ICYMI: Is The Public Option The Right Answer?

Apr 27, 2021

DENVER – As lawmakers continue to debate House Bill 21-1232 – which would create a new state government-controlled health insurance system, known as the state government option – “not everyone agrees the state should get involved,” reports The Denver Post.

The article highlights the broad opposition from hospitals, coverage providers, business groups and others in the health care community over the proposal, particularly rural hospitals. Dr. Korrey Klein – a family medicine doctor in Fruita, Colorado and affiliated with multiple hospitals in the area – expressed his concerns with HB21-1232, stating, “I’m worried that if it all becomes about the last dollar that we’ll forget who’s important, and that’s the patient … And we’ve shown in comprehensive primary care, that if you actually focus efforts in primary care, you actually lower hospital costs.”

He continues, “I’m just really afraid for rural hospitals … that if all we do is focus on the dollar, and they don’t care about outcomes in rural areas, then all they’ll do is starve rural Coloradans out of the market. They’ll starve hospitals out.” While Dr. Klein acknowledges the need to expand affordable health care in Colorado, the “public option bill isn’t it,” and he instead recommends “community-specific partnerships to reduce costs.”

Rural communities bear the brunt of any strains in Colorado’s integrated health care system. Rural Coloradans fear a state government-run health insurance option, which would cut reimbursements to hospitals and doctors – where rural communities that often rely on a single facility and for whom critical services are frequently hard to access – could limit resources, threaten access to care, increase costs, and lose the ability to recruit high quality physicians and specialists, among other concerns.

recent analysis by the University of Colorado found “the medical workforce is facing a crisis-level shortage”and “the problem is particularly pronounced in rural areas, which have a difficult time recruiting and retaining doctors to practice,” reports the Colorado Sun.

With 47 of Colorado’s 64 counties – 77 percent of Colorado’s landscape – considered rural or frontier, “Colorado’s rural areas have less than 10 percent of the state’s physicians, and rural job openings for doctors often take years to fill,” the Colorado Sun highlights.

Mark Deutchman, a physician at the University of Colorado Anschutz Medical Campus, highlights in the Colorado Sun the many ways Colorado’s health care system is fully integrated during his visits to small town clinics to train doctors in the use of emerging technologies. Rural hospitals rely on their urban counterparts to educate the next generation of health care providers and to create a pipeline of doctors and nurses to curb shortages in rural areas.

During the recent House Health and Insurance Committee hearing to consider HB21-1232, doctors, nurses, hospitals, business and residents from rural areas throughout Colorado expressed opposition to the bill.

“In fact, when we sat down and forecasted this model created by this option, we’re in the frightening position of not surviving in as little as three years,” stated Kenda Spaulding, the chief experience officer of Grand River Health in Rifle.

During the hearing, Dr. Rob Vissers, president and CEO of Boulder Community Health, said, “Our caregivers or doctors will have to reduce or stop costly needed services, such as mental health or trauma preparedness.” 

“Neither Medicare or Medicaid covers the full cost of care we provide to our patients. Adding another category pair, the Colorado Option, we anticipate will offer reimbursement rates below the low cost puts an additional unnecessary strain on our system,” added Brian Johnson, President of St. Mary Medical Center in Grand Junction.

It’s clear Colorado’s rural communities can’t be protected from the negative consequences of the state government option. Instead, lawmakers need to slow down and consider ways to build on and improve what’s working in health care to lower costs, protect patient choice, expand access, improve quality and foster innovation.