By Diane Carman
As the U.S. Congress resumes debate over the Patient Protection and Affordable Care Act this week, young adults in Colorado will continue to be eligible for coverage under their parents’ insurance plans, patients will still not be faced with lifetime limits on insurance coverage, children will not be refused coverage due to pre-existing conditions and state officials will continue to implement those and numerous other features of health care reform.
“It’s federal law and we as states are required to comply,” said Lorez Meinhold, senior health care policy advisor to Gov. John Hickenlooper. “We need to move forward.”
A vote on the measure, entitled the Repealing the Job-Killing Health Care Law Act or H.R. 2, is scheduled for Wednesday in the House.
While the failure of the repeal measure is all but certain given the Democratic majority in the U.S. Senate and President Obama’s vow to veto any version that might advance to his desk, the debate provides yet another forum for evaluating the Affordable Care Act that was signed into law on March 23, 2010.
Among the considerations is the impact on the federal budget, which is “roughly” estimated by the Congressional Budget Office to increase the deficit by $145 billion between 2012 and 2019. But there are others.
In Colorado, an estimated 18,000 adults under the age of 26 who are eligible for health coverage on their parents’ insurance policies would lose that opportunity, if the act were to be repealed.
“Among the highest rates of uninsured persons tend to occur among young adults,” said Meinhold. “They also tend to be a healthier population, so bringing young adults in adds stability to our markets.”
The state also would lose out on significant federal funds available through various implementation grants as well as matching funds for the Hospital Provider Fee program designed to help hospitals cover the costs of providing care to the uninsured.
One popular grant program provides student-loan relief to doctors who agree to practice in underserved rural areas in the state. The program, which provides $35,000 to $50,000 to doctors to help defer student loans, would end.
The soon-to-be-implemented health insurance exchange program to subsidize care for the uninsured would be eliminated. Meinhold said the exchanges are expected to provide coverage for about 300,000 uninsured Coloradans.
Funds for state pilot programs to encourage cost containment would be eliminated, as would funding for the investigation and prosecution of fraud and abuse by health care providers.
Insurer accountability provisions, such as those outlawing lifetime limits on coverage, rescissions of coverage when a policyholder gets sick, and the 2014 provision that would prohibit insurers from denying coverage for persons with pre-existing conditions, would be eliminated as would the consumer accountability provision known as the “individual mandate.”
The logic behind the individual mandate is, “If you’re going to tell the insurance companies that they have to take patients at any time, then it’s the responsibility of the patients as consumers to engage in the system,” said Meinhold. “If you’re just coming in when you’re sick and then leaving the system, we’re not building a sustainable market.”
Opponents of the Affordable Care Act propose replacing the act with a series of programs to encourage the private health insurance market to expand access and reduce costs. Among them are rule changes to allow individuals and businesses to buy health insurance across state lines; provisions to allow individuals, businesses and trade associations to create pools to negotiate lower-priced insurance coverage; incentives for states to create their own programs to reduce health care costs; and restrictions on medical malpractice lawsuits.
An analysis of the Affordable Care Act by staff members for Colorado’s bipartisan Blue Ribbon Commission on Healthcare Reform found that several of the recommendations of the state commission closely coincided with the federal law.
The side-by-side comparison, produced last October for The Colorado Trust, cited the commission’s recommendations to assure access to health care for persons with pre-existing conditions, require an individual mandate, create health insurance exchange mechanisms, provide incentives to providers for improved patient outcomes, establish medical homes and others, saying they are remarkably similar to those included in the Affordable Care Act.
The greatest diversion between the two documents came in areas where the commission called for stronger measures to expand access and reduce costs.
“We’re by no means calling this (the Affordable Care Act) perfect,” said Meinhold, “but if you look at this comparison, the Colorado commission clearly thought this is the path we should go down.”
Meinhold said she and her colleagues in the Governor’sOoffice have conducted hearings, public meetings and listening sessions across the state, to discuss health care reform concerns. She said they’ve reached 10,000 people in person and untold numbers via the website.
“There was frustration and sometimes anger either that health care reform didn’t go far enough or that it went too far,” said Meinhold. “There’s still a lot of misunderstanding. But having a dialogue is really important.”
Debate of H.R. 2 is scheduled for Tuesday with a vote anticipated on Wednesday.