Policy Priorities
CCHI Policy Committee Winter Schedule (Please note that these meetings are open to CCHI members only. For more information on becoming a member, click here) Policy Committee Meetings will be held every other Friday starting January 22, 2010. All meetings will be held at the Colorado Children's Campaign (1580 Lincoln Street, Suite 420, Denver) February 5, 2010
12:30 - 2:15 pm February 19, 2010
12:30 - 2:15 pm March 5, 2010
12:30 - 2:15 pm March 19, 2010
12:30 - 2:15 pm April 2, 2010
12:30 - 2:15 pm April 16, 2010
12:30 - 2:15 pm April 30, 2010
12:30 - 2:15 pm May 14, 2010
12:30 - 2:15 pm
How Will State Budget Cuts Affect Health Care?
Governor Ritter recently announced a broad range of cuts across the board aimed at closing an estimated $384 million budget gap in the current fiscal year. This includes deep cuts to critical healthcare services including Medicaid and the Colorado Indigent Care Program (CICP).
For an overview of cuts in the Department of Health Care Policy and Financing and a breakdown of how specific programs will be affected, click here
The Colorado Consumer Health Initiative and National Health Care Reform CCHI supports initiatives that: 1) Provide access to the most consumers and most significantly reduce the number of uninsured, 2) Reduce consumer financial burdens, 3) Provide the most extensive private market reform, competition, and transparency, 4) Reduce costs most effectively over time, 5) Reform the current fee for service provider reimbursement structure, and 6) Produce the highest quality outcomes, through prevention initiatives and pay for performance criteria. Currently, the House proposal most closely reflects these goals, even though there are still some significant areas of concern. However, CCHI’s “positions” on the House and Senate proposals will depend upon how they are modified over time via debate and the mark up process. Key Policies in the Debate Individual Mandate: CCHI’s support for an individual mandate is conditional. Without guaranteed issue and significant affordability protections including sliding scale subsidies, and individual mandate is unworkable. We would also prefer an individual mandate in conjunction with a public option. In the absence of a public option, an individual mandate will simply increase private market funding without a guarantee of distributed benefit, transparency, and improved competition. Employer Mandate: CCHI included a pay or play employer mandate in our proposal to the 208 Commission with protections for small businesses. If an employer mandate is included nationally, it should exclude businesses under a certain size, (in terms of annual payroll or number of employees), in order to protect their ability to remain viable and produce new jobs. Expansions and Reform to Medicaid/SCHIP Programs: CCHI strongly supports an expansion of Medicaid and SCHIP eligibility to ALL low-income people and families, including children, pregnant women, parents, and childless adults, as well as the disabled to at least 200% FPL. The “Cost of Care: Can Coloradans Afford Health Care?” study recently released by COFPI and CO Voices for Coverage (aka Affordability Study) shows that Coloradans at or below 200% FPL have no income to contribute to coverage. Medicaid reform should include: o Expand minimum eligibility to 200 % FPL in Medicaid and 300% in CHIP, and include legal immigrants. o Protect requirements for comprehensive services for all patients, especially children, through Medicaid (e.g. EPSDT program). o Maintain strong cost-sharing protections. Increase provider reimbursement rates. o Increase support for HCBS long term care services. o Develop quality measures that ensure high-quality, cost-effective services and coordinated care. o Create simple, streamlined eligibility and enrollment systems (e.g. 12-month continuous eligibility, standardized forms). o Automatically increase federal Medicaid matching funds in periods of economic downturn. Private Market Reform: Many of the proposals contemplate creating some sort of new market (called exchanges or gateways depending on the proposal). Products offered there would be subject to different market rules than products offered outside of the exchange/gateway. Plan options should be limited to avoid confusion comparable to that encountered in the implementation of Medicare Part D. Multiple exchanges in one geographical area are not a good idea – they would further complicate choices and increase administrative costs. For greater risk pooling and economies of scale, CCHI would support a national exchange or gateway as opposed to leaving it to each individual state. Other critical private market reforms: o Guaranteed Issue: An individual mandate also requires the implementation of a guaranteed issue scheme that eliminates coverage denial for pre-existing conditions. CCHI supports guaranteed issue if not across all markets, then at the very least for products offered within the exchange or gateway. o Modified Community Rating: Consumers should be able to purchase high-quality, affordable coverage without regard to health status, pre-existing conditions, or gender. We Tobacco use rating and age rating should be significantly tightened in the individual market. o Strong Cost-sharing Protections: There should be affordable caps on out-of-pocket costs (including premiums and cost-sharing) for people with incomes between the Medicaid eligibility standard and 500% FPL. Plans should be subject to a maximum on allowable deductibles, especially for populations receiving low-income tax credits. Plans should have protections against lifetime / annual limits on benefits, as well as, limits on services. Protections should be included in the required benefit package to ensure that coverage is sufficient to treat a broad range of conditions. o Transparency: All plans should be required to comply with transparency standards for comparability across benefit packages and cost-sharing levels. o Small Business Tax Credits: Tax credits to small employers, who generally have a more difficult time affording comprehensive coverage for their workers, will benefit both their businesses and their employees. Prevention: Investments in health promotion and disease prevention today will yield better health outcomes and health system savings in the long-run. Any proposal needs to reduce barriers to access for preventive care and screenings, particularly the reduction or elimination of cost-sharing for evidence-based preventive services. We would oppose wellness incentives that impose differential cost-sharing for people who do not meet prescribed goals, as such incentives can actually end up jeopardizing enrollees’ ability to obtain necessary services and become healthier. Public Option: CCHI supports the concept of a public option. The public option will introduce greater competition in the private market and will provide the most cost-effective and affordable way to cover individuals that are currently uninsured. The individual and small group health insurance markets do not work well today for many participants and potential participants alike. The cost of health care and the rate of health care cost growth make it difficult for many people to afford health insurance or essential care. There is a fundamental need to control health care costs and create a marketplace wherein insurers compete on value and customer satisfaction, rather than risk selection and marketing. Advantages of a public option include: o Consumer choice o A public plan can lower premiums by regulating how much is spent on administrative functions, marketing, and advertising o A public plan can effectively negotiate lower provider reimbursement rates or set rates at fair levels o A public plan can lower premiums by forgoing solvency requirements A public plan could face escalating premiums over time due to adverse risk selection. If private plans can design benefits packages that allow them to “cherry-pick” healthier individuals, then the public plan will see gradually rising premiums and over time only the sickest people will choose the public plan option. There are at least two possible solutions to this problem. One is to design and utilize a risk-adjustment mechanism between all plans in the Exchange—public and private. Risk-adjustment mechanisms are very hard to design and implement. A second solution is to limit the allowable benefit plan design variability to a more specific small set of plans with a more clearly defined set of covered benefits and cost-sharing provisions. In addition to Medicare on the national level, more than 30 state governments offer their employees a choice between traditional private health insurance products and a plan self-insured by the state. The programs show that plans operating with government appointed managers can compete with plans run by private managers if the rules of engagement are structured properly.
2008 Legislative Session For an overview of the 2008 session as it pertained to health care, as well as a listing of all the bills that CCHI supported and opposed, please view our “CCHI Legislative Summary for 2008 Legislative Session” |
