Health Care Report: Bills of Health

 Even before Gov. Jared Polis was sworn into office on Jan. 8, his agenda to improve the health-care industry in Colorado had begun to move forward with the introduction of two bills on the first day of the 2019 legislative session. 

A Senate bill would create a public option health insurance plan starting this fall that Coloradans who live in the highest-cost areas could buy instead of their current insurance. A House bill would expand the program to the entire state by fall 2020.

Polis’ health care plan was central to his campaign for the governor’s office. The plan includes reforms to reduce the costs of prescription drugs, lower premiums in rural and mountain communities, end the provider shortage, expand access to mental health care, strengthen consumer protections and reform wasteful payment procedures. 

“It’s clear that his focus is making health care better for Coloradans,” says Michele Lueck, president and CEO of Colorado Health Institute, a nonprofit research organization that works to inform policy and support better access to care for all Coloradans. “We are optimistic, but a little cautiously so, about doing all of this in the first 100 days.”

Polis has outlined a plan for his first 100 days in office that calls for a statewide geographic rating and reconfiguration of rating zones with protections for rural residents who have less access to doctors and higher insurance costs.

But Lueck says that while the idea of reconfiguring the rating zones is popular, it would mask the issue rather than address the problem.

“You’re just taking a larger population and sharing the burden of high costs rather than delving into why costs are so high in that area,” she says. “It’s not politically palatable to the people on the I-25 corridor who are subsidizing the prices for people who live in ski resort communities. It’s attractive because it brings short-term and immediate relief to consumers who are hard hit, but as a long-term solution, it’s disguising the problems more than fixing them.”

The high cost of insurance also negatively impacts providers — especially in mountain communities — who don’t want to turn away patients who need care, says Dr. Christine Ebert-Santos, a Summit County pediatrician who expanded into caring for adults about five years ago to give her practice more financial stability. 

“The question is, how are they going to get insurance companies to even out the prices around the state?” she says. “I’m very on-board with a universal health care program where everyone would pay a tax.”

While Polis’ plan addresses pharmaceutical and insurance costs, those elements of the health care system are primarily dealt with at the federal level, Lueck says. A better bet in trying to improve health care in Colorado is to focus on the things that can be addressed at the state level, such as hospital pricing and the Division of Insurance’s consumer protection role.

“There is more opportunity around hospital pricing,” Lueck says. “There will be scrutiny applied in hospitals, urgent cares and EDs (emergency departments). The state can actually do something about pricing, where the leverage is more indirect on pharma and insurance companies.”

Polis’ plan to strengthen the Division of Insurance consumer watchdog role is achievable, Lueck says. Polis plans to ensure, partly through a state audit, that the agency has every tool at its disposal to address insurers’ proposed rate hikes, curb abuses of power in insurer-provider negotiations and protect the benefits patients have earned. Polis has pledged to provide the division with real investigative and enforcement power to allow it to address insurers’ bad practices up front, as opposed to after a patient has been harmed.

That, Lueck says, would go a long way toward ensuring that another of Polis’ visions is realized: expanding access to mental health treatment. Lueck says there already are laws on the books that require insurers to provide mental health benefits as part of their coverage. But there is some question as to whether the Division of Insurance is enforcing them.

Kaiser Permanente spokeswoman Amy Whited says the health care provider believes that all Coloradans should have access to high-quality and affordable services. The company supported the expansion of coverage through the Affordable Care Act, and Whited says the state has made significant progress in reducing the number of uninsured, eliminating pre-existing conditions as a barrier to coverage and establishing a state-based marketplace for health insurance options. 

“However, Kaiser Permanente is increasingly concerned about the rapidly rising costs of health care in our state and the burden this is placing on consumers,” Whited says. “Health coverage premiums are derived from the actual costs of delivering health care services. Until we address the true drivers of health care costs, including the skyrocketing costs of hospital care in Colorado, we will continue to see rising premiums and health care that is out of reach for too many.”