without the threat of a “public option,” what will prevent the healthcare industry from reneging on promises to cut the costs of premiums?

A: The bill instead creates an insurance consumer ombudsman office that requires public hearings on health care access and affordability and puts the regulation of the state’s standardized insurance plan under the insurance commissioner. Companies that fail to meet the required 18% reductions would likely face significant fines from the state. 

Colorado Newsline explains more of the details here:

The amended bill, like the original bill, will require private insurers to offer three tiers of a standardized individual plan and small-group plan on Connect for Health Colorado, the state’s health exchange. Such plans make it easier for consumers to compare provider networks, premiums, copays and deductibles when choosing an insurance plan to purchase. Under HB-1232, the standardized plans would all have to include certain mandatory health care services.

 

Q: Are Republican lawmakers on board with this deal? What did Democrats get out of the discussion?

A: Most of the opposition from the healthcare industry has been removed. Republicans who oppose HB21-1232 are still going to shake their fists, but they’re now isolated on their own little island. 

As part of the deal, most industry groups — representing hospitals, doctors, insurance companies, etc. — shifted their position on the legislation from “Opposed” to “Neutral.” House Minority Leader Hugh McKean said a few weeks ago that this would be the “hill we die on,” and there’s no indication that the GOP has changed its mind. This will be a fairly pointless death, however, since negotiations between Democrats and industry groups made Republican opposition largely irrelevant. 

 

Q: How does this bill compare with the health care overhaul initially planned for the 2020 legislative session?

A: There’s no “public option” here, but the outcome is undeniably better. The 2020 version of this legislation would have cut premiums by 10% over two years and applied only to the individual market. The version likely to become law this year will have dramatic effects on how people and businesses can afford health care, which will make a big difference in a lot of lives. 

10 Community Comments, Facebook Comments

  1. MattC says:

    ".. no “public option” here, but the outcome is undeniably better."

     

    Agreed.

    However, it is complex and the made up opposition talking points are going to be endless: 

    – Grandma died in the hospital: Blame the D's government takeover.
    – My surgery was soo expensive.
    – My elective cosmetic surgery is no covered. 
    – I don't even believe my neighbor is here legally, and she had two babies for free.  
    – I loved my doctor and she quit practicing instead of taking this.  

    Whattaya expect with government takeover?

  2. kwtree says:

    HB1232 represents our legislators caving to health industry demands, at the expense of consumer interests. It has a goal of reducing health premiums by 18% over three years. But the enforcement mechanisms to make that happen are weak and ineffective. Por ejemplo:

    Toothless enforcement

    OOooh. We’ll have a “commissioner” and an “insurance ombudsman”. OMG, an ombudsman. I’m sure the very profitable health industry CEOs are just quaking in their boots at the thought that they might have to face an ombudsman.

    This commissioner might levy fines if an insurance carrier fails to meet premium reduction goals, or if a provider doesn’t accept consumers as it should.  The fiscal note to the bill asserts that revenue from fines will be “minimal”. So  open up and say “Aahh”. It’s really not a very big stick the Colorado Option Authority is carrying.

    The ombudsman might decide to mediate conflicts between carriers and consumers in favor of the consumer – or not.

    In the creation of their standardized bronze, silver, and gold plans, the carriers must make a “good faith effort”to incorporate diverse stakeholder voices. There are no penalties for failing to do this. All a carrier has to do is say, “Well, we tried.”

    Under the proposed amendment, providers won’t be required to accept the standardized private plans as long as “network adequacy” is met — meaning a provider network must be culturally responsive and reflect the diversity of consumers to the “greatest extent possible.” – Colorado Sun

    No reproductive health care mandate

    Oh, and there’s no provision for reproductive health care in these standardized plans. Remember when ColoradoCare was torpedoed by Democrats because it couldn’t offer coverage of birth control and abortion (because of Colorado’s previous adoption of the Hyde amendment).  Remember the outrage, the scolding, the grandstanding and backstabbing that went on? Where’s all the finger-pointing and outrage now?

    Guess what? Reproductive care is not guaranteed to be in these “standardized plans”. There is no language about reproductive health care in the bill. Obamacare used to mandate contraceptive coverage. SCOTUS disagreed. 

    Catholic hospitals, which are the majority of hospitals in the Denver Metro area, generally don’t offer contraception, abortion, sterilization, or any women’s health care services besides childbirth and disease care. Medically-assisted dying – also not on the Catholic hospital menu.  So if you have ovarian cancer, you can get care. But if you need an IUD or to get your tubes tied, forget it, at any hospital with “Saint” in the name, or “Centura”. Public health entities like Denver Health, teaching hospitals like CU, and nonprofits like Kaiser still offer these services.  HB21-1232 doesn’t do squat for women to access these services.Nor is there any option for “truth in advertising” on the Colorado Health Exchange. Women won’t know that the services aren’t offered – until they need them.

    Better than nothing? Or, wait for Obamacare Redux for Real Relief

    OK, the ‘standardized plans” are a consumer-friendly alternative to relying on the good graces of your employer’s HR Benefits coordinator’s explanation of benefits.. The format of the Health Exchange will allow for side-by-side comparisons of plans. If the carrier notifies its consumers of the existence of a less expensive standardized plan.  This bill relies completely on the good faith of industry professionals. History shows us that “good faith” is empty promises, multimillion dollar propaganda pushes, highest profits in the country, and business as usual.

    This bill relies completely on the Affordable Care Act and the Colorado Health Exchange. It also hopes for a public option bill to be implemented at the Federal level, and would phase out if that happens.

    The health industry is willing to become neutral and stop bombarding consumers with a million dollar propaganda push against the bill. Well, why not? They got everything they wanted. And are laughing all the way to the bank. We, Colorado health consumers, got punked.  Again.

     

    • MattC says:

      Kaiser owns no hospitals in Colorado. So access to the kind of hospital services you mention is no more available with a Kaiser insurance plan than with any other insurance.

       

      • kwtree says:

        Matt, it's true that Kaiser doesn't "own any hospitals" in CO. However, it has many affiliated hospitals. Unfortunately, as you say, most of them are Centura or "Saint ______" that don't cover contraception, abortion, medical aid in dying services. A few might choose to, but, per Trump and SCOTUS, hospitals can accept Obamacare payments, but don't have to offer treatments against their religious objections anymore.

        However, Kaiser doctors can prescribe medical abortions (mifopresterone), and contraceptives within the Kaiser clinic structure. They certainly used to cover D&C abortions – a family member got one when my Kaiser insurance covered her…but the actual procedure was at a Planned Parenthood clinic.  So Kaiser probably still refers out for these services, to the few clinics or hospitals in Colorado that still offer them. 

  3. davebarnes says:

    Why should I care?

    Medicare, baby.

  4. Peromyscus says:

    No contraceptive coverage???   Jesus H. Christ.  I was OK with this change until I read this. 

    Just went to NextDoor, looking for a thread from a few weeks back where a pediatrician was moaning about how bad the bill was.  I thought I could restart the discussion based on this new version, to see if the 50/50 split among my neighbors (Jeffco) had changed.  But the thread has been deleted.  I suspect the pediatrician who started it was just following orders, getting folks riled up.  Job completed I reckon.  

    • kwtree says:

      Peromyscus, yes, the job is completed. The Colorado health industry lobbyists have successfully backed our legislators down from a very promising attempt to hold costs down.

      What we have instead is a mealy-mouthed, "bring costs down if you can over three years", but if you don't, you have to see an ombudsman and perhaps pay a fine.  No teeth, in other words.

      And no, there isn't any language in this bill stating that insurors' standardized plans should mandate contraceptive coverage, as the original ACA did. Providers can cite their religious objections and still get paid. And, SURPRISE! Democrats were completely OK with this. 

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