Rx for Colorado's ailing wallet

State commission will get consultants' take today on final four plans aimed at insuring more Coloradans' health while slowing rising costs

Bill Scanlon, Rocky Mountain News

Thursday, August 23, 2007

Coloradans start getting answers today on how they'll pay for health care in the future and whether the state intends to tweak or thoroughly overhaul how it is delivered over the next decades.

The Blue Ribbon Commission for Health Care Reform will learn from its consultants how four proposals - ranging from modest to revolutionary - will affect Coloradans in the pocketbook and in the doctor's office, when it meets from 8 a.m to 5 p.m. at the Englewood City Center, 1000 Englewood Parkway.

The $30 billion spent yearly on health care in Colorado boils down to $6,315 per person, or $16,000 per household, and without reform those numbers will continue to rise.

If Colorado turned to a single-payer universal health system, it would save $1.4 billion annually and be less expensive than the other three proposals the commission is considering, a new analysis by the Lewin Group says.

But single-payer is controversial, would cripple the insurance industry, and would have wealthy Coloradans paying an additional $16,000 or more of income taxes.

The aim of all four proposals, and the task of the commission, is to sharply reduce the number of Coloradans - currently estimated at 772,000 - who have no health insurance, and to stem the ever-increasing costs.

The panel owes a report to the legislature by December.

Single-payer system

Colorado Health Services Plan, authored by Health Care for All Coloradans, a single-payer advocacy group.

Single-payer is controversial because it would require a wholesale revamping of how Coloradans pay for health care, and would require employers to pay 4 percent of their income to a health fund and individuals to pay 6 percent.

But look at how much Coloradans are paying now, say advocates, arguing that the $16,000 per household is keeping hundreds of thousands out of the system and costing everyone else more to subsidize the poor when they eventually get treated at $600-an-hour emergency rooms.

"I don't think people realize how much money is being spent currently," said Dr. Elinor Christiansen, long-time medical director at the University of Denver, who is retired but devoting her time to promoting single-payer coverage.

The plan would save $1.4 billion a year and cover 100 percent of the uninsured, advocates say. Everyone would get a card and emergency room visits would require about a $15 co-pay.

The first $7,500 of a person's income would be free of the 6 percent tax. That means a one-income family earning $50,000 would pay about $2,250 in extra taxes for coverage, but wouldn't have to pay premiums or most copays.

$15 co-pay would be the average for a visit to the emergency room.

Required health insurance

Solutions for a Healthy Colorado, authored by the Colorado State Association of Health Underwriters, the professionals who find health plans for companies and individuals.

The underwriters' plan would require all Coloradans to have health insurance.

"It injects a strong sense of personal responsibility," underwriters spokeswoman Cindy Sovine-Miller said. "It's controversial, but it brings the average person into ownership of his or her body and health care."

People who today can't afford health care because, say, their companies don't offer it, or because a chronic condition makes the premiums very expensive, could purchase a basic plan for no more than $178 per person per month, or $534 per month for a family of three.

It would cost an extra $271 million and reduce the number of uninsured Coloradans by 83 percent, proponents say.

The annual maximum benefit would be $50,000.

If medical costs exceed $100,000 in a year, the bills would be paid by a state reinsurance fund. If costs are between $50,000 and $100,000, the insurance company and the state would share the burden.

An extra tax on non-nutritious foods would help pay for the plan.

83% of Colorado's uninsured would get coverage underthe plan.

The union's plan

Better Health Care for Colorado, by the Service Employees International Union, the largest union representing health care professionals.

The union's plan calls for fewer changes and fewer mandates than the other plans, but would lower the number of uninsured Coloradans by less that other plans.

By subsidizing small businesses and the poor, a lot more people can get health coverage without gutting the private insurance market, said Jake Williams, SEIU spokesman.

Children from households earning less than three times the poverty level would get free coverage.

It would cost $595 million to implement the plan and reduce the number of uninsured by 41 percent.

Seventy million of the extra cost would fall on families and individuals. Companies now offering insurance would save $107 million, and companies not offering insurance would see no change.

State and local governments would spend an extra $53 million if the federal government approves a waiver to allow Colorado to make changes in how Medicaid dollars are spent. If the feds don't approve, it will cost an extra $283 million.

Advocates say the plan will keep costs of coverage affordable - not to exceed $250 a month in premiums.

Extra taxes on cigarettes and liquor would help fund the plan.

$250 a month would be the upper limit on premiums.

The employers pay

A Plan for Covering Coloradans, authored by the Committee for Colorado Health Care Solutions, a coalition of leaders from Denver Health and other hospitals.

Health care professionals are behind this proposal, which would require employers to offer coverage or pay an annual fee to the state. It also requires individuals to have health coverage or pay a tax penalty.

Upper-middle-class and wealthier families would pay more, so that lower-middle-class and poor families can afford coverage.

It would cost $1.3 billion to implement and is expected to reduce the total uninsured in Colorado by 87 percent.

Households earning less than $50,000 would pay less under the plan, those earning more would pay more. But any family of four earning less than $80,000 would get a subsidy to help pay for insurance.

Childless adults and the disabled earning $10,000 a year or less would get free coverage.

Risk pools would be expanded to spread the risk, and people couldn't be excluded from insurance or charged more because of their health status.

The plan would cost an extra $985 million, most of it coming from families and employers who now don't offer coverage.

$5 tax on hard liquor would help pay for this plan.