208 Commission Proposal: Better Health Care for Colorado

Thirty-one proposals were submitted to the state’s Blue Ribbon Commission for Health Care Reform (commonly called the 208 Commission), which was established by the legislature in 2006. In May, four proposals were selected for further analyses of their cost and coverage impacts, the results of which will be presented to the commission July 17. This week, Colorado Confidential will take a close look at each of the four proposals.

One chosen proposal, called Better Health Care for Colorado, was submitted by the Colorado Association of Public Employees (CAPE) and the Service Employees International Union (SEIU). SEIU is a 1.8 million-member organization comprised of workers in health care, public service, security and commercial cleaning services. The plan does not include a mandate for individuals or employers to purchase insurance, but instead focuses on expanding access and increasing affordability.

“Our main goal was to put us on a politically viable path to universal coverage here in Colorado,” said Jake Williams, primary author of the proposal and deputy director of SEIU healthcare.

“If you look at the uninsured population here in Colorado, 75 percent are people below 300 percent of the federal poverty level. That was the first big target we wanted to address,” Williams said.

Those under that limit would receive Medicaid-funded subsidies to help them purchase private insurance. Currently, 300 percent of the federal poverty level is $30,630 yearly income for an individual and about $62,000 for a family of four.

A regulated Health Insurance Exchange would be established to help connect the uninsured with a variety of affordable plans offered by private companies, and assistance with premiums would be available on a sliding scale.

Williams said the Exchange would benefit both consumers and insurance companies.

“We’ve already talked to insurance companies and they’d be thrilled to participate,” he said. “This way we can use a private-public partnership to enhance the market. This actually delivers more customers to them.”

Those who qualify for premium assistance but would rather enroll in their employers’ insurance could do so and use the premium assistance to pay for any employee contribution required of them.

Long-term care was also a high priority in developing the proposal, Williams said.

“We think it’s so important if we’re going to really and truly do comprehensive health reform in Colorado that we include long-term care,” he said. “A huge amount of our dollars right now are spent on long-term care.”

The proposal states:

“With projections that Colorado’s elderly population will increase by a staggering 59% during the next 15 years, we find ourselves inadequately prepared to address what can be the most expensive care of all – long term supports and services.”

According to the proposal, in-home care is both more cost-effective and more preferable to individuals than nursing home or assisted living facilities. The plan offers incentives and long-term reimbursement for in-home care and encourages reserving nursing home and assisted living facilities for those whom in-home care is not appropriate.

“The approach we take is we do our best to keep seniors healthy, happy and at home,” Williams said.

Medicaid reform is another major component of the proposal. Hospitals and long-term care facilities would be subject to pay-for-performance standards, meaning future Medicaid payment increases would be tied to various measures of performance.

Williams said his organization tried to reach a compromise among business, labor, consumers, patient advocates and providers.

“We see ourselves as a bridge between all these groups,” he said.

Williams sees the biggest opponents to the plan as coming from the far left and the far right of the political spectrum.

Some on the left, while usually in agreement with the union, are advocating more sweeping measures such as
individual mandates.

“We have a different assessment of what the politically viable solution should be,” Williams said.

The commission will likely also develop a fifth proposal incorporating different elements of the selected four and may use ideas from the 27 proposals that didn’t make the cut. A final report is will be presented to the Legislature by Jan. 31.