After choosing 4 health care reform proposals for evaluation by the Lewin Group out of 23 comprehensive health care reform proposals submitted (7 of them single payer), the 208 Commission wrote its own 5th Proposal. The elements of their own 5th Proposal make up the health care reform recommendations in their final report to the Legislature. The Commission proposal is fashioned after Massachusetts reform of 2006, designed around an Individual Mandate to purchase private insurance, with a substantial tax penalty for failure to comply, and taxpayer subsidies to private insurances for premiums. 

Seemingly, the insurance industry has co-opted the term "universal health care" to mean an Individual Mandate to purchase private insurance, assuring them a larger market, without assuring quality and better health care access for families and individuals. As noted in the piece below about the Commission Recommendations, Massachusetts commercial health care premiums are in their 8th year of average double-digit increases -- as premiums rise, more people become eligible for subsidized private insurance or public programs, which in turn shifts more costs to the state's taxpayers. There are no cost controls on commercial insurances in Massachusetts.

As you will see, the Commission marginalized the Colorado Health Services Single Payer proposal and disregarded the fact that it is the only systemic reform, demonstrating the ability to both save the state money -- $1.4 billion -- and to provide comprehensive coverage for all. Below is an overview of the 208 Commission Draft Final Report to the Colorado General Assembly, notable as much for what it excludes as for what it includes, as well as some notes about the serious shortcomings of the Massachusetts-style reform.

Michele Swenson

Health Care for All Colorado

Overview: Colorado Blue Ribbon Commission for Health Care Reform (Draft) Final Report to the Colorado General Assembly

The 208 Commission Recommendations fail to address:

    * Rising cost of health insurance premiums (82% increase in 6 years in Colorado), copays, deductibles and prescriptions

    * U.S. fragmented health insurance system that siphons more than 20 percent of health care dollars to profits, exorbitant CEO salaries, etc. and layers of administrative waste.

    * A greater than doubling of median family income spent on health insurance: 7.7% in 1987 to 19% in 2005

    * As premium costs continue to increase, coverage has decreased: "Insurance does not equal health care."

The 208 Commission’s proposed solution:

    * A cornerstone of the Commission Recommendation is the Massachusetts-style ‘Individual Mandate’ to purchase private insurance, with a substantial tax penalty for failure to comply.

    * The Commission counts heavily on taxpayer subsidies to private insurances.

    * The Commission attributes cost-shifts to the uninsured - yet Lewin's Graph on Cost Shift shows that the uninsured and under-insured combined (labeled 'self-pay') contribute less than 20% to the total cost-shift burden. John Sheils of the Lewin Group informed the Commission that half of all uninsured pay their own health care bills.

    * Commission Recommendations state: "A minimum benefit plan - a leaner health insurance package with high deductibles, annual caps or limited benefits (average monthly premium $200/individual) is considered essential for assuring availability of an affordable product."

Shortcomings of 208 Commission Recommendations:

    * The Massachusetts-style ‘Individual Mandate’ creates a captive market for commercial insurance without quality or cost controls on insurance charges. In Massachusetts, 2008 marks the 8th year of average double-digit premium increases, resulting in more who cannot afford insurance and are moved into subsidized or public insurance, at greater taxpayer expense. (Boston Globe, 9/13/07, 12/5/07)

    * The 208 Commissioin seeks to solve one problem by exacerbating another – by moving more of the uninsured into under-insurance, or Minimum Benefit Plans. Attributing all unpaid medical bills to the uninsured and to under-reimbursed public programs, the Commission disregards the rising trend of unpaid medical bills by the under-insured. The annual Trend Watch Reports of the American Hospital Association reveal that out-of-pocket costs have risen from $146.3 billion in 1995 to $249.4 billion in 2005 - a 59% increase that parallels the 60% increase in unpaid medical bills over the same period. See Graph of Increasing Out-of-Pocket Expenses.

    * The Families USA Report Too Great a Burden: Colorado's Families At Risk (12-13-07) reveals that 1,054,000 people under the age of 65 in Colorado are in families that will spend more than 10% of their family income on health care costs in 2008 before accounting for taxes. Out of these people, the vast majority, 82.6%, have insurance. Out of these Coloradans, 299,000 live in families that will spend more than 25% of their pretax income on health care costs in 2008. The numbers of under-insured people have increased since previous studies in 2000, and as a result, put thousands of families at risk due to a growing health care burden. 

    * As premium rates continue to rise faster than the rate of inflation or wage increases, more employers will either drop health coverage or move employees into Catastrophic ‘Minimum Benefit Plans’ with high out-of-pocket costs that leave families vulnerable to increasing health and financial risk, and contribute to over 50% of personal bankruptcies precipitated by high medical bills.

    * The Commission Recommendations add many new categories of coverage, eligibility testing, and new departments of administration, as well as layers of taxpayer subsidization, multiplying administrative and public costs of health care.

Some goals defined by the Commission – "to provide consumers with "a choice of insurances" and to "ensure the ongoing viability of Colorado’s insurance markets" – falsely equate insurance with health care access. People want a true choice of health care, not choice of ‘minimum benefit’ insurances. The Commission Report begs the question: Is reform intended to insure the bottom line of the health insurance industry, or health care access for all?