leading change for a healthier colorado health care in colorado: changes in health coverage gretchen...

Leading change for a healthier Colorado

Health Care in Colorado: Changes in Health Coverage

Gretchen Hammer

November 15, 2013


Health Coverage

Colorado has nearly 5.2 million residents, 4.4 million have health coverage

– 59.0% employer sponsored– 8.2% Individual – 9.3% Medicare– 7.3% Medicaid– 1.2 % CHP+– 0.8% Other Insurance

Source: Colorado Health Access Survey, www.cohealthaccesssurvey.org


Health Coverage

741,000 uninsured in 2013 (14.3%)

An additional 313,000 Coloradans were INSURED at the time of the survey, but were uninsured at some point in the prior 12 months.



Uninsured Rates by Region



Uninsured Rates by Age



Uninsured Rates by Race and Ethnicity



Uninsured Rates by Income



Uninsured Rates by Employment



Reasons for lacking insurance in CO



Length of Time Uninsured



Underinsurance

• 720,361 underinsured in 2013 (13.9%)– Out of pocket expenses exceed 5%

for those under 200% FPL, and 10% for all others



Underinsurance by Region



Blue Ribbon Commission, 2008

Improve Access to Care, with Mechanisms to Provide Choices

16) Require every legal resident of Colorado to have at least a Minimum Benefit Plan, with provisions to make the mandate enforceable.

20) Require all health insurance carriers operating in Colorado to offer a Minimum Benefit Plan in the individual market

21) Guarantee access to affordable coverage for Coloradans with health conditions (implement in conjunction with Recommendation 16).


Commission, cont.

17) Implement measures to encourage employees to participate in employer-sponsored coverage.

18) Assist individuals and small businesses and their employees in offering and enrolling in health coverage through creation of a “Connector.”

19) Maximize access to/enrollment in private coverage for working lower-income Coloradans who are not offered coverage at the workplace.


Commission, Cont.

22) Merge Medicaid and CHP+ into one program for all parents, childless adults and children

23) Improve benefits and case management for the disabled and elderly in Medicaid.

25) Expand eligibility in the combined Medicaid/CHP+ program to cover more uninsured low-income Coloradans.

26) Ease barriers to enrollment in public programs.


Commission, cont. 24) Improve delivery of services to vulnerable populations.

27) Enhance access to needed medical care, especially in rural Colorado where provider shortages are common.

28) Create a Consumer Advocacy Program including an Ombudsman Program.

29) Continue to explore the feasibility of giving Coloradans the option to enroll in coverage that will stay with them regardless of life changes, such as the Optional Continuous Coverage Portable Plan that the Commission

modeled.

30) Continue to explore the feasibility of allowing employers to offer 24-hour coverage (e.g., all of an employee’s health needs, including health and workers compensation claims, are covered by a single insurer).


• State based marketplace • Created by state statute in 2011 –

Access, Affordability and Choice• Non-profit, instrumentality of the state• Full time staff• Board of Directors• Legislative Implementation Review

Committee


Individual/Family Marketplace

• Customers have 150 plans choices from 10 carriers

• Prices vary by age, 11 rating areas, size of family and tobacco use

• Medical and dental plans, standalone dental, link to vision

• Financial assistance for those who qualify


Small Business Marketplace

• Employers will have 92 health plan choices from six carriers

• Prices vary by age, 11 rating areas, size of family and tobacco use

• Choice model – allows employer to provide dozens of health plans

• No requirement to provide insurance for employers with up to 50 employees


Customer Support

• Customer Service Center• Brokers/Agents• Health Coverage Guides

– Over 50 sites in over 75 locations, 23 will serve small businesses

• Unpaid Certified Application Counselors


Unique features of

• Open marketplace model with diverse range of health plans

• Two types of dental products

• Anonymous shopping feature

• Searchable provider directory


Medicaid

• Expansions of Medicaid and CHP+ through Colorado Health Care Affordability Act– Children and pregnant women,

parents– Children and adults with disabilities– Adults without dependent children

• Accountable Care Collaborative


Medicaid

• Expansion to adults and parents up to 133% of the federal poverty level beginning on January 1, 2014

• Estimates of newly eligible:

Uninsured parents: 20,000

Uninsured adults without dependent children: 159,000

Source: CHI analysis of the 2011 American Community Survey (ACS). Removes 19,250 AwDC up to 10% of FPL who will enroll under HB09-1293.


Source: Colorado Health Institute, April 2013.


October 2013

• Customer Accounts– 23,827 PEAK (State online system)– 52,542 Connect for Health Colorado

• Enrollments starting 1/1/2014– 34,168 Medicaid– 3,408 Connect for Health Colorado


Looking Forward

• Medicaid and CHP+ enrollment is year round.

• Open enrollment for products purchased through Connect for Health Colorado ends on March 31, 2014.

• Individuals/families with a qualifying event may still enroll.


Questions?


Gretchen Hammer, Executive Director

[email protected]

mailto:[email protected]

leading change for a healthier colorado health care in colorado: changes in health coverage gretchen...

Documents

colorado health access

healthier colorado health

healthier colorado commission

healthier colorado reasons

leading change

legal resident of colorado

health conditions

health insurance carriers