A close look at the five proposals now being evaluated by the Colorado Blue Ribbon Commission for Health Care Reform takes a big investment of time. I thought it would be helpful for people to be able to compare key elements in each plan at a glance. I used the commission’s technical advisor review and evaluation standards and the Lewin Group’s analysis of the estimated impacts to write up these summaries.
The Blue Ribbon Commission and its staff and consultants are doing a lot of work to analyze the five proposals, and Colorado has a great opportunity to debate what kind of health reforms are best for our state.
At any given time in 2006, about one in every four Colorado residents were not covered by health insurance. Perhaps you are one of these people, perhaps not. As you look over this matrix, I invite you to think about the kind of health care coverage you would want to have for yourself and your family if you did not have health insurance.
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Better Health Care for Colorado |
Solutions for a Healthy Colorado |
A Plan for Covering Coloradans |
Colorado Health
Services Program |
5th Proposal |
| Expand Medicaid & CHP+ |
Expand CHP+ to 300% of FPL |
Expand CHP to 250% FPL; Expand Medicaid to 100% FPL |
Merge Medicaid/ CHP+ expand to include parents and children up to 300% FPL; childless adults up to 100% FPL |
Covers everyone who has lived in Colorado at least 3 months, including those enrolled in federal programs such as Medicare, TRICARE (Military health benefits), FEHBP (Federal Employees Health Benefit Plan) |
Combine and expand Medicaid/ CHP+ to cover children up to 250% FPL; cover parents and childless adults up to 200% FPL; Medicaid buy-in program for disabled; Medically needy and medically correctable program |
| Subsidies for low-income |
Subsidies for parents and childless adults to 300% FPL; purchase private or employer insurance |
Subsidies to purchase health insurance for those up to 250% FPL |
Subsidies for those up to 400% of FPL |
Subsidies up to 400% FPL; catastrophic care fund for those eligible for subsidy |
| Non-subsidized |
Uninsured above 300% FPL and small businesses not providing insurance |
|
|
|
| Vulnerable populations |
Long-term care reforms to increase access to home & community-based care |
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Expand public programs for disabled up to 300% of FPL; elderly up to 100% FPL, medically needy up to 50% FPL |
Expand CoverColorado to cover more people with chronic conditions; Medicaid buy-in program for disabled; Medically needy and medically correctable programs |
| Exchange or connector |
One-stop shop for consumers |
One-stop shop for consumers |
|
Basic benefit package for all based on current Medicaid benefits: primary care, hospitalization, lab, emergency, auto and workers comp, mental health, substance abuse, dental and other benefits--eventually cover long-term care (room & board excluded for higher-income); minimal copays assessed for services
|
Connector for employers & employees to purchase insurance |
| Benefit package |
Core minimum benefits |
Core limited benefits |
Comprehensive coverage including dental, mental health, substance abuse, prescriptions |
Optional "Continuous Coverage Portable Plan" similar to Medicare; 24-hour coverage option for employers |
| Benefit caps |
Annual benefit cap $35,000; maximum monthly premium $150-$250 |
Annual benefit cap $50,000; mandates that affect less than 1% population & contribute more than 1% of claims cost eliminated |
Standardized benefit plans to allow consumers to compare plans |
|
| Cost controls |
Managed care for Medicaid & primary care in rural areas |
Transparency standards to control & maintain costs |
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Single-payer program governed & administered as a public trust; annual budget determines provider rates; Creates Colorado Health Trust Fund to insulate for state General Fund operating limits; index funding to rate of growth such as Gross State Product (GSP); statewide patient health information network; reward providers for high-quality care, identify and fund training needs
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|
| Market |
Individual |
Individual/ Guaranteed Issue |
Merge individual and small-group markets/ Guaranteed issue |
Individual; "healthy" people can't be turned down; modified community rating (rates vary by age, and geography only) |
| Risk pool |
Modified community rating for core minimum benefits |
Modified community rating; establishes reinsurance pool to cover claims greater than $100,000 |
Pure community rating |
|
| Provider incentives |
Pay-for-performance Medicaid hospitals and Medicaid long-term care facilities |
Establishes uniform provider reimburse-ments |
Safety net providers are included in the subsidy program |
|
| Individual mandate |
None |
Yes; income tax credit with insurance; tax penalty with no insurance |
Yes; pay tax assessment if not insured |
Program funded through income tax and payroll deductions; employers may pay for employees
|
Yes; pay assessment through income tax if not insured |
| Employer mandate |
None |
None |
Yes; must either contribute or pay assessment |
Not required to offer insurance but required to offer payroll deduction/pre-tax plan to help employees purchase insurance themselves |
| ** Remaining uninsured |
467,200 |
133,400 |
106,500 |
0 |
To be determined |
| ** State health spending |
$595 million increase |
$271 million increase |
$1.3 billion increase |
$1.4 billion decrease |
To be determined |
**Source: Lewin Group Technical Assessment, page 230.
