So You Want to Expand Coverage?
The Colorado Experience
Kelly ShanahanPolicy DirectorColorado Consumer Health Initiative
Health Action 2008January 25, 2008Washington DC
2007 MEMBERS & PARTNERS
MEMBERS: 9 to 5 National Association of
Working Women AARP Colorado Allied Jewish Apartments Alzheimer’s Association, Rocky
Mountain Chapter American Cancer Society, Great West
Division American Diabetes Association American Heart Association American Lung Association of
Colorado Arc of Arapahoe and Douglas County Arc of Aurora Arc of Denver Autism Society of Colorado Bell Policy Center Center for African American Health Center for Systems Integration Colorado Organization for Latina
Opportunity & Reproductive Rights (COLOR)
Colorado AIDS Project Colorado Center on Law and Policy Colorado Children’s Campaign Colorado Citizen’s for Accountability Colorado Coalition for the Homeless Colorado Coalition for the Medically
Undeserved (CCMU) Colorado Developmental Disabilities
Council Colorado Health Charities Colorado Progressive Coalition Colorado Rural Health Center Colorado Women’s Agenda
Colorado Women’s Health Care Coalition Colorado Women’s Lobby Community Health Charities of
Colorado Congregation Emmanuel Denver Urban Ministries (DenUM) Empower Colorado Family Voices Colorado The GLBT Community Center of Colo-
rado Health Care for All Colorado Hep C Connection Hunger for Justice Interfaith Hospitality Network of
Greater Denver Kid Connects The Legal Center for People with
Disabilities and Older People Lupus Foundation of Colorado Lutheran Advocacy Ministry Mental Health Association of Colorado Metro CareRing National Alliance on Mental Illness National Association of Social Workers,
Colorado Chapter National MS Society Parent to Parent of Colorado Pikes Peak Partnership Project SOL-Survivor Outreach to
Latinas with Breast Cancer (UCHSC) Rocky Mountain Farmers Union Rocky Mountain Residences Rocky Mountain Stroke Association Service Employees International Union Women’s Resource Center of Durango
PARTNERS:
American Academy of Pediatrics Boulder County Head Start Brookside Assisted Living CCB Partners Christian Healing Coalition Clínica Campesina Colorado Access Colorado Association of Alcohol and Drug Service
Providers Colorado Association of School-Based Health Centers Colorado Behavioral Health Council Colorado Community Health Network Colorado Dietetic Association Colorado Gerentological Society Colorado Gynecological & Obstetrical Society Colorado Health Department, CO Springs Colorado Nurses Association Colorado Organizations Responding to AIDS (CORA) Community Health Partnership Community Voices, Denver Health Covering Kids and Families Denver Department of Human Services Denver Health Denver Healthy People 2010 Denver Hospice Doctors Care El Paso County Department. of Public Health & Envi-
ronment Grupo SALUD Health District of Northern Larimer County High Plains Community Health Center Hospice of St. John Inner City Health Center JFK Partners Latino American Health Network Metro Community Provider Network National Jewish Medical & Research Center Peak Vista Community Health Center Pikes Peak Behavioral Health Group Penrose St. Francis Pikes Peak Mental Health Pueblo Community Health Center Foundation San Louis Valley Regional Medical Center SEIU Nurse Alliance of Colorado Switzer Counseling Center
Welcome to Colorful Colorado!
Employer-Sponsored
54%Public
Programs26%
Private Individual
5%
Uninsured15%
(57% CO)
(17% CO)
(7% CO)
(17% CO = 785,000) (155,000 are kids)
Coverage Nationally vs. Colorado
Fiscal Environment - TABOR
The Taxpayer's Bill of RightsColorado Constitution Article 10, Section 20
Basic Provisions• Voter approval for tax increases• Revenue limits• Government spending limit
– (inflation plus population)• Revenue refunds
Good times, bad times & economic recovery
The Ratchet Effect
Source: “TABOR: Ten Years Later”, (Powerpoint presentation), Carol Hedges, The Bell Policy Center. (www.thebell.org/PUBS/PPT/2003/10TABOR10-2.pdf)
Source: “TABOR: Ten Years Later”, (Powerpoint presentation), Carol Hedges, The Bell Policy Center. (www.thebell.org/PUBS/PPT/2003/10TABOR10-2.pdf)
Colorado Health Benchmarks
Expenditures per capita
Rank State spending required to reach US average
Total State Spending 44 $3.31 B
Medicaid 47 $993 M
SCHIP 32 $13.1 M
Source: Aiming for the Middle: Benchmarks for Colorado’s Future, Colorado Center on Law & Policy (June 20, 2007).
Public Program Eligibility
Colorado Blue Ribbon Commission for Healthcare Reform
• What? Senate Bill 06-208 (also known as ‘208 Commission’)
• Why? To come up with recommendations to the Colorado legislature by January 2008 for comprehensive healthcare reform in our state!
• Who? 27 members appointed by Governor and legislative leadership (consumers, business/industry, health experts)
• Goal: Increase access to affordable coverage for all Coloradans
2007• February: Formal solicitation for proposals• April: 31 reform proposals received• May: 4 proposals selected for analysis• Summer:
– 4 proposals modeled for cost and coverage– Commission developed its own 5th proposal
• Fall: – Public hearings around the state– 5th proposal modeled
• November-December: Recommendations to the Legislature developed
2008• January 31st: Report due to the Legislature
Colorado Blue Ribbon Commission for Healthcare Reform
• Formed the CCHI 208 Work Group– Weekly meetings late January – April 2007– Every week we tackled a different question– Ad hoc groups on specific issues
• Technical Team– Families USA (Washington DC)– Community Catalyst (Boston)
CCHI’ Proposal: Connecting Care & Health for Colorado
Step 1: Do we work with the existing public-private system we have OR do we wipe the slate clean and start all over?
A: Existing system(However, we don’t want to ‘tinker’, we want
major reform!)
Step 2: Public programs...??
Step 3: Private insurance…??risk rating vs. risk poolingcost-shiftunderinsurance
CCHI’ Proposal: Connecting Care & Health for Colorado
Online Tool Demonstration
Four Proposals Chosen & Modeled
No MandatesNo MandatesIndividual I ndividual MandateMandate
Individual & I ndividual & Employer Employer MandateMandate
Single Single PayerPayer
1 2 3 4
• Limited core benefit
• Subsidies ≤ 300% FPL• Age & Health Rating
Remaining uninsured = 10%
• Limited core benefit
• Subsidies ≤ 250% FPL• Community Rating w/i
exchange
Remaining uninsured = 3%
• Comprehensive benefits
• Subsidies ≤ 400% FPL• Community Rating
Remaininguninsured = 2%
• Comprehensive benefits
• No Rating
Remaininguninsured = 0
No MandatesNo MandatesIndividual I ndividual MandateMandate
Individual & I ndividual & Employer Employer MandateMandate
Single Single PayerPayer
1 2 3 4
• Limited core benefit
• Subsidies ≤ 300% FPL• Age & Health Rating
Remaining uninsured = 10%
• Limited core benefit
• Subsidies ≤ 250% FPL• Community Rating w/i
exchange
Remaining uninsured = 3%
• Comprehensive benefits
• Subsidies ≤ 400% FPL• Community Rating
Remaininguninsured = 2%
• Comprehensive benefits
• No Rating
Remaininguninsured = 0
No MandatesNo MandatesIndividual I ndividual MandateMandate
Individual & I ndividual & Employer Employer MandateMandate
Single Single PayerPayer
1 2 3 4
• Limited core benefit
• Subsidies ≤ 300% FPL• Age & Health Rating
Remaining uninsured = 10%
• Limited core benefit
• Subsidies ≤ 250% FPL• Community Rating w/i
exchange
Remaining uninsured = 3%
• Comprehensive benefits
• Subsidies ≤ 400% FPL• Community Rating
Remaininguninsured = 2%
• Comprehensive benefits
• No Rating
Remaininguninsured = 0
Final Recommendations to Legislature
Connector
Improving Value in Health Care Authority
High Risk Pool: Cover
Colorado
Chronic Condition
Subsidized
Individual Mandate
Individual market = guaranteed issue, modified community rating
Small group market = no change
3 Plans (not comprehensive)
Above 400% FPLOn your own
205-400% FPLSliding scale subsidy
(depending on if have offer of ESI)
Streamlined Medicaid / CHP+0-205% FPL
Medically Needy / Catastrophic
Fund
300-500% FPL
Medicaid Buy-In
Medically Correctable Program
Consumer Advocacy Program
Connector
Improving Value in Health Care Authority
High Risk Pool: Cover
Colorado
Chronic Condition
Subsidized
Individual Mandate
Individual market = guaranteed issue, modified community rating
Small group market = no change
3 Plans (not comprehensive)
Above 400% FPLOn your own
205-400% FPLSliding scale subsidy
(depending on if have offer of ESI)
Streamlined Medicaid / CHP+0-205% FPL
Medically Needy / Catastrophic
Fund
300-500% FPL
Medicaid Buy-In
Medically Correctable Program
Consumer Advocacy Program
Lessons Learned for CCHI
Great opportunity for consumer groups to • Dream big!• Think systemically• Build consensus
Helped us to develop…• Consumer Bill of Rights & Responsibilities• Guiding Principles for State Health Reform
Moving forward, gives us direction • legislatively • in our coalition-building efforts
Thank You Families USA and
Community Catalyst!
Colorado Consumer Health Initiative
Kelly Shanahan
(303) 839-1261
www.cohealthinitiative.org