So You Want to Expand Coverage?

The Colorado Experience

Kelly ShanahanPolicy DirectorColorado Consumer Health Initiative

Health Action 2008January 25, 2008Washington DC

2007 MEMBERS & PARTNERS

MEMBERS: 9 to 5 National Association of

Working Women AARP Colorado Allied Jewish Apartments Alzheimer’s Association, Rocky

Mountain Chapter American Cancer Society, Great West

Division American Diabetes Association American Heart Association American Lung Association of

Colorado Arc of Arapahoe and Douglas County Arc of Aurora Arc of Denver Autism Society of Colorado Bell Policy Center Center for African American Health Center for Systems Integration Colorado Organization for Latina

Opportunity & Reproductive Rights (COLOR)

Colorado AIDS Project Colorado Center on Law and Policy Colorado Children’s Campaign Colorado Citizen’s for Accountability Colorado Coalition for the Homeless Colorado Coalition for the Medically

Undeserved (CCMU) Colorado Developmental Disabilities

Council Colorado Health Charities Colorado Progressive Coalition Colorado Rural Health Center Colorado Women’s Agenda

Colorado Women’s Health Care Coalition Colorado Women’s Lobby Community Health Charities of

Colorado Congregation Emmanuel Denver Urban Ministries (DenUM) Empower Colorado Family Voices Colorado The GLBT Community Center of Colo-

rado Health Care for All Colorado Hep C Connection Hunger for Justice Interfaith Hospitality Network of

Greater Denver Kid Connects The Legal Center for People with

Disabilities and Older People Lupus Foundation of Colorado Lutheran Advocacy Ministry Mental Health Association of Colorado Metro CareRing National Alliance on Mental Illness National Association of Social Workers,

Colorado Chapter National MS Society Parent to Parent of Colorado Pikes Peak Partnership Project SOL-Survivor Outreach to

Latinas with Breast Cancer (UCHSC) Rocky Mountain Farmers Union Rocky Mountain Residences Rocky Mountain Stroke Association Service Employees International Union Women’s Resource Center of Durango

PARTNERS:

American Academy of Pediatrics Boulder County Head Start Brookside Assisted Living CCB Partners Christian Healing Coalition Clínica Campesina Colorado Access Colorado Association of Alcohol and Drug Service

Providers Colorado Association of School-Based Health Centers Colorado Behavioral Health Council Colorado Community Health Network Colorado Dietetic Association Colorado Gerentological Society Colorado Gynecological & Obstetrical Society Colorado Health Department, CO Springs Colorado Nurses Association Colorado Organizations Responding to AIDS (CORA) Community Health Partnership Community Voices, Denver Health Covering Kids and Families Denver Department of Human Services Denver Health Denver Healthy People 2010 Denver Hospice Doctors Care El Paso County Department. of Public Health & Envi-

ronment Grupo SALUD Health District of Northern Larimer County High Plains Community Health Center Hospice of St. John Inner City Health Center JFK Partners Latino American Health Network Metro Community Provider Network National Jewish Medical & Research Center Peak Vista Community Health Center Pikes Peak Behavioral Health Group Penrose St. Francis Pikes Peak Mental Health Pueblo Community Health Center Foundation San Louis Valley Regional Medical Center SEIU Nurse Alliance of Colorado Switzer Counseling Center

Welcome to Colorful Colorado!

Employer-Sponsored

54%Public

Programs26%

Private Individual

5%

Uninsured15%

(57% CO)

(17% CO)

(7% CO)

(17% CO = 785,000) (155,000 are kids)

Coverage Nationally vs. Colorado

Fiscal Environment - TABOR

The Taxpayer's Bill of RightsColorado Constitution Article 10, Section 20

Basic Provisions• Voter approval for tax increases• Revenue limits• Government spending limit

– (inflation plus population)• Revenue refunds

Good times, bad times & economic recovery

The Ratchet Effect

Source: “TABOR: Ten Years Later”, (Powerpoint presentation), Carol Hedges, The Bell Policy Center. (www.thebell.org/PUBS/PPT/2003/10TABOR10-2.pdf)

Source: “TABOR: Ten Years Later”, (Powerpoint presentation), Carol Hedges, The Bell Policy Center. (www.thebell.org/PUBS/PPT/2003/10TABOR10-2.pdf)

Colorado Health Benchmarks

Expenditures per capita

Rank State spending required to reach US average

Total State Spending 44 $3.31 B

Medicaid 47 $993 M

SCHIP 32 $13.1 M

Source: Aiming for the Middle: Benchmarks for Colorado’s Future, Colorado Center on Law & Policy (June 20, 2007).

Public Program Eligibility

Colorado Blue Ribbon Commission for Healthcare Reform

• What? Senate Bill 06-208 (also known as ‘208 Commission’)

• Why? To come up with recommendations to the Colorado legislature by January 2008 for comprehensive healthcare reform in our state!

• Who? 27 members appointed by Governor and legislative leadership (consumers, business/industry, health experts)

• Goal: Increase access to affordable coverage for all Coloradans

2007• February: Formal solicitation for proposals• April: 31 reform proposals received• May: 4 proposals selected for analysis• Summer:

– 4 proposals modeled for cost and coverage– Commission developed its own 5th proposal

• Fall: – Public hearings around the state– 5th proposal modeled

• November-December: Recommendations to the Legislature developed

2008• January 31st: Report due to the Legislature

Colorado Blue Ribbon Commission for Healthcare Reform

• Formed the CCHI 208 Work Group– Weekly meetings late January – April 2007– Every week we tackled a different question– Ad hoc groups on specific issues

• Technical Team– Families USA (Washington DC)– Community Catalyst (Boston)

CCHI’ Proposal: Connecting Care & Health for Colorado

Step 1: Do we work with the existing public-private system we have OR do we wipe the slate clean and start all over?

A: Existing system(However, we don’t want to ‘tinker’, we want

major reform!)

Step 2: Public programs...??

Step 3: Private insurance…??risk rating vs. risk poolingcost-shiftunderinsurance

CCHI’ Proposal: Connecting Care & Health for Colorado

Online Tool Demonstration

Four Proposals Chosen & Modeled

No MandatesNo MandatesIndividual I ndividual MandateMandate

Individual & I ndividual & Employer Employer MandateMandate

Single Single PayerPayer

1 2 3 4

• Limited core benefit

• Subsidies ≤ 300% FPL• Age & Health Rating

Remaining uninsured = 10%

• Limited core benefit

• Subsidies ≤ 250% FPL• Community Rating w/i

exchange

Remaining uninsured = 3%

• Comprehensive benefits

• Subsidies ≤ 400% FPL• Community Rating

Remaininguninsured = 2%

• Comprehensive benefits

• No Rating

Remaininguninsured = 0

No MandatesNo MandatesIndividual I ndividual MandateMandate

Individual & I ndividual & Employer Employer MandateMandate

Single Single PayerPayer

1 2 3 4

• Limited core benefit

• Subsidies ≤ 300% FPL• Age & Health Rating

Remaining uninsured = 10%

• Limited core benefit

• Subsidies ≤ 250% FPL• Community Rating w/i

exchange

Remaining uninsured = 3%

• Comprehensive benefits

• Subsidies ≤ 400% FPL• Community Rating

Remaininguninsured = 2%

• Comprehensive benefits

• No Rating

Remaininguninsured = 0

No MandatesNo MandatesIndividual I ndividual MandateMandate

Individual & I ndividual & Employer Employer MandateMandate

Single Single PayerPayer

1 2 3 4

• Limited core benefit

• Subsidies ≤ 300% FPL• Age & Health Rating

Remaining uninsured = 10%

• Limited core benefit

• Subsidies ≤ 250% FPL• Community Rating w/i

exchange

Remaining uninsured = 3%

• Comprehensive benefits

• Subsidies ≤ 400% FPL• Community Rating

Remaininguninsured = 2%

• Comprehensive benefits

• No Rating

Remaininguninsured = 0

Final Recommendations to Legislature

Connector

Improving Value in Health Care Authority

High Risk Pool: Cover

Colorado

Chronic Condition

Subsidized

Individual Mandate

Individual market = guaranteed issue, modified community rating

Small group market = no change

3 Plans (not comprehensive)

Above 400% FPLOn your own

205-400% FPLSliding scale subsidy

(depending on if have offer of ESI)

Streamlined Medicaid / CHP+0-205% FPL

Medically Needy / Catastrophic

Fund

300-500% FPL

Medicaid Buy-In

Medically Correctable Program

Consumer Advocacy Program

Connector

Improving Value in Health Care Authority

High Risk Pool: Cover

Colorado

Chronic Condition

Subsidized

Individual Mandate

Individual market = guaranteed issue, modified community rating

Small group market = no change

3 Plans (not comprehensive)

Above 400% FPLOn your own

205-400% FPLSliding scale subsidy

(depending on if have offer of ESI)

Streamlined Medicaid / CHP+0-205% FPL

Medically Needy / Catastrophic

Fund

300-500% FPL

Medicaid Buy-In

Medically Correctable Program

Consumer Advocacy Program

Lessons Learned for CCHI

Great opportunity for consumer groups to • Dream big!• Think systemically• Build consensus

Helped us to develop…• Consumer Bill of Rights & Responsibilities• Guiding Principles for State Health Reform

Moving forward, gives us direction • legislatively • in our coalition-building efforts

Thank You Families USA and

Community Catalyst!

Colorado Consumer Health Initiative

Kelly Shanahan

(303) 839-1261

www.cohealthinitiative.org