By Katie Kerwin McCrimmon
Sen. Irene Aguilar, D-Denver, unveiled legislation on Wednesday that would establish universal health care in Colorado.
Aguilar designed her bill as an amendment to the Colorado Constitution. That means she would need to get support from two-thirds of members in the state Senate and House along with the governor’s signature. Then, at the soonest, Coloradans would weigh in on the referendum next November.
“I want to put something on our ballot in front of our voters. We can try to do it in a different way in Colorado,” Aguilar said. “Here’s the conundrum…when people come to our hospitals and they’re sick, we want to try to take care of them whether they have insurance or not. But the only time you’re guaranteed that access is if you’re at risk of losing your life.”
Providing care for people only in emergencies is breaking the bank, Aguilar said. The group supporting Aguilar and her bill, Co-operate Colorado, has commissioned an economic feasibility study and expects to present findings soon that would show universal care would cost Coloradans less while also covering everyone in the state.
Aguilar said it’s unclear whether undocumented immigrants would qualify under universal care. The legislature and board members ultimately would decide that.
Funding for what Aguilar would call the Colorado Health Care Cooperative would come from payroll and income taxes on individuals combined with federal and state dollars that already support public health programs. Aguilar said it was unclear how much every citizen would need to pay — perhaps somewhere between 4 and 6 percent of earnings. Employers would no longer have to shop for health plans or offer them to their employees since all residents of Colorado would have basic health coverage through the cooperative.
Aguilar said the bill is an “opening gesture” and she expects to refine it as she meets with business representatives and Republican lawmakers whose support she would need.
“I am not going to try to shove this down people’s throats,” said Aguilar. “I had hoped we could do (universal health care) as a nation. In the interim, real people are dying every day and all of us are experiencing escalation of costs.”
The Colorado Association of Commerce and Industry, which represents businesses including health insurance companies, fought Aguilar’s earlier attempt in 2011 to establish a universal health care system.
A CACI spokeswoman said she would need to float the draft with members before giving a formal comment on Aguilar’s bill.
“If the bill looks anything like the bill from 2011, I’m sure we’re going to have the same kind of response,” said Loren Furman, senior vice president for state and federal relations for CACI.
Tony Gagliardi, Colorado director for the National Federation of Independent Business, said he would reserve judgment until reviewing the bill and speaking with Sen. Aguilar.
Aguilar’s proposal is different from another venture called the Colorado Health Insurance Cooperative, a consumer-owned nonprofit health insurance company now being created. The Colorado Health Insurance Cooperative received a $69 million loan from the U.S. Department of Health and Human Services and is ramping up to sell insurance on Colorado’s health exchange starting in 2014. A spokeswoman from the nonprofit insurance company declined comment on Aguilar’s proposal.
Aguilar, who is a primary care physician for Denver Health, believes the U.S. is wasting up to a third of health expenditures. She cited a recent Institute of Medicine report that uncovered $750 billion in wasted health expenditures in a single year. Aguilar says she’s a pragmatist who believes in providing basic health care to everyone so we can reduce high-cost emergency care which is now the only place that uninsured people are guaranteed care. She thinks by streamlining care for all people, we can save costs and improve health.
Aguilar says many of the uninsured — including some of her patients — skip necessary treatments or medications because they can’t afford them. Then they either become so ill or destitute that taxpayers eventually foot the bill for much more costly care. She described a woman who at age 44 could not afford basic diabetes medication. For years the woman became sicker.
“She couldn’t afford to do everything. She would pick and choose,” Aguilar said.
The woman’s kidneys eventually failed and taxpayers had to pay 100 percent of her escalating costs.
“She died at 64 after an amputation and two heart attacks,” Aguilar said. “This is just crazy. I could have given this woman the care she needed at 44 and she would still be working.”
Under Aguilar’s proposal, everyone in the state would pay in to the health cooperative and would have access to care. Patients would then choose integrated health systems with whom to seek care. Aguilar envisions a major role for current nonprofit health systems including Denver Health, Kaiser Permanente and Rocky Mountain Health Plans. The bill would not bar for-profit insurance companies. Some are busy buying up medical practices so they might become “integrated health care systems themselves,” Aguilar said.
If patients wanted to pay out of pocket for additional health care, they could certainly do so. Aguilar likened the system to our current public schools. Everyone in the state supports pubic education. Some families opt to spend additional dollars on private schools.
Aguilar envisions the Colorado health exchange surviving. Colorado would get waivers from the federal Affordable Care Act to implement health care under a state-managed plan. The exchange, an online shopping marketplace for health insurance, would be a mechanism through which people could select their health plans. Less certain is why for-profit insurance companies would be necessary. If insurance companies face the loss of their businesses, their lobbyists are sure to mount major challenges.
But Aguilar expects her proposal to be popular among owners of small businesses who are tired of seeing health costs rise every year and having to devote time to shopping for health insurance plans instead of growing their businesses. Furthermore, people living in rural parts of Colorado don’t have access to enough health care providers even if they do have insurance.
“We’re on an unsustainable (path). Every year, our budget gets worse because of health care costs,” Aguilar said. “I really want to figure out a way to do this that’s appealing to everybody.”