Blueprint for Colorado health care

Lacking medical insurance could lead to tax penalty

David Montero, Rocky Mountain News

Tuesday, September 11, 2007

Health insurance would be mandatory, Medicaid eligibility expanded and employers would not be required to cover their workers under a fifth proposal considered Monday by a group given the task of overhauling health care in Colorado.

Under the plan, Coloradans would be required to provide proof of health insurance when filing their state income taxes. Failure to do so could result in a tax penalty equal to the cost of a year's worth of coverage.

The proposal is among those being considered by the Blue Ribbon Commission for Health Care Reform, which is looking for solutions to problems such as how to cover the roughly 700,000 people in the state without health insurance.

The commission is sending various recommendations to the Lewin Group, Virginia-based consultants who are crunching numbers and working on the details of how the plans would be implemented.

The 23 commissioners sparred over details in the fifth proposal before agreeing on many of its components.

Mark Simon, an advocate for the disabled, became animated when he talked about the direction in which he perceived the reform process going - namely forcing people to have insurance through for-profit companies.

"I have an increasing level of discomfort . . . but I've got to say the solution is not to give more money to the insurance companies," Simon said. "That's outrageous."

The daylong meeting was one of the last before the commission must firm up the ideas that will be sent to the consultants.

The Lewin Group already has come up with models for how four other proposals could work and what their impacts would be - ranging from universal coverage that would raise the income tax rate to one that doesn't change much from how things currently operate.

The commission will present its recommendations to the legislature by January.

Many see the fifth proposal as a blend of the others. Ideas for funding it include a tax on soft drinks and snacks and increasing the tax on tobacco and alcohol.

Barbara Yondorf, a commissioner who works for Rose Community Foundation, a major funder of health policy initiatives, said they were interested only in those ideas that would generate serious revenue, not "$1 million or $500,000 ideas."

Also debated Monday were requirements for Medicaid eligibility. Several commissioners wanted eligibility to begin at 200 percent of the federal poverty level, but a few said that didn't provide a wide enough safety net and suggested allowing it to begin at 250 percent. Federal poverty level for a family of four is $19,350.

The commission must come up with a way to address health care for illegal immigrants, too, said commission chairman Bill Lindsay. He said federal laws require they be treated at emergency rooms and yet they would not be eligible for the state's health care plan under current law.

"I don't think they should be excluded from the conversation," said Lisa Esgar, who works with the office of state planning and budgeting.

The commission said it still wants to study several recommendations in the fifth plan including the role of employers.

One option discussed was assessing a fee for employers who don't provide health insurance for employees, but some cautioned that employers might decide it's easier to pay a fee than provide health insurance.

Fifth proposal highlights

• Would require every legal resident to have basic coverage

• Would be enforced through a tax penalty equal to one year's worth of coverage

• Would create three or four basic plans that must be offered by all carriers

• Would not require employers to cover employees

• Would provide one year continuous eligibility in Medicaid

• Would increase taxes on tobacco and alcohol and levy a snack and soft drink taxSource: Blue Ribbon Commission For Health Care Reform

monterod@RockyMountainNews.com or 303-954-5236