208 Commission Passes Fifth Health Reform Proposal

It wasn’t easy, but during an all-day meeting Monday members of Colorado’s Blue Ribbon Commission on Health Care Reform finished its draft of a fifth proposal for reforming the state’s health care system. Members of the group (often called the 208 Commission after the 2006 legislative bill that created it) were appointed by both Democrats and Republicans and come from across a spectrum of health care backgrounds. That made agreeing on the more than 30 issues debated throughout the day difficult.

The commission hammered out a plan to allow members with “substantive disagreements” to the proposal to include dissenting opinions with the final draft.

But, chairman Bill Lindsay warned, if the proposal was riddled with dissenting opinions, “We haven’t done our job.”

continued…The proposal developed by the 208 Commission will join four others already analyzed by members and task forces and modeled by the Lewin Group, a consulting company that looked at how much each would cost and how many people would be covered. The first four proposals were chosen from a total of 31 submitted by various outside groups. The commission’s fifth proposal is mainly comprised of different elements from the original 31.

Under the plan, individuals would be required to have health insurance, but employers would not be mandated to provide it. People who didn’t produce proof of coverage at tax time would be assessed a fee equal to a year of coverage. A Coverage Clearinghouse would be created through which individuals could purchase a basic, guaranteed-issue plan, and subsidies would be available for low-income residents.

Medicaid and CHP+, the state’s health coverage program for low-income children and pregnant women, would also be expanded. The feasibility of the latter will depend on what happens in Washington this week as Congress debates the reauthorization of the State Children’s Health Insurance Program (SCHIP), the federal program that funds CHP+. The House is expected to pass an SCHIP bill as soon as today, but President Bush has threatened to veto it. Bush objects to states’ efforts to expand eligibility for SCHIP, which is set to expire Sept. 30.

The proposal also includes elements that aim to increase the efficiency of the health care system and reduce administrative costs.

The commission couldn’t, however, agree on what to do about undocumented residents. Several members expressed concern that if the proposal addressed the issue, the public debate would turn into one about illegal immigration instead of one about health care reform. Others objected, saying undocumented residents drive up health care costs and the commission is obligated to consider that.

“The Commission recognizes the important public health, child health, and emergency room use issues relevant to this population,” the commission’s draft recommendation read. “While undocumented residents may continue to purchase private coverage from their employer or an insurance company as they can today, undocumented residents will not be subject to the individual mandate and will not be eligible for the full benefits provided under Medicaid, CHP+ or the subsidy program.”

Near the end of the meeting, several members of the public thanked the commission for its hard work but expressed their disagreement with some of its measures. Several people were concerned that full dental benefits would not be included in a basic plan, while others said they were disappointed the commission isn’t looking more closely at a single-payer plan.

One of the four already modeled proposals outlines a single-payer plan in which the state would administer health coverage for all residents. The Lewin Group determined the plan, submitted by the Health Care For All Colorado Coalition, would save $1.4 billion in overall health care spending and cover all of the state’s 792,000 uninsured. As the only proposal that would save money and cover everyone, the single-payer plan has a broad base of support. But insurance companies and those who prefer a free-market solution are solidly against it. The strong opposition would guarantee a legislative battle royal next year if lawmakers tried to pass such sweeping reform. Still, supporters of single-payer say health care costs have become so overwhelming that such an overhaul is necessary.

The fifth proposal will be sent to the Lewin Group for modeling this week with the results due back in mid-October. In the meantime, the commission will seek input at a series of meetings from residents across the state. The commission will present its final recommendations to the Legislature in January.