Medicaid expansion bill advances without support of two Republicans

By Diane Carman

The Senate Health and Human Services Committee voted Thursday to support Medicaid expansion in Colorado.

And while no one appeared in the four-hour hearing to testify against the bill, SB 200, an exchange between Sen. Kevin Lundberg, R-Berthoud, and representatives of the health insurance industry vividly illustrated why objections to expanding Medicaid under the Affordable Care Act are waning in Colorado and across the country.

I understand why the business community is trying to grasp onto short-term advantage by grabbing the federal cash, said Lundberg, fuming, but Obamacare is designed to shut the private sector down. I warn you at the very best, youre kicking the can down the road.

Patrick Boyle of the Colorado Group Insurance Association shot back.

The Affordable Care Act is now the law of the land, he said, and since President Reagan signed the Emergency Medical Treatment and Active Labor Act, which requires hospitals to provide emergency care to patients regardless of their ability to pay, these are fixed points.

Hospitals must treat the uninsured who arrive in health crises in their emergency rooms and the Affordable Care Act offers a way to pay for that care.

Theres no question that individual insurance is not long for this world, Boyle said. We support SB-200 because we think it will be better for the market than the status quo.

Marc Reece, associate director of the Colorado Association of Health Plans, told Lundberg that the insurance industry operates in the real world.

Providing Medicaid for persons earning 133 percent of the poverty level would have little or no effect on the economics of the insurance industry, he said., because odds are, they cant afford our products.

Furthermore, Travis Berry of the Colorado Competitive Council said Medicaid expansion brings transparency to the industry.

Instead of shifting the cost of care for the uninsured to patients with health insurance through ever-increasing premiums, Medicaid would pay for the care.

The business community doesnt have the luxury of rhetorical opposition to the Affordable Care Act, Berry said. We have a responsibility to make this work.

The complex realities of operating as an insurance company, a provider, a hospital and, most dramatically, as an uninsured mother of three in Colorado were described at length at the hearing.

We cant afford private health insurance for ourselves, said Tish Barber, whose husband works at Big O Tires in Olathe. She said the familys annual income is $31,000. Their three boys are eligible for Medicaid under the CHP+ program, but she and her husband dont qualify because under the current eligibility standard, their income is too high.

I havent been to a doctor for a physical since high school, said Barber, choking back tears. If we ever seriously got sick, I dont know how we would pay for it. You have a chance to change lives for the better.

In poor, rural regions, the Medicaid expansion would be a boon to hospitals, administrators said.

Russ Johnson, CEO of the San Luis Valley Regional Medical Center, told the committee, Expansion of Medicaid is vital to Colorado. You dont serve the valley without Medicaid.

Johnson said over 30 percent of the centers patients are on Medicaid and 20 to 25 percent are uninsured.

Sen. Ellen Roberts, R-Durango, joined Lundberg in voting against the bill. She expressed concerns about the availability of enough health care providers in the state to handle the increased demand for services and said she is not satisfied with progress in addressing waste, fraud and abuse in the Medicaid program.

It fell to Lundberg, however, to deliver the familiar anti-Obamacare message, calling it a distortion of the free-market system, irresponsible spending and saying that it is inviting not better care, but rationing.

When Sen. Jeanne Nicholson, D-Georgetown, a long-time public health nurse, said she was pleased to be able to vote yes on the bill because its one step that could lead us to universal health care, making health care more affordable to all of us, it was just the line Lundberg was waiting for.

That it is one step closer to universal health care is exactly whats wrong with it, he said. It means that it puts the government in charge of medical decisions.

Sen. Irene Aguilar, D-Denver, a physician and the bills sponsor, told the committee that hard-working families need the security of quality coverage. While expanding Medicaid is optional for states, it would be unfair to deny it when theres no immediate risk to Colorado and so much to gain.

The committee voted 5 to 2 to advance the bill to the Appropriations Committee.