Health Policy Solutions

By Debra Judy

The Colorado Consumer Health Initiative is celebrating the end of the Colorado legislature because the takeaway is “Colorado health care consumers win big this session!”

For all of us, getting the care we need, when we need it isn’t too much to ask. So we were delighted that Colorado’s legislators and Gov. John Hickenlooper really took this idea to heart this year as they helped move toward barrier-free access to quality and affordable health care for all Coloradans. 

Sponsored by Rep. Beth McCann and Sen. Irene Aguilar, the bill to modernize stop-loss health insurance is an important step toward stabilizing and protecting the small group insurance market.  This bill raises the attachment point for businesses purchasing stop-loss insurance and will ensure that small businesses are not inappropriately self-insuring, thereby protecting the small group market from employers who jump into the market only when they have unhealthy employees. In addition, the Division of Insurance will collect data about stop-loss policies in Colorado so that we can better understand the impacts on the market.

One of the biggest health care issues the Colorado General Assembly faced this year was the creation of the New Medicaid program. On election night, Speaker of the House Mark Ferrandino said he hoped Colorado would honor Obamacare’s provision to expand Medicaid eligibility to individuals making about $15,000 a year or $30,000 a year for a family of four. After Gov. Hickenlooper announced his support for the expansion in January, the bill passed at the end of April. Adult dental care was also added to Colorado’s Medicaid program. Thanks to these bills, thousands of Coloradans will have better access to the health care they need.

Colorado took another huge step forward in implementing Obamacare with the passage of the Health Insurance Alignment Federal Law. While Colorado is one of the leader states in implementing health care reform, many of Obamacare’s consumer protections were not in Colorado law. With the passage of this bill, in 2014, Colorado will ban discrimination based on pre-existing conditions and allow young adults to stay on their parents’ plans up to age 26, among many other popular benefits.

Moreover, Colorado is well on its way to establishing its new health care marketplace, Connect for Health Colorado. The General Assembly passed a funding bill to ensure Connect for Health Colorado is financially sustainable in 2015 and beyond. Open enrollment begins Oct. 1, when thousands of Coloradans will be able to easily compare health plans – and use tax credits to help afford their insurance premiums. Now it’s time to get Coloradans enrolled in Connect for Health Colorado!

These great accomplishments are just a few of the health care related bills that passed this year, thanks to our legislative allies and the thousands of health care advocates across the state. Colorado is moving full steam ahead in implementing Obamacare to help thousands Coloradans gain health care coverage. This session has shown that our voices matter when it comes to decisions about health care – cheers to a great 2013 session.

Debra Judy is the policy director at the Colorado Consumer Health Initiative.

By Katie Kerwin McCrimmon

Coloradans hunting for health insurance will have 19 companies competing for their business with up to 1,000 different plans that could be offered through the state’s new health exchange and on the open market.

Starting in 2014, for the first time, insurance companies selling to individuals won’t be able to exclude people with pre-existing health conditions. That’s one of the reasons consumers and competitors are eagerly awaiting plan details and costs, which Colorado authorities plan to unveil Wednesday.

For now, Colorados Commissioner of Insurance Jim Riesberg says he’s pleasantly surprised that 19 health insurance companies want to vie for business here.

“It’s a rather significant number, which should mean we’re going to have good competition in Colorado,” Riesberg said on Thursday.

Commissioner of Insurance Jim Riesberg said he’s pleasantly surprised that 19 companies want to offer about 1,000 new health insurance plans in Colorado.

Riesberg said he had expected about a dozen companies to offer plans in Colorado.

The deadline for health insurance companies to notify regulators that they wanted to sell plans in Colorado was midnight Wednesday. Riesberg and a beefed-up staff of rate reviewers are now analyzing the proposals and plan to make the proposals public on May 22. He declined to name the companies until next week.

The plans won’t be approved or rejected until July 31. Then, potential customers will be able to start shopping for them on October 1 when Colorado’s new health exchange, an online marketplace called Connect for Health Colorado, is slated to open.

Riesberg did not yet have a sense of whether there will be “rate shock” over the prices for the new plans. He urged caution about reading too much into the numbers when they become public next week.

In part that’s because the plans feature a “base rate.” Many lower-income people will qualify for tax subsidies that will bring their rates down from that base price. Other customers may have to pay more than the base rate since insurance companies are allowed to charge higher rates to smokers, older people, those living in certain geographic areas and based on family size.

“The base rates are not what the ending prices are going to be,” Riesberg said.

Consumers will also be able to select from plans that offer varying levels of coverage for a package of “essential benefits” that all companies must provide.

“There may be rate shock or may not be rate shock,” Riesberg said. Regardless, “the essential health benefits (package) is a fairly rich package. It’s a very good policy. You get what you pay for.

“Putting too much emphasis on prices early on is going to muddle the decision-making. People can’t even begin to purchase plans until October. And they can’t find out what their subsidies are going to be until then,” Riesberg said.

Analysts with the Division of Insurance will review all the proposed plans to ensure that the prices are not too high or too low (which could mean that a company cannot fulfill its obligations) and that insurers are not discriminating against anyone.

Pricing will be a gamble for all the companies.

“We’re in a brand new marketplace,” Riesberg said. “Within the individual market, no one has ever had to do this before (accept all those with pre-existing conditions),” Riesberg said.

It’s unclear how many people will want to buy insurance, and how many will have gone without health care for years and may have pent-up needs.

“They may want every (medical) test under the sun,” Riesberg said. “It’s just a guess as to what the trend is going to be.”

Or, there could be less demand than anticipated if some of the estimated half-million uninsured people expected to buy through the exchange decide not to buy health insurance and pay federal fines instead.

Learning about the new proposed plans and their pricing is one of many puzzle pieces that must fall into place as the Affordable Care Act begins to be full implemented in 2014.

“This is a first step in a process of crafting a whole new marketplace,” Riesberg said. “In the individual marketplace, it’s a whole way of doing business not only for the consumers, but also for the (insurance companies.)”

Riesberg said he previously had concerns that the federal data HUB would not be ready by this fall. States like Colorado that are building their own health exchanges must be able to connect with the HUB in real time to determine if consumers qualify for tax subsidies. Recently, Riesberg said he’s become more confident that all the pieces of the puzzle will fall into place.

“Any time you have something brand new, there could be a hiccup,” he said. “But I think we’re setting the stage for some very exciting times for people to begin to take more personal responsibility for their health care decisions and as a result of that, building a healthier society.”

By Linda Gorman

Spending money makes some people feel better, especially when it is other people’s money. As a case in point, the Colorado legislature has voted to expand Medicaid eligibility.

By Katie Kerwin McCrimmon

Colorado’s health exchange board approved a new federal grant request of $125 million on Friday that will include about $13 million to provide in-person assistance to the uninsured.

Some board members tried but failed to boost the grant request even higher — to between $133 and $135 million — to ensure that Colorado will have enough money to reach out to people who may never have had health insurance and could need extensive help signing up for federal subsidies starting this fall.

Now dubbed Connect for Health Colorado, the new exchange is slated to start signing up customers on Oct. 1.

After a contentious hearing Tuesday with lawmakers on an oversight committee, other board members opposed the $125 million request, saying it was already too costly. (Read more about Tuesday’s meeting: Despite outrage, health exchange wants additional $125 million.)

Steve ErkenBrack, president of Rocky Mountain Health Plans, said that both the high-dollar figure of the grant request and a rushed process that left some Republicans lawmakers angry threatened to undermine a history of bipartisan cooperation on health reform in Colorado.

“I am very troubled by how this has played out,” ErkenBrack said during a Friday morning board meeting.

He praised exchange staff members for working on tight deadlines and said it’s not their fault that the grant application deadline in mid-May coincided with the end of the legislative session. But, ErkenBrack said managers and board members could have done a much better job of briefing and winning support from lawmakers on both sides of the aisle.

That’s why he ultimately voted against the $125 million request and vigorously opposed asking for even more money.

“To come back and say we’re going to increase it even more is extremely problematic,” ErkenBrack said.

Board member Arnold Salazar, who is executive of Colorado Health Partnerships, had pushed exchange managers to ask for more federal cash in case Colorado needs help promoting the exchange and signing up new customers, many of whom don’t have a clue what the health exchange is or how it may help them get insurance.

Salazar said the exchange will only get one chance to launch and needs to do it right.

“If we fail…we’re going to pay in other ways,” Salazar said. “Let’s see if we can get the money in. If it needs to go back to the feds, that’s fine. I don’t want to undercapitalize this venture at a time when I think it’s going to be critical.”

Sue Birch, executive director of Colorado’s Medicaid programs, is a non-voting member of the board. She joined Salazar and board member Nathan Wilkes in their unsuccessful bid to convince fellow board members to spend at least $18-to-$20 million on an assistance network and heed states like California where foundations and exchange managers will be spending hundreds of millions to promote outreach and assistance.

Birch said the exchange’s success hinges on signing people up.

“If we miss on this round, we will forever have tainted our work going forward,” Birch said.

In the end, five board members voted in support of the $125 million grant while two opposed it. Voting in favor were Gretchen Hammer, Richard Betts, Nathan Wilkes, Arnold Salazar and Robert Ruiz-Moss. Opposing the grant request were ErkenBrack and Mike Fallon.

The chair and vice-chair of Colorado’s legislative review committee have already indicated that they will sign off on the grant and staff members are expected to submit it to the federal government by next Wednesday.

By Francis M. Miller

The script for the Colorado Health Benefits Exchange is beginning to read like the storyline of Gilligan’s Island. It all started as a “three-hour tour.”

From the outset the debate has centered on whether Colorado should set up its own exchange or have the feds do it for us. So far, 13 states, including Colorado, have opted to set up state-run exchanges. More than half the states, 26 of them, are refusing to participate and the feds will have to run it out of Washington, D.C. This has pretty much divided along party lines with Republican-led states resisting Obamacare whenever and wherever they can.

Colorado in the past two decades has become  a metropolitian oasis and its politics have been bleached from purple to blue. Once the Republicans lost control of the state, Gov. Bill Ritter’s 208 Commission became a blueprint for a socialist field of dreams. That includes mandates, exchanges and a cooperative.

The focus of attention has been on the exchange’s budget and its logo. That seems par for the course these days, whether it is higher education or health care branding. It is the means to demonstrate a customer orientation. Starting out as a modestly funded organization, the exchange is now chasing $125 million dollars in grants. When they get awarded, they can relax and not feel forced to seek a premium tax on insurance premiums to fund their organization. Their funding, when combined with several hundred million dollars to expand Medicaid and nearly $70 million dollars to launch the health cooperative, represent the lion’s share of economic development that has taken place in Colorado since the 2008 recession. Legislators can now declare victory and go home.

I would have been more comfortable if the Obamacare debate had centered on two other issues. One is how do we bend the cost curve?  No one has been able to show  how this will get done.  I suspect we will crash through the 20 percent of GDP ceiling soon. Keep it up and eventually half the population will be caring for the other half. The only question is which half will be paying taxes.

The other question that has been ignored is — tell me again — how does the exchange create a competitive marketplace?  The current hyper-inflation in health care is not symptomatic of a competitive marketplace. It’s more a team of health provider rivals governed by insurance company oligarchs. Increasingly we treat the health market as an extractives industry.

Let me confront this issue by way of analogy. Let’s say you are unhappy with the level of competition in the auto industry. If you believe prices are too high and quality too low, to whom do you turn? Do you switch from an American manufacturer to a Japanese or Korean car? Or do you set up an exchange and have Ford Credit compete with GMAC Acceptance? None of us would pay $50,000 for a car without cheap financing, just as none of us would pay the outrageous bills for the average hospital stay without tax-favored subsidies from government or our employer. But, is the crucible of the marketplace formed by the financial intermediaries or by the competition between providers? I would argue that insurance is the source of the dead-weight loss in the health care industry.

Is competition furthered by standardizing benefits designs, regulating medical loss ratios and forcing fee schedules down the throats of providers? Or is it created by empowering the consumer?

To many of you, I am arguing distinctions without differences. Most people believe that insurance companies are high profit organizations and that we can squeeze their lemon to lower costs. Forget that it is the intensity of care, excessive administrative overhead and myriad other reasons that explain high health care costs. Why do you think the 12 leading socialized democracies in Europe expend half the money we spend and get superior outcomes? Wouldn’t you think a competitive market-based system would spend even less, not more? In an ideal world we would spend half what they spend, not twice as much.

In the end, the exchange can justify its existence by serving other purposes. The CBMS has been so broken and dysfunctional that the exchange can play a major role in getting people enrolled in Medicaid. It will also shepherd the 800,000 uninsured in Colorado. Even if they manage to enroll 150,000 of them, the subsidies will be a steroidal injection into Colorado’s economy.

So, all in all, the exchange promises to contribute more to economic development than any other agency the state could conceive. The combined effects of Medicaid dollars and subsidies when doubled by the economic multiplier effect will have more of an effect than highway dollars or promoting snowboarding. Whether it was conscious forethought or accidental isn’t worth debating. The cascading, trickle-down effects are sure to ripple through the economy affecting us all. Well, maybe not us all.

What still must be answered is whether Coloradoans want to base their economic future on federal transfer payments. Or do we seek to encourage wealth creating export industries? Clearly the natural resource extractions economy is the past and the window of opportunity is closing. The in-migration of the past 20 years has changed Colorado politics permanently. The eastern Front Range is now more of a city-state. You have to drive 100 miles in any direction (Cheyenne, Limon, Pueblo, Grand Junction) to reach the great outback that stretches for 1,000 miles before you encounter another urban area of consequence. Without wealth-creating exports, Colorado will be an island economy exchanging dollars internally.

I would argue that the in-flow of federal transfer payments is unsustainable in the very long run given deficits and unfunded liabilities. Eventually the rhetoric of our debate will have to change.

Until then, party on Wayne.
Francis M. Miller is the past president of the Colorado Business Coalition for Health and the vice chairman of the Colorado Health Data Commission. He founded the first consumer cooperative for health care called the Alliance and is the current president of Health Smart Co-op.

By Katie Kerwin McCrimmon

Despite outrage from some lawmakers who called review of Colorado’s health exchange a “mockery,” a bid for an additional $125 million in federal dollars is likely to move forward by next week.

“I would anticipate that we will sign off on this,” said Sen. Irene Aguilar, D-Denver. This (federal) money exists. If we don’t take it, we’re going to have citizens picking up the costs for their premiums. Our goal is to have the most successful exchange in the country and this is part of that.”

Aguilar anticipated “sticker shock” over such high costs, but as chair for the legislature’s exchange review committee, she and vice-chair, Rep. Beth McCann, D-Denver, can authorize the grant request.

The 10-member oversight committee did not take a vote and has no plans to do so before the legislative session ends Wednesday.

Members of Colorado’s health exchange board plan to meet again to finalize the grant application before exchange managers must submit it next week.

Republican members of the committee scolded exchange managers for dramatically boosting the estimated costs to run the online health insurance market, which is supposed to make it easier for uninsured people to find and buy private health insurance.

“I am stunned, shocked and horrified at this proposal at this time,” Sen. Ellen Roberts, R-Durango, said early Tuesday when exchange managers came to the legislature to ask for approval for a new federal grant request. The new $125 million grant request is far larger than two previous federal implementation grants of $18 million and $43 million respectively. In earlier cost estimates, exchange managers have predicted that the exchange would cost $22 to $26 million a year to run.

Roberts said she had only seen the drafts seeking $125 million more in federal cash for the first time on Tuesday morning and could not possibly live up to her obligation to properly oversee Colorado’s health exchange. She called the review process a “mockery.”

In part because some states are refusing to build their own health exchanges, there is more federal money available to states like Colorado that are building exchanges. And the U.S. Department of Health and Human Services is now allowing states to request “implementation” funds for costs that stretch well into 2016. Colorado’s health exchange is supposed to open for business on October 1 of this year for plans that will cover people starting on Jan. 1 of 2014. Previously exchange managers planned to ask for funds to build the exchange and run it during 2014.

Lawmakers on Tuesday scolded sxchange board members and managers. Testifying were Rob Ruiz-Moss, an exchange board member who works for Anthem Blue Cross and Blue Shield, exchange CEO and executive director, Patty Fontneau and board president, Gretchen Hammer, who is also executive director for the Colorado Coalition for the Medically Underserved.

Now, with looser federal rules, they are asking for additional funds. For instance, managers are considering using $3 million in federal funds to buy a building in Colorado Springs that will house the exchange’s call center. Previously, managers planned to rent the space and cover those costs as an ongoing expense.

Among other major costs included in the $125 million application:

• $52 million for technology costs
• $10 million for customer service center infrastructure
• $13 million for customer service staffing
• $8 million for “back office” staff to handle manual processing that IT programs can’t yet do
• $10.5 million for a customer assistance network
• $15 million for marketing and outreach campaigns and consultants

Sen. Kevin Lundberg, R-Berthoud, joined Roberts in his frustration with the exchange managers saying that he was “disgusted” and “flabbergasted.”

Just last week in a health committee meeting, Lundberg said he asked about costs for the exchange and recalls managers telling him they’d be $48 million in 2013 then $22 to $26 million thereafter.

“This adds an extra $60 million over the next three years,” Lundberg said. “Last week I’m told one number. Somehow it’s magically changed.”

Exchange CEO and executive director Patty Fontneau told lawmakers that Colorado is applying for federal grants to save Colorado taxpayers money.

“Our main and primary goal is ‘how do we do this while keeping costs to individuals in Colorado as low as possible?’”

She said Colorado is right in line with other states including Washington that requested a similar grant for $127 million and Maryland that applied for one for $123 million.

Sen. Jessie Ulibarri, D-Commerce City, defended the $125 million request.

“If we don’t receive (the grant) these funds will go to another state,” Ulibarri said. “We as Colorado taxpayers are paying into this fund.”

He said Colorado should reduce health costs for its citizens by applying for the funds.

On Monday, during an exchange board meeting, a similar schism erupted between board members. Dr. Mike Fallon, who owns urgent care clinics, said the exchange should be run like a lean business operation.

“What I’m a little bit aghast at is that we are now an entity closing in on $200 million to sell insurance,” Fallon said. “I don’t think we need $125 million.”

“We are supposed to be a market savvy business operation, not a government entity. Just because other people are doing it (asking for additional federal dollars) doesn’t mean we should.”

On the opposite side, Arnold Salazar, executive director of Colorado Health Partnerships, LLC, said Colorado should be applying for as generous a grant as possible.

“We are implementing an exchange that we know nothing about. It’s never been done,” Salazar said.

He added that it’s impossible to accurately estimate how much it’s really going to cost and that it will be difficult to go back to the federal government and “backfill” with new grant requests later.

Telluride businessman and board member Richard Betts seconded Salazar’s opinion.

“The No. 1 reason businesses fail is a lack of proper capitalization,” Betts said. “We need to make sure we ask for enough money. We made certain promises of accomplishments in the first 18 months.”

Several board members wanted additional funds for navigator programs. In previous board meetings, exchange managers estimated that they would need at least $20 million to successfully help people sign up for health insurance. People who have never before had insurance could need at least 90 minutes in a face-to-face session with someone who could help them through the complicated process.

The federal grant request so far includes a specific request of about $10 million for an assistance network. But Fontneau has said other sources of cash could bring the funding for navigators to about $14 to $16 million.

Fontneau told both the board members on Monday and lawmakers on Tuesday that she and her colleagues are building “a sophisticated web-based marketplace.”

She said the grant application includes funds for a “creative and celebratory” public outreach campaign and that the exchange supports options for small businesses and the opportunity to connect the public and private sectors, although she emphasized that there will be only minimal “interoperability” between public systems like Medicaid and the health exchange.

As for the increased cost estimates and the much larger than expected $125 million grant request, Fontneau said that exchange managers had a new understanding of federal rules.

“We had understood that when they said we had to be self-sustaining by December 31, 2014, that meant no federal funds could be used after that,” she said. “When we pulled the grant request up, it says that the grant can be used for three years.”

By Francis M. Miller

In declaring American independence, our founders sought to eliminate two perverse forms of tyranny that had ruled private lives for centuries.  The monarchy and the church had become corrupt and were oppressive.

My great-great-grandfather immigrated from Poland. Peasants there were not even allowed to pick up dead tree limbs for firewood. As Walter McDougall, the historian, wrote in “Freedom Just Around the Corner,” these medieval systems were never reformed.  They were replaced when the peasants dropped their hoes, walked out of the fields and boarded ships to America.

The 18th century mindset of our founding fathers did not envision predatory global corporations or the massive apparatus of government that rules our lives today.  If we go back to 1776, the lands west of the Mississippi River were hunter-gatherer and the colonial economies were agrarian.  Adam Smith was just writing his “Wealth of Nations” and the steam engine had just been invented.  There was really no concept of a market economy. Health care was carried out by blood-letting and leeches.  Our country had neither an income tax or a federal reserve.  And, whether you disagree with all or part of what’s happened recently, we can all pretty much agree that if our founding fathers were alive today, they would share our anxiety about the future.

Take health care, where I work. It took 200 years for health care to become 4 percent of our economy.  Since the 1970s, our so-called “competitive” health care system has hyper-inflated to where it is now 18 percent of GDP, twice that of the socialized democracies of Europe.

Sadly, it produces inferior results.  Every new law passed speaks to affordability, but during implementation, it always seems that a cascade of unintended consequences conspires and results in higher insurance premiums.  High health care costs have made it all but impossible to provide health care for our population without mandates and subsidies from either government or employers.  A vicious cycle has been set up and we seemingly cannot escape.

The most recent law, the Affordable Care Act of 2010 promises to reshape the health care landscape on a scale not witnessed since Medicare’s passage in 1965.  Everyone will be required to purchase insurance.  Medicaid will be enlarged, and much of the regulation of insurance will be transferred to federal oversight. On the surface it all sounds good until you meet the devil in the details.

Consider the health exchanges that are being instituted at a cost of billions.  The idea was to create an Internet-based bazaar where insurance could be compared and purchased.  The application form that the exchanges recently published is 21 pages long. (It is 61 pages long if you get one with instructions.)  This will require prospective applicants to go through a forced-march enrollment process.

My review has concluded that buying insurance through the exchange will be far more complicated than filing income taxes.  Not only that, the process calls for constant monitoring of your income by the IRS to continue qualifying for subsidies and eligibility.

Once the form is filled out, it must be passed up the line for approval by  three federal agencies. You can bet this will take another two to three weeks to be approved under the best of circumstances.  You and I both know that if one ‘t’ is not crossed or an ‘i’ is not dotted, you will have to go through it all again.

In a world where we can buy a car using an iPhone, this process defies all common sense.  Tell me again.  Why can’t I just go buy insurance where I see fit and file for a credit on my tax forms.  Why submit everyone to the “tyranny-of-the-process” about to be imposed by the exchange?

There is a serious question whether all of this is going to work.  We all know what happened when Colorado implemented it’s $300 million dollar CBMS benefits management system:  it has been in a state of failure for years.  Now, the apparatchiks are going to layer the exchange on top of that house of cards.

The legislature has not yet talked about how to fund the exchange, but you can bet they will need to layer another 3 to 5 percent onto insurance premiums to fund it all.

I think I am a typical man on the street. I am a free-market capitalist when it comes to iPhones and a socialist when it comes to fire and police protection or water and sewer.  There are private goods and public services and we need different ways to deliver and finance each of them.

The recent election validated that the public wants access to health care as an entitlement.  Perhaps we should take a lesson from the Europeans. Margaret Thatcher steadfastly increased funding for the British Health Service, all the while privatizing vast tracts of their socialized economy.  It is time for us to stop,  rethink what we are about to do, and be prepared to pivot.

The problem in all of this, of course, is that there are huge insurance companies and hundreds of thousands of people employed to implement the federal government’s 20,000 pages of new rules. Like the church and the monarchy, these players will resist any changes not in their self-interest. Health care is bigger than education and national defense combined. This is not chump change.  We, mere peasants, now that the middle class has been devastated, simply cannot drop our hoes and board a ship to America.  Health care is our Alamo.

I am sanguine that the right thing will happen.  I do, however, have faith in Herbert Stein’s famous dictum that stated, “If something cannot go on forever, it will stop,” In saying this he meant that if a trend  cannot go on forever, there is no  need for action or a program to make it stop, much less to make it stop immediately; it will somehow stop of its own accord.

Francis M. Miller is the past president of the Colorado Business Coalition for Health and the vice chairman of the Colorado Health Data Commission. He founded the first consumer cooperative for health care called the Alliance and is the current president of Health Smart Co-op.

By Katie Kerwin McCrimmon

Sen. Irene Aguilar, D-Denver, withdrew her universal health care bill but has no intention of giving up the fight.

“This is Step One,” Aguilar said. “This is going to be a long process.”

Aguilar introduced a different measure calling for a study of universal care. That measure, SJR 13-021, passed the Senate and now moves to the House.

Aguilar has twice introduced measures into the Colorado Legislature — both in 2010 and this year — seeking universal health care only to face a buzz saw of opposition from health insurance and business lobbyists.

This year, Aguilar hoped to win support from at least one Republican colleague so that she could put an amendment to the Constitution before Colorado voters seeking universal care.

Mark Reece, associate director of the Colorado Association of Health Plans, sat next to Sen. Irene Aguilar and praised her during a hearing on universal health coverage. Nonetheless his industry group and other business groups opposed Aguilar’s measure seeing universal health coverage in Colorado.

Under Aguilar’s plan, employers would have paid a 6 percent payroll tax for each worker while employees would have covered 3 percent of the cost. Self-employed people and investors would have paid a 9 percent tax on income and capital gains.

In exchange, all Coloradans would have received extensive health and dental coverage. They could have picked from networks of nonprofit health plans and providers.

“I faced a well-funded opposition,” Aguilar said.

Nonetheless, she plans to move forward in future years either in the legislature or through the ballot initiative process.

Aguilar believes that when consumers see the cost of health coverage under the Affordable Care Act, they will realize that the state could do better by removing the middle men — for-profit insurance companies — and paying for universal coverage instead.

She vowed to carefully watch and publicize health insurance rate increases so consumers know they could fare much better under universal care.

Businesses groups and Republican lawmakers contended that Aguilar’s proposal amounted to a government takeover of health care. They argued that Colorado is leading the way on implementation of the Affordable Care Act and should allow that process to work.

Augilar has been working with a group called Co-Operate Colorado that has advocated for an owner-run cooperative in the mold of REI.

A separate group is advocating for a public universal health system that would bring Medicare-style health coverage to people of all ages. That group, Health Care for All Colorado, is already moving forward with plans for an initiative on Colorado’s ballot in either 2013 or 2014.

Among the advocates for that group is Nathan Wilkes, who is vice president for advocacy for the group. Wilkes is also a member of Colorado’s health exchange board.

The group’s working title for its measure is “Right to Health Care.” Ultimately they will need to get approval for the language from the Secretary of State, then get as many as 100,000 signatures to get the measure on the ballot.

The measure would call for a public health insurance program for every resident of Colorado.

“We see this primarily as a human rights issue. Even with full implementation of the Affordable Care Act in Colorado, you are still going to have several hundred thousand people who won’t have health insurance. And there will be at least that many who are underinsured,” said Wilkes, who has been working with Health Care for All Colorado since 2007 and is a volunteer vice president for advocay.

A hearing at the Capitol on universal health coverage drew dozens of activists seeking better, more affordable health care coverage in Colorado.

Wilkes became an activist on health policy issues by necessity after his young son, Thomas, was born with severe hemophilia. The cost for Thomas’ care routinely exceeded caps that health insurance companies set.

Wilkes thinks universal coverage will do far more for people than the Affordable Care Act alone. And he says moving forward on two tracks makes sense.

“Reforming our health care system is going to take several years. We have to start somewhere. By tackling the human rights component, we will also serve a huge part of the financial component. Health care costs aren’t going down. We need to capture the waste that’s in the system and use it for health care,” Wilkes said.

The Colorado health exchange is spending tens of millions of dollars to set up a system so consumers can shop for and buy private health insurance.

Wilkes said if Colorado moves toward a public health insurance system, the exchange technology would not be wasted.

“Obviously the exchange is set up to be a marketplace for private health insurance plans. The system of universal public health insurance would make the private insurance players obsolete in Colorado,” he said.

That part of the exchange technology would be unnecessary.

“But certainly we could use or reuse the exchange technology, not so much in selecting plans, but in selecting doctors or looking up information about providers,” he said. “You want to use the technology investments where you can.”

By Dr. Shelley Dworet

Back in the 1960s when I first thought about becoming a pediatrician, I was in my mid-teens.  I asked my own pediatrician, a woman who had known me since birth, if I could shadow her for a day. What an experience to watch her see patients at Brigham Women and Children’s Hospital in Boston, then follow her back to her elegant office in Brookline.

Behind the closed doors of her private space, her desk was piled with charts and letters, and journals stacked on the floor and chairs.  All at once, I didn’t feel so guilty about the state in which I left my bedroom that morning.

To her patients and their families, Dr. Allers was a warm, soft-spoken woman who inspired confidence.  She took time to talk to me and offer support to my single Mom rearing three kids in the shadow of her incorrectly diagnosed mental illness.

No hospital owned Dr. Allers or told her how much time she could spend with her patients, now called consumers by insurance companies.  No one dictated how she should code her visit to “improve her numbers.”  When my mother did not pay her bill on time, the phone did not ring on a nightly basis with calls from collection agencies.

The overall sense was one of caring and pursuit of a highly trained calling.

What happened to this beloved profession?  It has become a profit-driven financial institution owned by the medical equivalent of the big Wall Street banks.  These “owners” are insurance companies and corporate hospital entities all about profits. We have pharmaceutical giants spending a fortune marketing their overpriced drugs, while new drug research is funded through grants from the NIH, paid by the taxpayer. Medicine has been hijacked and held hostage by corporate control and greed.

How do we save this noble profession?

We, the people, must insist that health care be publicly financed and universal. It must be available to everyone equally, like public education, and police and fire protection.  The majority of people polled say YES to publicly-funded, universal health care.

How do we do it?  We have a voice and a movement.  It is Health Care for All Colorado.  Join this grassroots organization and create the tidal wave of support for publicly-funded health care for all.

We can do this.   Go to www.healthcareforallcolorado.org and sign up now.

Oh, and Dr. Allers?  When I was 18, she left Boston, headed for Arizona, and helped create the Pediatrics Department at the new University of Arizona School of Medicine. Never underestimate the power of each person, and then the next, and then the next…

Dr. Shelley Dworet is president of  Health Care for All Colorado, a group advocating for a public universal health care system in Colorado.

By Michele Lueck

In college basketball, being No. 1 means winning the Final Four. In cinema, it means taking home an Oscar. But when it comes to Colorado’s health, being No. 1 could improve hundreds of thousands of lives and greatly benefit the local economy and business environment.

Though Colorado already is No. 1 in certain measures (we have the leanest and most-active adult population of any state), the 2012 Colorado Health Report Card shows there’s plenty of room for improvements.

For example, we’re No. 31 among other states in prenatal care and No. 38 in children’s preventative dental care. And though our adult population is the leanest relative to other states, our obesity rate for adults and children has risen dramatically in recent years

For the most part, Colorado is pretty average when it comes to health, but these statistics reveal a level of mediocrity that belies our national reputation as a healthy, vibrant and innovative state.

In fact, Colorado’s grades haven’t changed much since the Colorado Health Foundation partnered with the Colorado Health Institute to produce the first Colorado Health Report Card seven years ago. While that’s frustrating in many respects, it also begs the question: “What if we were No. 1?”

For the first time ever, the 2012 Colorado Report Card looks at exactly what it would mean if Colorado were No. 1 in key health indicators.

For example: If Colorado were ranked No. 1 instead of No. 36 on the percentage of children without health insurance, an additional 78,593 children would have coverage.

Among the other possibilities if Colorado were No. 1:

• 2,100 more babies would be born at a healthy weight
• 123,400 more children would have access to a medical home
• 24,900 fewer children would be obese
• 32,600 fewer high school students would smoke cigarettes
• 92,600 fewer adults would report mental health difficulties
• 376,800 fewer adults would binge drink
• 16,200 more older adults would have all of their recommended immunizations

It’s worth noting that most of these numbers reflect “modifiable health risk factors” – in other words, actions we can take to improve our health. A recent article in Health Affairs magazine noted that 22 percent of what we spend on health care can be mitigated or modified — such as lifestyle, behavior, the things we eat and how much we exercise.

Frankly, given our state’s resources and collective brain power, being No. 1 in these indicators isn’t much of a stretch.

Being No. 1 would not only make a difference to hundreds of thousands of Colorado lives, it’s a goal that would boost business and the economy.

Tom Clark, CEO of the Metro Denver Economic Development Corp., once told me that health is a major factor that companies consider when they look to relocate or expand to Colorado. He said ranking in the “top three” of key health measures greatly improves the “win rate” of landing prospective employers.

For businesses that are already operating in the state, the supplement to the 2012 Colorado Health Report Card “Keeping Colorado Competitive: Roadmap to a Healthier, More Productive Workforce,”  shows how certain health indicators affect Colorado’s economic health and competitiveness in terms of dollars saved.

For instance, Colorado employers and employees could save an estimated $121 million annually in health care costs if the state had the lowest rate of depression. Likewise, employers and employees could save an estimated $229 annually in health costs if obesity rates returned to 1996 levels.

The supplement also highlights nonprofits that are working to make a difference in improving Colorado’s health. They include The Youth Foundation in Eagle County, which uses an evidence-based program to increase the level of physical activity among at-risk K-8 children. We also highlight Mental Health First Aid Colorado, which focuses on increasing literacy and awareness about mental illness, reducing social stigma and supporting the community with tools for coping with mental illness.

A vast majority of us aren’t destined to win the Final Four or an Academy Award, but striving for the goal of being No. 1 in these key measures of health is worth doing and within reach. And it can be achieved through the individual and team efforts of Coloradans if work together.

Michele Lueck is president and CEO of Colorado Health Institute.