I’m still trying to get my head around the Colorado Care single payer initiative. One of the big questions is how would it be financed and a subquestion is how would the 1332 Wyden State Innovation Waiver apply as well as how 1115 Medicaid waivers would move funds. Yes, your eyes should glaze over here but we’re talking about big money.
A new report highlights one of the big questions.
Proponents believe a study by the Colorado Health Institute overlooked aspects of Amendment 69. The institute’s analysis earlier this month concluded that ColoradoCare would struggle to cover costs….
“Amendment 69 requires the state to maintain its current funding of Medicaid, including the state match for Medicaid expansion and CHP+,” said Ivan Miller, executive director of the ColoradoCare campaign. “The federal government matches all state funding sources for Medicaid.”
But Michele Lueck, president and chief executive of the Colorado Health Institute, pointed out that while Amendment 69 calls for a full transfer of Medicaid funds to the state, the federal government is not required to follow state law.
“Our policy experts advise that only some Medicaid funds will be available to finance ColoradoCare,” Lueck said. “This is based on years of analyzing when and how federal grants and waivers are awarded.”
This is a major question. Does the financing actually make sense? If Colorado Care can’t get a firm commitment for 100% transfer of Medicaid money and Exchange money into the Colorado Care pool, then the financing falls apart.
I have two major concerns with Colorado Care. Financing is one of them and the second is a deep reluctance to put any more people and their health coverage under Hyde restrictions. If I was a Colorado voter, I would be very reluctant to vote yes without better answers than handwaving and hope that the money adds up and Hyde is limited to no worse than the currently impacted population with the hope that Hyde hits fewer people.
TaMara (HFG)
Can’t be any worse than what is already going on. My small business clients can’t afford health insurance, friends can’t retire for two more years, despite severe health issues, because they can’t afford the premiums. Another friend lost his job and the premiums about broke the family.
And it only gets worse if you’re trying to get insurance outside any of the metro areas.
This is what I hear – and most of these people are hard core Libs. They report the exchange is useless. Interested to hear any other Colorado BJers’ experiences.
piratedan
well thanks to the GOP, we can’t fix any of this as the insurance companies continue to stick a shiv into it. Really hoping for a wave election so a comprehensive review of the ACA can be done and to either help repair it or transition it out of the hands of the private providers, some of whom appear to be in full scorpion mode.
Robert
Yeah, while I think Richard is right the the CO initiative is likely to be problematic on several fronts, I can understand why it’s becoming more and more tempting to just take a big jump without even checking all the math – when the math on the other side keeps getting worse. Basically, something needs to be done about medical costs, not (just) insurance costs but until people start to realize that docs have been part of the billing problem it will likely not happen.
At my small company we got hit by some older employees with health issues. Last year we had 1 option for insurance and it kind of sucked. This year they added a true high deductible plan, but the “regular” insurance is closer to a high deductible (IMO) than it should be. This was likely done to try and cap the cost at 9.5% of the lower salaries. However it means that our “normal” insurance covers 5 doctors visits a year – after that you pay the negotiated rate out of pocket until you hit the deductible. Plus pay 100% of all urgent care visits until deductible. No option to buy “up” to a higher level of coverage. I’m fairly well paid, but a bit risk adverse and my wife and I have been talking about starting a family in the near future. I’m sure @Richard has a lot more in depth ideas about where things are going wrong, but you can see where the pain and frustration are coming from. For example if it were easier and more popular to “buy in” to the exchanges for small business I think that might be a start, right now I’ve seen lots of attention on the ads for individual sign ups, but nada for the SHOP plans (which I admit I don’t know much about other than they exist but are pretty limited).
germy
@piratedan:
I hope to see it eventually taken from the private providers. I’ve accepted being nickel and dimed in every aspect of my life, but I’d rather not experience it during my (or my wife’s) final illness.
Mary G
I’m encouraged if only different things are being tried. Even if they they don’t work it’ll lead to knowing what does. Like @piratedan: says, insurance and drug companies are in full robber mode and the more that gets publicized the better.
Emma Anne
As a Coloradan, I kind of wish some other states would go first. Although we did go first on legalizing marijuana, and that worked out well. If it is way behind, as I expect, I’ll probably vote for it. If it might pass – I don’t know yet.
Miss Bianca
Oh, Richard, I was hoping you’d weigh in on this! I got an email from the Colorado Care campaign citing this exact thing – only they were, of course, spinning it as “CHI is wrong!” I immediately wondered about it.
I’ve noted before that one of my other concerns is how abortions get funded, since legislation passed in 1984 specifically prohibits public funds being used for them. The pro-69 folks argue that the new statute would supercede the old; NARAL is arguing that it wouldn’t. Not sure who’s right.
jnfr
Here in Colorado, IIRC, there is a state law barring state monies from being used for abortions in any case. So Colorado Care, if implemented, would mean no abortion coverage, period. That’s not really acceptable to me, and it’s why NARAL opposes the bill.
jnfr
Or in other words, what @Miss Bianca said.
coloradoblue
As a voter who signed the petition to get this on the ballot I had very serious reservations about how and if it would work. Based on nothing but my gut I don’t think single payer works at the state level, it has to be national and everyone has to be in. I’m on Medicare and won’t be part of if this passes so there is already one group not participating. And what about the VA and the native American plans? Mostly I signed to get a conversation started, and to scare the living s**t out of the death by spreadsheet companies.
I doubt very much it will pass, millions of dollars will come into the state to defeat it, many people are scare of change and there are just too many questions.
Interestingly enough I haven’t seen any TV ad on this yet are we’re only 10 weeks out.
Richard Mayhew
@Miss Bianca: I’ll trust NARAL’s analysis as that is there area of expertise.
john fremont
@TaMara (HFG): My friends who live outside of Parker and Elizabeth have pretty much said the same thing about the exchanges. Although my friends are Repubs, so they blame insurance company issues now all on Obama.
Mnemosyne
Getting healthcare to rural areas is probably the biggest challenge we’ve got — we’re even having issues with it here in California (which still has a LOT of very rural areas). I’m not sure what the solution is, frankly — more telemedicine? More independence for nurse practitioners and physicians assistants, which seems to be one of the ways we’re going in CA?
Starfish
Next year, the plan offered through my spouse’s work is going to be a high deductible plan. We are going to “save money” with the assumption that we shall spend $0 on prescriptions. You know those $700 EpiPen packs? We buy three every year. One for school, one for home and one for an adult. This does not include the asthma medication that we may or may not need depending on how many bugs come home from school in the winter months.
He poked around on the exchanges. In our part of Colorado, most of the plans are high deductible plans, and the only ones comparable to the ones through his employer are Gold plans. There might be three of those available in our area.
Miss Bianca
Plus – and this may seem like a petty thing – I did find myself kind of disturbed by a quote I saw attributed to Dr. Aguilar, when she was asked about what would happen to the insurance industry in CO: “What happened to people who used to work in the vinyl record pressing industry?”
The implication of course being that that industry became obsolete as a result of technical/business model changes; but I have to admit that that attitude kind of bothers me. Yeah, I mean we can all agree in theory (present company excepted, of course!) that insurance companies are eeevil and maybe deserve to go the way of the vinyl record, but I still find that attitude disturbingly flippant, because of course, what happened in the short run is that a lot of people lost their jobs!
ETA: And it’s not like Dr. Aguilar is facing the prospect of losing *her* job!
workworkwork
@TaMara (HFG): I get my insurance through Connect For Health Colorado and it’s been okay. It’s kind of confusing at first, but I called the 800 number and the associate walked me through the process and it went pretty smoothly.
I’m mainly interested in the single payer initiative to see if it will lower my premiums. I managed to save $250/month compared to COBRA (which I had pre-ACA) but my wife’s pension goes away next May and I’m not going to be able to work full-time while being her caregiver. (Currently I work from home doing course development and teaching online college classes.)
Starfish
I thought under the current system, some of the mountain towns with ski resorts had particularly ugly health care plan offerings. Here is a story about that.
Mnemosyne
@workworkwork:
Since your wife is disabled, can you get her on Medicare or Medicaid? There are sometimes weird loopholes where a person under 65 can get Medicare depending on their diagnosis.
stichomythia
I live in Colorado, and I’m definitely not voting for it, primarily because I’m retired. Under ColoradoCare, retirees would pay ten percent of their income into the CC system, and would get no benefit because most of them are on Medicare. CC advocates are quick to point out that due to various exemptions, retirees would end up paying around seven percent. Seriously? I’m supposed to be relieved because my new 10% tax is really just 7%? If this passes (and I don’t think it will) I’m selling my home and moving out of state—and that’s not an empty threat.
I agree with coloradoblue above; single payer must be national to work. The CC proponents have done a miserable job explaining how this is going to work; much of their rhetoric is simply handwaving and “let’s pass it and figure out the money part of it later,” accompanied by cheerful graphics and stock photos of happy people.
Five Points Dem
I’m a Colorado resident, have bought a plan on the exchanges, have been in the high-risk pool high-deductible state managed plan that preceded Obamacare, have recently had great private insurance and now have an OK HSA plan. Also, parents are Medicare age, sister’s on Medicaid.
So, given my personal experience and knowledge–I’m absolutely terrified this will pass. And I’m a huge Obama supporter liberal Democrat type. ACA passed Congress on my birthday, which pleased me to no end.
But I’m terrified this will pass. There’s no indication this will do much for the people who have crappy experiences with their current options (and they are crappy, no doubt about that.)
I know there’s a real desire to in one fell swoop create a better system that remedies those problems, but this isn’t it. No one has explained to me how this bill makes any injustices or market distortions go away.
I worry because Colorado voters are VERY susceptible to passing cleverly named constitutional amendments, like our infamous Taxpayer Bill of Rights, which has crippled state government for 20-plus years, or amendments with no implementation plans, like marijuana legalization.
Meanwhile, thrilled to support the minimum wage hike.
germy
@Miss Bianca: No one was particularly concerned when my jobs disappeared over the years. I was a proofreader, then I was a typesetter, then I designed slide presentations. I retrained and moved on.
nastybrutishntall
@TaMara (HFG): The exchange plans in ski / rural SW CO offered are 30% – 50% more expensive than my grandfathered HD Anthem plan, with even higher deductibles. Since I don’t qualify for subsidies, Obamacare would be a pure loss for me with no upside if I couldn’t keep my pre-ACA plan. Everyone I know here is a liberal, and almost all of them take the penalty instead of getting insurance, since none can afford it if they don’t have the subsidies. Basically, insurance would put them into poverty, but since they aren’t yet poor BEFORE their ACA care, they get no subsidies. Asking people to live hand to mouth so that someday an insurance company MIGHT decide to pay all of their catastrophic medical bill (but might not!) is ridiculous. It’s no better than prior to the ACA. It’s still either have healthcare or have (insert necessity here).
Mnemosyne
@nastybrutishntall:
High-cost area + (relatively) low population = giant fucking mess that needs to be fixed.
burnspbesq
@piratedan:
And into … what, pray tell?
burnspbesq
@Miss Bianca:
Bad choice of analogies: pretty much every pressing plant in the world is running flat out and putting customers on allocation. Presses are being taken out of mothballs and refurbished whenever they can be found gathering dust in warehouses.
Mnemosyne
@burnspbesq:
At a minimum, to non-profit, highly regulated private companies, which IIRC is the Swiss model (they’re only allowed to make a profit on supplemental insurance for luxuries like private rooms). Single-payer like Canada would be nice, but I think we’re way too big both geographically and population-wise to have a single-provider model.
Though there should be a caveat that even with single-payer, Canada has trouble getting healthcare to more remote parts of the country.
piratedan
@burnspbesq: in your case Burnsie, something slimming that is suitable for evenings out….
Yutsano
@Mnemosyne: New doctors in Canada all want to live in either Vancouver or Toronto, not Yellowknife or Whitehorse. Or worse for Canadian medicine, go down to the US to make even more money. I’d personally be more okay with the Australian model which has a public model to support the basic stuff but private insurers pick up the big shiny stuff. Either way folks get covered.
@coloradoblue:
Canada went single payer one province at a time. In larger countries that’s usually how it ends up going.
Mnemosyne
@Yutsano:
Also, too, most countries have some kind of regional divisions. The NHS in the UK is four separate entities (England, Scotland, Wales, and Northern Ireland) that all work together. Organizing the administration by state in the US is what the rest of the world does anyway.
Miss Bianca
@burnspbesq: Heh, indeed.
workworkwork
@Mnemosyne: She’s already on Medicare. She got early retirement from her job at a major Chicago bank, so her pension and SSD are a major part of our income.
I left my full-time job to work from home partly because the first year she was in a wheelchair we spent 25K on caregivers.
That being said, I prefer my new work situation since I control my own schedule and can work anywhere there’s Internet. But her pension from the bank stops at 65 and I’m not sure what’s going to happen with her SS. (I’m 58, so I can’t even tap into our IRA if necessary.)
workworkwork
@Mnemosyne: Agreed. I’m not sure single payer will work for us at this point. The private insurers are too entrenched. Of course, that means they’ll be harder to regulate.
In any case, I like the sound of the Swiss system.
Guinn Unger
@jnfr: A constitutional amendment trumps an existing state law. While Amendment 69 does not specifically state that elective abortion will be covered, it is pretty clear that medical abortions will be. When you add the fact that contraceptives will likely be provided at no charge, it seems pretty clear that women will be better off. Many, if not most, insurance plans don’t currently pay for elective abortions anyway, so it’s not as if ColoradoCare would be taking something away.
Guinn Unger
@stichomythia: I suggest you actually read the amendment. You will see that it is carefully thought out. There are also substantial exemptions for retirement income, so most seniors will actually pay little if anything in additional taxes. You can find an analysis of this at the following URL:
http://www.couniversalhealth.org/wp-content/uploads/2016/08/ColoradoCare-Medicare-Beneficiaries-and-seniors-8.30.16-v3.0.pdf
Guinn Unger
@Mnemosyne: Most people think that Canada has a single payer system, but actually each of the provinces/territories have their own payment system. I agree that it would be much better to have a national single-payer system, but that’s not going to happen anytime soon. Colorado is large enough to carry this off, and our hope is that other states will see how well this works and push for their own systems, eventually carrying us to a national system.