Steve Winters, a 55-year-old retired small business owner from Denver, has a straightforward question for The Colorado Independent: What are lawmakers and the governor doing to achieve universal health care in Colorado?
The answer depends on how you define the term. Some would say the governor and lawmakers are making steady progress toward affordable health care for all. Others would say the steps being taken will not lead to the system overhaul that many people are hoping for.
Winters wants to see a taxpayer-funded health care model that would replace private insurance in Colorado to cover everyone. That’s not the direction the governor and lawmakers currently are headed, though they argue the end result — that all Coloradans have access to affordable health insurance — could be the same.
Before diving in, a quick glossary:
Universal health care means everyone has insurance. The term does not specify how that coverage is achieved.
A single-payer system is a form of universal health care and typically replaces insurance premiums with taxes, providing coverage to everyone for just about anything. Insurance billing would be managed by a single government entity. (“Medicare for all” is basically a single-payer system in that it would take the existing federal program and expand it to everyone.)
A public option, which is gaining traction in the Colorado legislature this year, creates a public insurance plan, funded in part through customers’ insurance premiums, to compete with private insurance.
Colorado made an attempt at a single-payer system in 2016. A ballot measure, Amendment 69, would have imposed a 10-percent payroll tax to provide coverage to all residents. It tanked with about 80 percent of residents voting against it. Since the ballot’s failure, elected officials have been mum on the issue of single-payer.
Even so, on the campaign trail, Gov. Jared Polis, who touts his support for universal health care, pitched the idea of a single-payer system across several western states, which he called a “multi-state consortium to offer a universal, single-payer option.”
But so far, there is no indication that the administration has made any headway on that promise. When asked about a single-payer system in Colorado at a town hall in Denver last week, Polis did not mention this plan. Instead, he told a crowd of nearly 100 people, who snapped their fingers in support every time the idea of single-payer was mentioned, “What we have focused on is what is our leverage to drive down rates.”
“Can we bring down rates? Can we expand coverage? Can we even achieve universal in Colorado? I think we can,” Polis said at the town hall.
Lieutenant Gov. Dianne Primavera, a cancer survivor who is working on health care policy for the administration, said she has not yet spoken to other states about creating a regional single-payer system in the West. But she said the concept is still on the table.
For now, she said, the administration is focused on reducing the cost of care and health insurance, which she described as “one of the biggest barriers to universal coverage.”
A recent survey by the Colorado Consumer Health Initiative and the Health Care Value Hub of Altarum, both nonprofit research groups, found cost is a top reason residents do not have health insurance. Colorado’s uninsured rate of 6.5 percent, according to the most recent data from the Colorado Health Institute, is below the national uninsured rate of about 8.8 percent.
But beyond costs, Primavera said, people in Colorado still lack access to certain types of care, specifically those dealing with mental illness.
“An insurance card doesn’t necessarily guarantee you access either,” said Primavera, who worked as a mental health rehabilitation counselor early in her career. “Part of the reason we have access issues is that we have a workforce issue; we don’t have enough providers, especially in rural areas.”
In January, Polis, flanked by Primavera and others, signed an executive order creating the “Office of Saving People Money on Health Care.” During the press conference, he gave a nod of approval to a variety of efforts to drive down the cost of care and health insurance already underway in the state legislature.
They include the following:
A public option
A public-option plan would be a state-run insurance plan similar to the state’s Medicaid program. The goal of a public option, supporters say, is to bring more competition to the health insurance market, especially in rural Colorado, to help drive down premiums.
The bill, HB-1004, commissions a study to explore how such a program would work. There are many unknowns, including how providers would be reimbursed, who would be allowed to use the public option, and how much it would cost the state. But if lawmakers like the results of the study, they could seek a waiver from the federal government to use federal money to implement it. No state has done so yet. There are currently eight states considering public options, according to State Health and Value Strategies, a health care research group.
A drug transparency bill, HB-1131, would require drug representatives to present doctors with a price comparison for the drugs they are selling — one for the brand name drug and another for the generic version. The hope is that transparency will give patients more choices and shed light on what’s driving costs.
“The more we know about what health care costs us, the more we can make the right decisions,” said the bill’s sponsor, Rep. Sonya Jaquez Lewis, a Democrat from Boulder who is a licensed pharmacist.
Another bill would allow the state to import prescription drugs from Canada with the hope of driving down costs even more.
Reinsurance is often described as insurance for insurance companies. The proposed legislation, HB-1168, would pool state and private money to help cover high-cost claims with the goal of reducing costs for insurance companies. The hope is that these savings would be passed on to customers in the form of lower premiums. The bill includes a sunset provision after five years so that the legislation could be reassessed if it is not lowering premiums.
None of these efforts are universal health care as Ask the Indy questioner Winters sees it. He calls the fixes “Band-Aids.” Supporters of a single-payer plan don’t view this piecemeal approach as true progress toward universal health care. Single-payer, they say, is the clearest path forward.
“You can’t possibly get from here to there incrementally,” said Ivan Miller, executive director for the Colorado Foundation for Universal Health Care, which supports single-payer health care. He added, “Unless you take the plunge, you don’t get it.”
Another bill in the works would set up a task force to study the cost of a variety of health care options, including a single-payer plan versus the current system.
Vermont, a state that spent years working on a single-payer health care system, serves as a cautionary tale. Though the state’s economy was less active than Colorado’s is now, the plan was considered too expensive for businesses to swallow. Likewise, the cost of Amendment 69 was estimated at $36 billion per year, more than the entire state budget.
Even so, a recent study in New York found that a single-payer model would cost less than the status quo for that state. And supporters of the cost study bill in Colorado hope it will be a step toward promoting a single-payer system in the state.
“If [single-payer] was the most cost-effective system,” said Rep. Emily Sirota, a Democrat from Denver who is sponsoring the study bill, “that would cause people to take notice.”