Colorado lawmakers look for long-term cost solutions as ACA sign-up deadline looms

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December 12, 2018, 11:52 am

With just a handful of days left to sign up for first-of-the-year health-insurance coverage on the individual market, Colorado is actually trending ahead of the nation in terms of signing people up for plans under the Affordable Care Act, or Obamacare.

Nationally, the first four weeks of the open enrollment period that kicked off Nov. 1 saw 2.4 million people signup this year compared to 2.8 million in 2017. Colorado’s state exchange, called Connect For HealthColorado, reports 46,332 signed up inthe first month this year compared to 43,881 last year, or anincrease of 5.2 percent.

In Colorado, open enrollment runs through Jan. 15 for plans that begin Feb. 1 and Dec. 15 for plans that start Jan. 1. State officials are encouraging people to go to the website and see what they qualify for in terms of both coverage and ACA premiumtax credits.

“We have a statewide network of 1,000 brokers and assisters who can help with these important decisions,” Connect for Health Colorado CEO Kevin Patterson said. “I urge anyone in Colorado who buys their own health insurance to go now to Connect For Health Colorado to see what financial help they can get. Many are pleasantly surprised with what they find.”

While Democratic House Leader Nancy Pelosi has prioritized health care after her party on Nov. 6 reclaimed the House for the first time in eight years, it seems highly unlikely the Senate, which remains under GOP control, will play ball – especially after Senate Majority Leader Mitch McConnell expressed support for a lawsuit on preexisting conditions.

Even Colorado’s Senate delegation is split on how best to fix nation’s failing health care and insurance system.

“I’ve supported efforts to reform our healthcare system because costs continue to goup on Coloradans,” Republican Sen. Cory Gardner told Colorado Politics via a spokeswoman. “We can do better than what we have now, and Republicans and Democrats should be able to work together on new ideas that drive down costs.”

Gardner this session introduced legislation to yet again delay the Health Insurance Tax (HIT), which essentially acts as a sales tax on Obamacare plans to pay the cost of administering the law. Currently suspended for 2019, it’s estimated the tax will collect $16 billion that opponents of the tax say will be passed on to consumers if it’s reinstated in 2020.

Gardner recently signed onto a letter to Senate leadership asking them to pass a HIT delay in what remains of the lame-duck session.

“This is simply a tax that is being passed on to consumers who are purchasing coverage in the individual market, and why we’ve been concerned about it is because small businesses bear the overwhelming majority of the cost of the tax,” said Stop the Hit spokeswoman Clare Krusing, whose organization represents a national coalition of small businesses.

Another suspension of the HIT would save consumers about $420 a year in Colorado, Krusing said.

“When you have a tax like the Health Insurance Tax that does exponentially increase by billions and billions each year, it really is the most backwards policy when you’re trying to make coverage affordable for the people who need it most,” Krusing added.

Gardner also has introduced legislation to make it easier for rural hospitals to recruit and hire physicians, and he’s working on telehealth policies to give people in rural areas better access to healthcare professionals. 

“Politics can’t get in the way of attempts to fix Colorado’s rising healthcare costs in both rural and urban communities across the state, and I’m confident proposals I’ve introduced to delay the Health Insurance Tax and to make it easier for rural hospitals to hire physicians will pick up support as it’s clear we needto take steps to fix the broken system,” Gardner said.

Colorado Democratic Sen. Michael Bennet, a member of the Senate Committee on Health, Education, Labor and Pensions (HELP), last year introduced Medicare-X with Virginia Sen. Tim Kaine – a public option aimed at offering more choice and competition. Initially it’s only aimed at areas where there are a shortage of insurers or higher costs due to a lack of competition, but eventually the plan would be offered in every zip code in the nation.

“We must take meaningful action to rein in health care costs,” Bennet told Colorado Politics via a spokeswoman“I’m hopeful we can make progress to reduce costs and increase competition in the marketplace — and one of the most effective ways to do this is with Medicare-X.”

And Bennet and Republican Louisiana Sen. Bill Cassidy are working on bipartisan legislation to protect patients from surprise medical bills – a major issue recently in Colorado.

“Increasing transparency is one of the most important steps we must take to improve our health care system,” Bennet said. “Patients deserve to know how much they are paying for health care services and procedures at the point of care. I’ll keep working with my colleagues to find bipartisan solutions like this to lower costs and improve patient care.”

Former President Barack Obama on Monday took to Twitter to urge people around the country to sign up for Obamacare by Saturday, Dec. 15: “No jump shots. No ferns. No memes. Not this time. I’m going to give it to you straight: If you need health insurance for 2019, the deadline to get covered is December 15. Go to http://HealthCare.gov  today and pass this on — you just might save a life.”

Colorado, of course, has its own exchange, with a Jan. 15 deadline for Feb. 1 coverage.

But in Colorado’s high country, the cost of individual and small-group health insurance remains prohibitively high, even with the federal government essentially stripping out the federal health-insurance mandate in the 2017 tax reform bill. Since the ACA kicked in fully in 2014, self-employed individuals and small businesses in Colorado have seen rampant increases.

For that reason, the valley-wide chamber of commerce known as the Vail Valley Partnership recently launched its One Valley Healthcare program – a medical cost-sharing alternative to health insurance that can save chamber members up to 60 percent versus traditional insurance.

As for actual health insurance, there are only two ACA options in Eagle County — Anthem and Kaiser. Before tax credits, a bronze Kaiser plan for a family of five costs around $2,200, while Anthem runs more than $2,900 – and those plans come with deductibles in excess of $6,500. A similar bronze plan on the Front Range, where there are far more options, costs around $1,600 a month before tax credits (if you qualify).

Across much of the state’s rural Western Slope there are typically only one or two ACA options, and plans for a family of five can run north of $2,000 a month. In mountain-resort counties, where everything from groceries to gas to housing costs significantly more than the state’s Front Range, it can actually be difficult to live on the family-of-five income cap of $117,680 ($48,560 for individuals) to qualify for ACA tax credits.

Connect For Health Colorado has been touting mere single-digit increases for 2019, but some observers aren’t impressed.

“Some Anthem people here actually got rate decreases, but it’s already ridiculously high,” insurance broker Bethe Wright of The Wright Insurance Company in Eagle recently told Colorado Politics. “[Obamacare] was unaffordable in 2017; it went up 30 percent in 2018; and it was unaffordable in 2018. Even if it only went up 2 percent in 2019, it was still unaffordable two years ago.”

Republican attempts to repeal and replace the ACA failed repeatedly in 2017, and critics say the GOP has since worked to undermine the law. Now Democrats, buoyed bythe 2018 midterm election results, have promised to stabilize Obamacare and expand Medicaid.

While Republicans couldn’t do away with Obamacare in 2017, they did manage to strip out its individual mandate tax penalties in their tax reform package. For that reason, a Texas-led federal lawsuit backed by 20 elected GOP officials around the country is seeking to have Obamacare and its protections for preexisting conditions deemed unconstitutional. The White House and Justice Department are not standing in the way of those efforts.

With those development as a backdrop, Wright this year stopped signing people up for Obamacare plans and is instead selling US Health Group plans underwritten by Freedom Life. The plans are considerably cheaper than Obamacare plans – with no danger of tax penalties in 2019 — but are not ACA-compliant and can deny applicants for preexisting conditions.

One of her client’s recently obtained a US Health plan for four family members for $1,350 a month but one child was denied for a moderate case of scoliosis (no surgery, braces or other treatments) – requiring a separate, catastrophic Obamacare plan from Kaiser for $250 a month. Wright says a family like that pulling out of Obamacare will lead to more ACA rate increases.

“It’s all a snowball effect,” Wright said. “Health insurance is cyclical, so in a couple years we’re going to see the impact of healthy people getting out of the Obamacare pool because they can qualify on non-compliant plans and not have to worry about the tax penalties.”

Democrats have railed against Republican efforts to undercut the ACA – without offering an alternative — just when it was starting to gain traction in most of the country.

“Many Americans are still unaware of the open enrollment period because of Trump’s sabotage,” Democratic National Committee Chairman Tom Perez said in an email blast. “Democrats believe health care is a right for all, not a privilege for the wealthy few. That is why we’re encouraging Americans everywhere to sign up for health care coverage. Coverage may be more affordable than you think.”

But not on Colorado’s Western Slope, where Democratic state lawmakers vow to tackle the problem in the upcoming legislative session in January.

Newly elected Democratic state Rep. Dylan Roberts of Eagle – having just knocked on hundreds of doors during campaign season — is keenly aware of the pressing problem of rapidly rising health care and insurance costs in his house district,which also includes Routt County.

“Something has to happen or else the stratification of Eagle County’s socioeconomics is going to become even more stark really fast, because we’re losing those people in the middle who want to live here and want to start families here and want to be part of a productive middle class, but they can’t make it work because of health insurance costs,” Roberts said.

Roberts last legislative session ran a study bill that would have funded a hard look at the possibility of setting up a public option, allowing people to buy into a state plan at competitive rates and hopefully then drive down the prices of the private insurance companies. He’s also focused on forcing increased transparency for prescription drug and medical procedure pricing.

“Transparency is a place to start so that people can start having choices and answers as to why the prices are going up, and it might actually help insurance companies with controlling their costs, but if we’re ever going to actually reduce monthly premiums for people, it’s got to start with having more choices in the insurance market,” Roberts said.

Roberts’ efforts on both the transparency and public-option front passed out of the Democrat-controlled House but died in the Republican-controlled Senate last session. Now Dems have control over both chambers.

Adam Fox, director of strategic engagement for the Colorado Consumer Health Initiative, said reinsurance is another idea worth revisiting this legislative session. A bill was introduced late last session was killed in the Republican-controlled Senate.

“We’ve seen reinsurance work pretty well in other states like Alaska to keep premium increases down and in some cases lead to premium decreases,” Fox said. “It’s one of the more immediate ways to provide premium affordability relief in the high cost areas of the state.

“Would it bring premiums to an ‘affordable’ level for everyone? No, we need to start getting atthe underlying costs of health care and create competition in the insurance market to do that. I think it’s likely we’ll see another run at reinsurance this legislative session, and if it’s passed relatively early in the session, it could affect premium filings for the 2020 plan year that get submitted in May.”

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David O. Williams
David O. Williams is an award-winning freelance reporter based in the Vail Valley of Colorado, writing on health care, immigration, politics, the environment, energy, public lands, outdoor recreation and sports. His work has appeared in 5280 Magazine, American Way Magazine (American Airlines), the Anchorage Daily News (Alaska), Aspen Daily News, the Aspen Times, Beaver Creek Magazine, the Chicago Tribune, the Colorado Independent, Colorado Politics formerly the Colorado Statesman), Colorado Public News, the Colorado Springs Gazette, the Colorado Independent (formerly Colorado Confidential), the Colorado Springs Independent, the Colorado Statesman (now Colorado Politics), the Daily Trail (Vail), the Denver Daily News, the Denver Post, the Durango Herald, the Eagle Valley Enterprise, the Eastside Journal (Bellevue, Washington), ESPN.com, the Glenwood Springs Post-Independent, the Greeley Tribune, the Huffington Post, the King County Journal (Seattle, Washington), KUNC.org (northern Colorado), LA Weekly, the London Daily Mirror, the Montgomery Journal (Maryland), The New York Times, the Parent’s Handbook, Peaks Magazine (now Epic Life), People Magazine, Powder Magazine, the Pueblo Chieftain, PT Magazine, Rocky Mountain Golf Magazine, the Rocky Mountain News, Atlantic Media's RouteFifty.com (formerly Government Executive State and Local), SKI Magazine, Ski Area Management, SKIING Magazine, the Summit Daily News, United Hemispheres (United Airlines), Vail/Beaver Creek Magazine, Vail en Español, Vail Valley Magazine, the Vail Daily, the Vail Trail and Westword (Denver). Williams is also the founder, publisher and editor of RealVail.com and RockyMountainPost.com.
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