Healthcare

The healthcare system in our nation and our state is complicated from all perspectives. Providers are constantly negotiating with insurance companies for reimbursement for services rendered; private insurance companies must provide reimbursement, but have an obligation to their shareholders; so that leaves patients in the middle, trying to figure out what is covered, what is not covered and how much a service really costs. And, to compound the complexity, with each visit of an uninsured person to an emergency room, we see costs to providers and to the insured increase.

During the 2006 legislative session, the Colorado Legislature passed a bill to study and establish healthcare reform models for expanding coverage – especially for the underinsured, uninsured and those at risk of financial hardship due to medical expenses. In addition, their mission is to decrease healthcare costs for Coloradans. The Commission, nicknamed the 208 Commission, solicited proposals to address health care reform in Colorado. In public meetings, 208 Commission members tell us that 785,000 Coloradans (180,000 of them children) are uninsured. That number constitutes 17% of our population and is higher than the national average. We also know that a great number of individuals are “underinsured,” meaning that while they may carry health insurance, it may cover only a catastrophic illness. The Commission also tells us that the number one cause of bankruptcy in this country is medical bills. Most people are labeling this situation a crisis, and I agree.

I have been meeting with individuals and groups that are committed to finding solutions to our healthcare crisis. The good news is that healthcare reform is at the forefront for all the stakeholders including patients, doctors, insurance companies and government. All of the groups are generating ideas and proposals for addressing the healthcare needs of Coloradans. These solutions will take serious negotiation and compromise by all parties and I am committed to working with all the stakeholders to attack healthcare reform head-on.

We have to start somewhere in dealing with this difficult issue.

First, we must all begin to think and talk about health care in a different way. We must move from the notion that health care is a "benefit" to the belief that health care is a “public good.” We need to focus on an individual having “access” to a system and not “insurance” against sickness. Just as we expect our population to have access to education and be well educated, we must have the expectation that our population will have access to health care and be healthy. Health and education are key to a thriving economy and society.

Second, we must disconnect health care from employment. Following the second World War many businesses offered health care “benefits” to entice people to work for them. This made sense when people worked for the same company for most of their adult life. Today, however, people change jobs frequently, work as independent contractors or consultants and don’t have the “benefit” of employer based health care. The access point for health care should not be an employer.

This fundamental shift in thinking, however, will not likely come in the immediate future. We are, therefore, left with developing measures in the short term to provide more health care access for the uninsured and underinsured and provide better services to those who are insured.

We need to start with the 785,000 Coloradans who are uninsured. Four of the five proposals reviewed by the 208 commission included recommendations to expand Medicaid and the Children’s Health Plan Plus (CHP+) to cover uninsured at 200% to 300% of the Federal Poverty Level – and I agree. I also believe that we must take a hard look at how we administer the Medicaid and CHP+ program to find ways to increase the efficiency and cost-effectiveness of the program. Strides were made during the 2008 legislative session to provide access to 50,000 more children. This is a good start, but we must do more. Finally, I support the concept of an “exchange” or insurance purchasing pool that will provide uninsured individuals and small businesses access to reasonably-priced and, possibly subsidized, insurance plans.

Improve access and coverage for underemployed and underinsured Coloradans. For now we depend on employers to provide access to health care for many individuals. While many companies will continue to offer healthcare benefits, we need a way for individuals who work without this benefit to have access to health insurance. The concept of an "exchange" that provides a menu of health insurance plans should help address this issue.

Improve efficiency and cost effectiveness for the insured. When I talk with individuals who do have health insurance, they often highlight how difficult it is to unravel the medical billing process. If you have had a catastrophic illness or simply a blood test, most agree that finding the true cost of any service is next to impossible. I believe that we need to ask insurance companies to provide more transparency when it comes to billing and cost of service.