Thirty-one proposals were submitted to the state’s Blue Ribbon Commission for Health Care Reform (often called the 208 Commission), which was established by the legislature in 2006. In May, four proposals were selected for further analyses of their cost and coverage impacts, the results of which will be presented to the commission July 17. This week, Colorado Confidential will take a close look at each of the four proposals.
The Colorado Health Services Program was submitted to the 208 Commission by the Colorado Nurses Association and the Health Care for All Colorado Coalition (HCAC). The HCAC was established in 2001 by a group of doctors, health professionals and others interested in creating a single-payer system for health care.
“It is basically an off-shoot of an organization called Physicians For a National Health Plan,” said Dr. Rocky White, lead author of the proposal.
A single-payer system is one in which a public agency pays for all health care costs. This is the only proposal being considered by the 208 commission that includes a single-payer system. “One of the biggest problems with our health system today is the for-profit insurance industry,” White said. “They are part of the problem, and to make them part of the solution is just making the problem worse.”
The proposal would create the Colorado Health Services program, which would be run by the state and governed by a board of representatives from across the state. The proposal states:
In a sense, the CHS is a publicly owned, not-for-profit health insurance company run in a similar fashion to a public utility.
The CHS would be funded through income taxes or payroll deductions, with employees paying a six percent tax and employers paying four percent for each employee. Employers would have the option of paying for all, part or none of employees’ contributions.
“We don’t want to put the onus of paying for health care on employers groups,” White said. “We want individuals to have some responsibility too. Some employers may want to do that because it could be part of a benefits package used to recruit employees. It just makes them a little bit more competitive in the job market.”
The money going toward the program would be separate from the General Fund “in order to prevent health care dollars from being used as a political football.” Current federal funds for programs such as Medicaid and Medicare would be funneled into the fund.
The program would give all Coloradans equal benefits and access to a wide range of primary and preventative care, including prescription drugs, mental health, substance abuse treatment, chiropractic, dental and vision. Originally, the plan called for no co-pays or deductibles for the first three to five years of the program, but White said there will likely be modest co-pays.
Covering such a wide range of services would be expensive, but public dollars would be saved in the long run, ‘White said. For instance, substance abuse help would keep many people off of welfare and out of the prison system.
Individuals could purchase private insurance for things not covered by the public insurance, and they could choose their own provider.
Health care providers would remain in the private sector, but they would all be paid the same amount for the same services. According to the proposal, competition would come from customer service and patient satisfaction.
While some doctors would object to such a move, White said he’s received positive feedback from others in the medical community.
“Doctors practicing today are fed up with the system,” he said.
Eventually, the plan could include incentives for Coloradans to be healthier.
“One of the things that we’re hoping to do in the future is if we have corporations that will encourage an exercise program with their employees or if they hold meetings twice a year for smoking cessation, then maybe we could lower their tax from four percent to three percent,” White said. “Eventually, it might work for individuals, too.”
As a publicly-funded health care system, the proposal is viewed by many as the most radical option being considered by the 208 Commission. Such a program could run into problems with the Employee Retirement Income Security Act of 1974, or ERISA. The law, originally intended to protect employees’ pension plans, contains provisions that relate to state health insurance laws. The proposal acknowledges that ERISA could be a roadblock, but states:
No matter what type of Colorado plan we eventually adopt, we will run into the potential of an ERISA-related suit; which is why a federal solution is ideal, but as of yet, we do not have that luxury.
White says a single-payer system is a viable option for Colorado because it will save the state money and everyone would have health insurance.
“I think that the mood in Colorado is such that people are actually willing to sit down at the table and look at all the options very seriously,” he said.
The biggest opponents to the plan, unsurprisingly, will be from the private insurance industry, White said. It’s a big change, but a necessary one, he said, and programs would be put in place to help those who would lose their jobs.
“We will be able to absorb a lot of those jobs into the system,” he said.
Read 208 Commission Proposal: Better Health Care for Colorado
Read 208 Commission Proposal: Solutions for a Healthy Colorado
Read 208 Commission Proposal: A Plan for Covering Coloradans
The commission will likely also develop a fifth proposal incorporating different elements of the selected four and may use ideas from the 27 proposals that didn’t make the cut. A final report is will be presented to the Legislature by Jan. 31.
