Expanded Medicaid, nurse line part of plan

Panel divided over insuring illegal immigrants

David Montero, Rocky Mountain News

Published September 25, 2007 at midnight

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They decided health insurance should be mandatory for everyone but couldn't figure out what to do about undocumented workers in Colorado.

They liked the increased taxes on tobacco and alcohol but didn't like the $30 million to be spent on preventative initiatives.

For more than eight hours Monday, the Blue Ribbon Commission on Health Care Reform debated those and other details that made up the first draft of a proposal to change the way Coloradans get health insurance.

And when chairman Bill Lindsay finally ended the meeting, that draft was to be sent to a firm in Virginia tasked with crunching the numbers and reporting the impacts of the findings back to the commission.

The vote to move it forward was 13-0, with three abstentions.

"I'm sure the other people in their small groups had similarly difficult conversations. This is an eclectic group not of a common mind, and I think we have come a long way," Lindsay said. "Admittedly there will be tweaks and there will be refinements. That is what this process is all about."

The process started in 2006, when the state legislature passed a bill creating the commission - dubbed the 208 Commission after the bill number. It was part of the state's attempt to reform the health care system in Colorado. The commission sought proposals and received more than 30 before settling on four plans for review.

Of the four proposals submitted, the only one that guaranteed coverage for more than 780,000 residents who went without health care for at least six months in a one-year period was the so-called single-payer system. Insurance underwriters, a powerful union and health care providers submitted other proposals.

After vetting the original four proposals, a fifth proposal began to emerge - a collection of ideas from the other four as well as a series of new recommendations. The commission has been tackling the aspects of the fifth proposal for months.

And that's where the serious wrangling began and continued.

Among the recommendations passed by the commission Monday were to expand Medicaid eligibility to all Coloradans at 200 percent of the federal poverty level and to establish a Medicaid buy-in program for adults and children with disabilities at 250 percent of federal poverty level.

The new proposal also included setting up a 24-hour, seven-day-a-week nurse line for residents and providing continuous enrollment for insurance despite changes in employment and income.

The commission also decided insurance should be mandatory for all residents, but employers have the option to not provide it. Instead, employers could refer workers to a connector system that would allow them to choose their own plan. Standardized identification cards also were part of the proposal.

The commission included tax penalties for people who didn't carry health insurance but allowed that those whose income fell between 400 percent and 500 percent of the federal poverty level to be exempt if the cost of the insurance premium exceeded 9 percent of their income.

But the commission members couldn't agree on what to do about covering illegal immigrants. They acknowledged the problem - that people here illegally continue to use emergency rooms as primary care facilities.

However, commissioner Mark Simon asked everyone to remember what the scope of their task was as the day dragged on and commissioners debated principles of the proposal.

"I think to some degree, we've lost sight of what we're doing," Simon said. "This is not the proposal we are writing for health care reform in Colorado. As a result, we should be looking to get as much data and as many concepts as we can wring out of Lewin."

The Lewin Group, which analyzed the four proposals and will analyze this one as well, will return the data to the commission next month.

Highlights of the fifth proposal for Colorado health care coverage

• Mandates that all legal residents have health insurance.

• Merges Medicaid and the Child Health Plan Plus into a single program and expands eligibility programs.

• Provides subsidies for low-income residents so they can be insured.

• Requires standardized identification cards.

What's Next?

• Draft of fifth proposal sent to Virginia-based Lewin Group for analysis this week.

• The commission gets the results in mid-October.

• Commission will study and tweak the results and send them back to Lewin two more times.

• Final proposal will be finished at the end of November.

monterod@RockyMountainNews.com or 303-954-5236

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