19 May 2007

HCAC makes the final cut!

The Health Care for All Colorado proposal to the Blue Ribbon Commission for Health Care Reform made the final cut and will go on to the evaluation firm, Lewin, for analysis. In fact, the proposal was the only proposal in yesterday’s discussion that seemed to have a clear mandate to go in – all the others were batted back and forth, some of them because they were so similar to one another that they didn’t offer clear enough differences for separate evaluation, others because of questions about their merits.

Here is a round-up of the four plans that will be evaluated, with their numbers. The plans names are similar, and although it would have been just as easy to refer to them by the submitting entity, i.e., HCAC’s plan, SEIU's plan, or the underwriters’ plan, commissioners were referring to them by number.

HCAC’s proposal (#16) the Colorado Health Services Plan, was submitted in coalition with the Colorado Nurses Association, the Older Women’s League, and the Physicians for a National Health Program. Rep. John Conyers is in favor of state efforts like ours, and we expect that he will endorse the proposal as well.

The proposal is a single payer, publicly financed program that covers all primary, preventive, specialty, surgical care, automobile and work-related injuries, prescription drugs, mental health services, chiropractic, dental, basic vision, audiology, home health, long-term care, and hospice services, among others. Under this program, all providers and hospitals would be paid the same for the same level of service, thus competing by the quality of care provided. Through it, every resident has equal access to program benefits. There is no opt-out provision.

It calls for a statewide, fully integrated information technology network to track outcomes, utilization and expenditures. Colorado Health Services would be a non-profit government “insurance company," administered and governed as a public utility with five districts.

The other proposals to be evaluated are those submitted by the Committee for Colorado Health Care Solutions, the Service Employees International Union, and the Health Insurance Underwriters.

A Plan for Covering Colorado (#12), submitted by the Committee for Colorado Health Care Solutions, requires all Coloradans to have health insurance. A fee would be assessed through income tax filing that would cover the uninsured. Employers would pay a portion of the employees' health insurance or an assessment to the state. This plan would create a single purchasing pool that could negotiate rates and plans, and which would have guaranteed issue and community rating. The plan would create the Colorado Health Insurance Purchasing Authority, which will define benefit packages. The standard set of benefits would be based on effectiveness and cost. The authority will also decide guidelines for performance of providers and determine the amounts paid to the providers.

Better Health Care for Colorado (#2), proposed by Service Employees International Union, provides premium assistance for purchasing private coverage. It would provide Medicaid-funded insurance subsidies for those under 300 percent of the Federal Poverty Level (FPL). Those subsidies would cover all of the premium’s cost for those at 100 percent of the FPL; with pro-rated subsidies for those up to 200 percent of poverty to ensure that they don’t spend more than 5 percent of their income on premiums. It would provide a basic benefit package (with annual benefits capped at $25,000 to $50,000) with no deductible through a pool. The plan would also allow individuals to use the subsidy for employer-sponsored insurance. This plan would also reform Medicaid by implementing pay-for-performance for Medicaid hospitals and Medicaid long-term care facilities and other methods.

Solutions for a Healthy Colorado (#5), submitted by the Colorado State Association of Health Underwriters, requires all Coloradans to have health insurance in a reformed market that would include guarantee issue product in the individual market. It would also require guarantee issue of a core benefit plan in the individual market that would include a “Core Limited Benefit Plan” that all carriers would be required to offer with guaranteed issue and with modified community rating. The government would subsidize purchase of the limited benefit plan for those up to 250 percent of the FPL. All provider reimbursements would be tied to one common basis, adjusted for performance on quality benchmarks.

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