Paid for by Colorado’s Health Care Future, a project of Partnership for America’s Health Care Future Action.
What They Are Saying
Coloradans And Elected Officials Express Apprehension To A State Government Insurance Option
Denver – After Colorado officials unveiled a final proposal to establish a state government insurance option, voices throughout Colorado began expressing concerns about the harmful consequences of government-controlled health insurance systems. Leaders across the state and elected officials from both sides of the political aisle continue to express apprehension and encourage lawmakers to consider alternative solutions that provide affordable, high-quality health care.
Colorado Elected Officials Voice Hesitation
“Because the public option proposal has received minimal review or analysis, it is impossible to determine the full impact on access to care, employer-sponsored coverage and whether it will truly reduce costs. However, evidence suggests the unintended outcomes could be far-reaching and costly.”
Bob Rankin, State Senator, Colorado:
“The public option has two things that I’ll vehemently oppose — one of them is mandatory participation by providers and the other is price controls.”
Patrick Neville, House of Representatives Minority Leader, Colorado:
“[The public option] scares the heck out of me. It’s not just a small step toward single-payer [health care], it’s a giant leap.”
Coloradans React to Lack of Analysis
Chris Brown, Director of Policy and Research, Commonsense Policy Roundtable:
“[The public option proposal] is focusing on the prices rather than what’s driving those costs. You benefit a few at the expense of many, without addressing the full economic impacts that occur in a community.”
Loren Furman, Senior Vice President of State and Federal Relations, Colorado Chamber of Commerce:
“There are too many unknowns in this proposal with the potential of a domino effect of higher prices for patients and employers — which inherently increases the cost of doing business in Colorado.”
Chris Romer, President and CEO, Vail Valley Partnership:
“The risks of a state option are too great to move forward with so many unknowns. The proposal does not provide thorough economic impact analysis, nor does it consider the impacts on access to and quality of care.”
Coloradans Consider Competition and Access to Care
Dirk Draper, President and CEO, Colorado Springs Chamber and EDC:
“The state-government option is likely to make [delivering high-quality care] that harder by pushing insurers out of the state and creating more one-size-fits-all health coverage options,” he said. “And it may increase private health care costs, which can make the difference between hiring a new employee, investing in capital or growing a business.”
Simon Lomax, Fellow, Common Sense Policy Roundtable:
“No matter where you stand on the public option, can it really be called a public-private partnership when private health plans are being threatened with elimination if they don’t go along? Of course not. That’s coercion, not collaboration.”
Brad Niederman, Legislative Council Member, National Association of Health Underwriters:
“The [report] keeps referencing increased competition. The reality is, I’ve already heard from one carrier in the individual market that if this actually comes to fruition and they’re forced to do this they are going to pull out of the state. Right there, we don’t have increased competition because we lost a carrier… The unintended consequences need to be at the forefront of the discussion.”
Coloradans Examine Rate-Setting
Rachel Zenzinger, State Senator, Colorado:
“It seems to me like the proposal is more focused on hospitals, carrying really the burden here of making sure that this plan can get off the ground. I guess I’m interested in hearing from the department. What are we doing? You know, I look at the three ideas that are outlined here. And the three ideas are pharmaceutical rebates, setting hospital reimbursement rates, and raising the medical loss ratio. The medical loss ratio is kind of immaterial cause it’s not having any impact. Pharmaceutical rebates don’t seem to be all that pertinent to the conversation so it seems to me like it’s all really landing on the hospital reimbursement rates. So, I would be interested in hearing, are there ways that we are trying to balance that a little bit with other ideas so that it’s not all landing on that one to make the plan go?”
“[Rate-setting] could exacerbate a shortage of doctors and nurses, force hospital closures and push out other insurers from the market.”
Peter Banko, President, Centura Health:
“All the proposed savings would be paid solely by deeply slashing payments to hospitals. Equally concerning is this plan may encourage employers to drop coverage.”
Coloradans Contemplate Cost-Shifting
Margo Karsten, President and CEO, Northern Colorado Banner Health:
“If this state option is implemented, absolutely we’re going to cost shift, and absolutely it’s going to impact our employment and employees.”
Chris Tholen, Executive Vice President, Colorado Hospital Association:
“With at least $235 million in cuts to health care providers in the first year – and upwards of $1.5 billion over five years – costs will be shifted to the 53 percent of Coloradans with employer-sponsored insurance.”
“[Costs] are likely to be shifted to other insurance pools, like employer-sponsored plans, which cover more than half of Coloradans. As a result, many residents could be forced to pay more just to maintain the coverage they have now.”
Impact on Coloradans
Chris Romer, President and CEO, Vail Valley Partnership:
“[T]he State Option is expected to cut at least $235 Million of reimbursements to health care providers in the first year and by as much as $1.5 billion within five years… As a result, patients will have to travel further, wait longer and have fewer providers to choose from when they need care the most.”
Peter Banko, President, Centura Health:
“The reality is that the plan, as proposed, isn’t sustainable, has unintended consequences and jeopardizes access. The proposal does not address adequately Colorado’s uninsured rate. It will not reduce premiums for low-income consumers purchasing coverage on the exchange.”
Ray Scott, State Senator, Colorado:
“Either prices will go up for most residents — more than half of whom are covered by employer plans — or Coloradans will have fewer choices. Many could be forced out of the plans they enjoy if their carriers leave.”
Coloradans Response to Mandated Participation
Andrew Forbes, Joint Budget Committee, Staff Analyst:
“I have a concern relating to mandating hospital participation… I would recommend asking of the [HCPF] and [DOI] is how we will deal with individual, independent provider clinics and how that would affect the care that they’re able to provide as well.”
Amanda Massey, Executive Director, Colorado Association of Health Plans:
“Typically, a partnership includes a choice. And [the State Option] we’re mandated to participate in. So, it’s hard to call it a partnership.”
Amanda Massey, Executive Director, Colorado Association of Health Plans:
“There is nothing in the plan that guarantees that carriers can successfully offer the public option plans. The proposal requires health plans to participate, but nothing compels hospitals or providers to contract with health plans offering the state option.”
Impact to Concurrent Programs
“The report also fails to consider how other programs being implemented concurrently could affect the outcomes of a Colorado public option. Instead, the public option proposal relies on an actuarial analysis that the report’s authors acknowledge omits many important issues.”
Jenn Penn, Principal, Dome Strategies:
“All of this is coming on the back of another pretty aggressive change in the health care marketplace – what we call the reinsurance program… A lot of folks are saying, ‘Let’s let the reinsurance program be fully implemented and fully funded before we make any more changes to the health care system in Colorado. Let’s take a break, catch our breath before we make another massive change.’”
Julie Lonborg, Vice President of Communications, Colorado Hospital Association:
“By establishing government price controls and forcing insurers and hospitals to participate, the proposal as submitted has the potential to undermine other affordability efforts underway, especially community-based solutions and value-based care.”
Concerns with Funding and Implementation
Margo Karsten, President and CEO, Northern Colorado Banner Health:
“I’d be curious to know, is there a different option we’d create together to impact more people than that? The Colorado Hospital Association would like to be engaged in a broader conversation that will impact many more lives than that.”
Chris Holbert, Senate Minority Leader, Colorado:
“I think that we should not move forward on that, at least not this year, that we should allow the reinsurance bill that was passed last year more time to have hopefully greater influence. I think that too much change too suddenly in something as important as health care is too risky. It seems precarious.”
Brad Niederman and Tim Hebert, Colorado State Association of Health Underwriters:
“How will the state option ensure premium affordability? How will affordability be defined and monitored?” The public option program draft assumes carriers, providers, and hospitals will participate in the State Option, what if they don’t? How can the state require their participation?”
Coloradans Want to Slow Down and Get It Right
KC Becker, Speaker of the Colorado House of Representatives:
“Big policies like [a public option] typically don’t get done in a span of a couple months. Sometimes it takes a couple of years.”
Peter Banko, President, Centura Health:
“This isn’t a time for politics. Most certainly, it isn’t a time to rush the process. It is a time to put sound policy into action that creates wholeness and health for every life, every neighborhood and every Colorado community.”
Editorial Board, Colorado Springs Gazette:
“Before imposing this on Colorado, legislators should consider whether most consumers want or trust it… A whopping 73%, including 61% of Democrats, prefer improving the system we have instead of creating a state option. Only 34% say they trust the state government to design an effective plan. Nearly 80% are ‘unwilling’ to pay extra for their health care to help fund a government plan.”
Implications for Rural Colorado
Chad Vorthmann, Executive Vice President, Colorado Farm Bureau:
“Health care is critically important to the more than 700,000 Coloradans who live in rural and agricultural communities. We need solutions that expand access to care and make coverage more affordable. Sadly, as proposed, the state-government option may have the opposite effect — hospital closures, service cuts and fewer insurance choices. We encourage Colorado lawmakers to put the proposal on hold until it can be fully analyzed and focus instead on solutions that get to the root of our health care problems.”
Don Shawcroft, President, Colorado Farm Bureau:
“A state government option would only further exacerbate the physician shortage plaguing rural communities and health care facilities statewide. Policy makers should be focusing on ways to help rural communities attract and retain new medical talent, not drive any possibility of doing so into the ground. Worsening our already notable doctor shortage only serves to reduce options for patients and undermine efforts to provide high-quality primary, preventative and emergency care for rural communities.”
Michelle Mills, CEO, Colorado Rural Health Center:
“Colorado has avoided the rural hospital closures that plagued other states. Nonetheless, 22 rural hospitals operated in the red last year… That’s double the number in 2018.”
Nurses React to Consequences
Melissa Shields, Oncology Registered Nurse, Sky Ridge Medical Center in Douglas County:
“The reimbursement constraints in this bill would force healthcare providers and hospitals to accept payments that do not cover the costs of care. They will face pressure to cut services or close their doors, effectively cutting off access to healthcare to those who need it most – our patients… Like you, I want everyone to have affordable health insurance and access to high-quality care. But, doctors, nurses and hospitals did not cause these problems. So, they should not be punished. The State Option is well- intended, but it is the wrong way to go.”
Particularly for community-based oncology clinics in rural communities throughout Colorado, a government-run health care insurance system could undermine access to life-saving medicines and more… In rural Colorado, small clinics — like most small businesses in rural Colorado — operate on a razor-thin financial margin. These providers would be hard pressed to survive the increased taxes, decreased reimbursement and the guaranteed expansion of expensive federal regulatory red tape.
Will Bertram, Registered Nurse:
“Poor reimbursement for the care we provide will directly impact the personnel who provide the care and the quality of care we are able to provide. We will not be able to sustain current staffing levels and will lose qualified professionals to other states with better reimbursement. We will not be able to purchase or maintain the technology that our patients deserve. In the end, the quality of care will decline, outcomes will decline, and our ability to practice the best medicine will be drastically interrupted.”