19 May 2007

Thursday's 208 Commission discussions

For those interested in a glimpse of what the commission’s discussion looks like, here’s a snapshot from Thursday’s discussion of Health Care for All Colorado's single-payer proposal.

Commissioner Mark Wallace, a physician from Greeley who may be closest to being a single-payer proponent on the commission, said that the Colorado Health Services (CHS) Program was a bold proposal, and he liked that. "Rocky is always bold," he said.

He was referring to Rocky White, MD, the Western Slope physician who wrote the proposal. The general agreement and laughter at that from around the table left me feeling as though Rocky was a rather mythic figure, something out of a movie about the Old West.

Mark Simon of the Cross Disability Coalition said that the proposal was unique in that it actually reforms the insurance industry (actually, it does away with it). He criticized the proposal’s claim that Medicare works well, when in fact he says it does not work well for his community. He very much liked the fact that the proposal addressed long-term care. However, he had a question about a 25 percent increase in home and community-based care, finding the following unclear:

Full long-term care will be incorporated over time, with consideration for the increased demand that will occur upon its initial inclusion. In the first year there will be allowance for a 25% increase in home and community-based care (in addition to any savings from institutional care and anticipated savings from consolidation of all current programs for LTC, including 80 federal programs). Long-term care will be financed by CHS, with the exception of ‘room and board’ payments by patients who are not low-income requiring institutional care.

“Increase from what?” Simon asked. He also had concerns about hospitals getting the same payment for everything. What about specialty hospitals, like Craig? They would need more, he thinks.

Bill Lindsay, the commission's chair and president of the Benefits Group, Lockton Companies of Colorado, Inc.
, said that the fact that providers would be reimbursed at the same rate everywhere was both good and bad in his mind. He would like to see some element of quality also being a contributing factor for reimbursement.

Sarah Schulte, the commission's technical advisor, liked the fact that the CHS plan offered two financing mechanisms, especially since most of the other plans had not addressed financing at all.

On that issue, Lindsay had earlier said that he liked the fact that another plan had proposed its own revenue stream that would be insulated from the legislature. Then he realized he was remembering a point from the HCAC plan, not from the one being discussed. (The commissioners — all of them people with jobs — frequently mixed up proposals, something that was completely understandable considering they'd been deluged with thousands of pages of dry descriptions.)

Regarding funding, Lisa Esgar, senior director of operations & finance, State Department of Health Care 
Policy & Financing, reminded the commission that there's really no such thing as an insulated fund. All it takes is another vote and the monies are no longer separate. She also worried about hospitals around the state receiving the same funding, as their costs are different, she said.

Elisabeth Arenales, director of the Colorado Center on Law & Policy, liked that the program has a reduction in premiums based on healthy lifestyles.

Dan Stenersen, president and CEO of Shalom Park a long-term care provider, also spoke favorably about the proposal. He said it's well articulated and does a wonderful job of expressing "what we've talked about for the last few months."

There was concern that there was a lack of accountability.

One of the new commissioners, Lynn Westberg, director of the San Juan Basin Health Department, liked that the plan hit the idea of "sin taxes," also that it dealt with the idea of workman's comp.

(Although earlier in the day, in regard to another proposal, there seemed to be general agreement over how bad Pinnacol, Colorado's privatized workers comp, was.)

Westberg said she'd like to see the HCAC plan modeled.

Discussions of other plans included Allan Jensen, an independent life insurance broker warning that Propsal #10, from the Colorado Coalition for the Medically Underserved, could drive away business by requiring employers who do not provide insurance to their employees to pay a fee. For this plan and several others, commissioners wondered what the enforcement would be that required people to buy insurance, especially with guarantee issue. "If it's guarantee issue, why buy it [before you get sick]?"

David Downs, president, Colorado Medical Society, said that plan's requirement was enforced through default enrollment into a public program. They liked that public health and environmental concerns were folded into this plan.

For Plan #11, a Community of Caring, Barbara Yondorf, senior program officer, Rose Community Foundation, said, only partly tongue in cheek, that she loved its language, and whatever plan the commission chose, she wanted to use its language – like "community of caring," and "safety-net stabilization." Commissioners also liked how the plan called for a paradigm shift on how Coloradans view health care; there was a problem with portability with this plan; no mention of long-term care; David Rivera, former state commissioner of insurance, likes the big risk pool here; Lindsay likes strong prevention and patient education. Someone described this proposal as a private sector single-payer plan. The plan generated Tabor questions for Lisa Esgar; in fact, she said, they needed to discuss Tabor in relation to all the plans. Allan Jensen worried about the plan putting insurance companies out of business -- although, he said, that might not be all bad. Bill Lindsay said it had similar concepts to the pool purchasing models of the '90s, the Federal Employee Health Benefit program, which worked well some places.

Yondorf's comment on language prompted Dr. Wallace to praise another proposal for its use of the word, "eschew."

A couple of commissioners said that proposal #12 was their favorite -- a Plan for Covering Coloradans. They liked its purchasing pool concept; its emphasis on quality and information technology. Lindsay wondered about the two-year phase in. Simon said it doesn't address long-term care. Peg Burnette, chief financial officer for the Denver Health and Hospital Authority, one of the new commissioners, said it was like single-payer but realistic. Dr. Downs said it addresses the delivery system, which he said was the elephant in the room. Donna Marshall, executive director, Colorado Business Group on Health, likes how it tiers providers by quality, and how well the premium collection process was thought through. Julia Greene of SEIU likes the "connector," the governance board, and the phase-in. Dr. Wallace pointed out that a previous proposal had elements that entered the housing market; this one has elements addressing getting grocery stores into every neighborhood and obesity in the schools. He wondered how realistic that was.

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