By Thomas Gottlieb, M.D.
Health Policy Solutions (Colo.), May 29, 2013
Coloradans need health care. It’s a basic human right. Yet as we get more information about Colorado’s new health insurance exchange, it seems less certain that people will get the health care they need.
The exchange, also called a marketplace, seems more complex every day. I wonder if Coloradans who need the help most will even be able to understand this new system, much less figure out how to get care.
There is a simple solution. We need universal health care, specifically a public single-payer health system that would assure all of us who need care can access it.
The complexity of implementing and understanding the reforms required under the federal Affordable Care Act (ACA) also known as Obamacare, has become more apparent in recent days. Health Care for All Colorado, the state’s leading advocacy group for a universal public single-payer system, contends that this complexity will lead not only to unnecessary confusion for patients and caregivers but also to increased costs for premiums and other administrative costs that will continue to drive the cost of health care ever higher.
Obamacare regulates health insurance companies. Its major values include 1) a definition of basic health plans, 2) expanding Medicaid, 3) a progressive funding plan, 4) and expanded benefits for Coloradans who previously were excluded. However, its implementation is complex.
Coloradans need access to quality health care, not more access to the complexity of hundreds of various iterations of for-profit health insurance policies with high premiums, co-pays and deductibles as well as potentially life-threatening gaps in coverage. Watching as the state spends more than $200 million setting up the ACA exchange with all of this complexity defies logic when investing those many millions in the actually providing health care seems so much more logical and critical.
By now, many Coloradans have been seeing the Connect for Health Colorado advertising that precedes the Oct. 1 opening of the Colorado marketplace for health insurance. While the ads may make it seem as though shopping for insurance will be a wholly positive experience, the release of more details portends more difficult sailing for those wishing to navigate the new waters of the exchanges being set up to comply with the ACA.
It has been widely reported that Coloradans looking for health insurance will have 17 companies competing for their business with more than 800 different plan variations offered through the state’s new health exchange and on the open market. Yet as more details have come in, the complexity seemed to be increasing. We also have many questions about costs for premiums and the availability of plans that provide affordable options for quality care which the ACA’s name seems to suggest and its intent seemed to promise.
We must move to a more sensible and simple system to cover everyone in our state. Our group advocates for a universal public single-payer health system that would cover all Colorado residents and eliminate the need for the complexity of private insurance sold on the exchanges or purchased and provided through employers.
Another one of our leaders, Nathan Wilkes, who also serves on Colorado’s health exchange board, summed it up well when he recently said, “The rates under the ACA are pretty much guaranteed to be slightly higher because insurers are now required to cover higher-risk people they used to turn away before. The insurers will spin any increases as being due to the additional mandates, but studies show that their additional costs should only be minimal. The private insurers are wasteful, irrelevant dinosaurs creating huge, systemic administrative costs while adding little or no value to the provision of actual health care in Colorado. Where the rates are the same or lower than before, it is likely because the insurers found ways to limit coverage by shifting more medical costs to the people through higher co-pays/coinsurance, higher deductibles, higher cost sharing for prescriptions, reduced provider networks, and other coverage limits.”
A search of Colorado’s Division of Insurance website shows a lengthy list of the companies and plans that have filed for inclusion on the Colorado marketplace/exchange, but searching for the rate filing information and then understanding those documents points to the complexity of the process and the plans. The plan Health Care for All Colorado advocates has no such complexity or huge variation of rates to decipher.
Health Care for All Colorado leaders and members will be educating, advocating and supporting the push to bring ballot initiative No. 12 to the 2014 ballot for Colorado’s voters to take advantage of the state innovation provisions of the ACA and to create a more comprehensive universal sustainable public and truly affordable health system for all Coloradans.
The initiative title reads, “Shall there be an amendment to the Colorado constitution concerning the provision of one public health insurance program to allow all Colorado residents access to a single standard of health care as a matter of human right and public good, and, in connection therewith, requiring the General Assembly to enact legislation creating a public health insurance plan, requiring the Colorado department of revenue to collect a premium not to exceed 9 percent of an individual’s income to fund the plan, and prohibiting the control or administration of premiums by a for- profit, nonpublic entity or corporation?” If the Colorado Constitution defines health care as a human right, then our governor and legislators will be held responsible to fulfilling this right.
This Saturday, June 1, Health Care for All Colorado will welcome U.S. Rep. John Conyers, Jr., to our annual meeting as our featured speaker and to help us kick off our “Health Care is a Human Right” campaign in Colorado. Mr. Conyers is the chief author of HR676, the national improved and expanded Medicare for all bill, and he will speak at 7 p.m., at the First Plymouth Congregational Church at Hampden and Colorado Boulevard in Englewood. The public is welcome. For more information on the public universal single-payer health care system we support, please visit www.healthcareforallcolorado.org
Dr. Thomas Gottlieb is president-elect for the Health Care for All Colorado Foundation. He trained as a biochemist at the University of Colorado Boulder and as a physician at the CU School of Medicine. He worked for the Indian Health Service, the CU Division of Clinical Pharmacology, as medical director for the Denver Neighborhood Health Center and in private practice.