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Health Care & Health Insurance

Health care is a hot topic of conversation at both the Federal and state government levels, in the human resource departments of companies, and around the kitchen table.  Everyone is trying to come up with a plan to make health care more affordable.  It is frustrating to all of us that “tweaks” in the system don’t seem to have much of an impact and “big ideas” such as the Affordable Care Act (“ACA”) haven’t been able to stem the rapid increase in the cost of health care either.  The issues are big and complex.  No one denies that.  We also know that there is no magic wand that can be waved to fix the system. 

Despite the 2016 rejection of Amendment 69, by a margin of 79% to 21%, which would have created a single payor health system, over $10 billion of the total State budget (equaling 33% of the total budget) is dedicated to health care with 22% of the General Fund allocated to health care.  Is this spending truly consistent with the wishes of Coloradans as evidenced by the vote on Amendment 69?  I think not.  Any version of a single payor health system, and indeed the current level of State spending, is going in the wrong direction.

I believe the first step in addressing the problem is splitting the discussion about the cost of actual health care (from your doctor, at the hospital, etc.) from the discussion about who pays for it (the health insurance discussion).  Without addressing the cost of health care, there will never be a viable solution regarding health insurance

The State can and should take action to address the cost of health care.  Following is just a short list of changes that the State can implement to reduce the cost of health care:

  • Reduce the cost of hospital stays by eliminating the hidden Hospital Provider Fee and any additional fees or taxes that are imposed on health care providers and facilities outside of normal income taxes.  These fees and taxes are passed along to patients, thereby increasing the cost of health care and health insurance. 
  • Review the level of services that are allowed to be provided by various levels of professional certification with the goal to allow lower levels of trained and certified medical professionals to provide services at a lower cost if they can do so safely and within the level of their training. 
  • Institute tort reform to lower the cost of settlements and liability insurance premiums.  Providers, facilities and insurance companies do not ultimately pay either the insurance premiums or the settlements.  These “costs of doing business” are passed along to patients resulting in higher cost of health care. 
  • To avoid surprising patients with uncovered, out of network charges, require that every provider who works in a medical facility, such as a hospital, either participate in the insurance networks that the facility participates in or provide an equivalent in-network pricing for their services.  In many cases, patients may not even have any say in whether or not that particular provider treated them, yet the patient later receives a large bill for out of network charges. 
  • So that patients can become more informed consumers of health care, require that providers and facilities provide cost of treatment estimates to patients in advance of treatment for non-emergency services.  The complete lack of transparency in pricing of health care services has allowed costs to escalate unchecked by the ultimate consumer, the patient.  There is no other service that individuals purchase without any idea of the costs of that service so why do we accept this with our health care?

Given the current state of Federal government involvement as a result of ACA mandates, there are limits to what the State can do to address health insurance.  Still, the State does have some options. 

  • Request Section 1332 waivers from ACA requirements.  While this still requires that the State operate within narrow bounds established by the ACA, other states operating under these waivers have experienced lower insurance premiums than they would have had they not obtained the waivers. 
  • Enhance your ability to purchase insurance that is tailored to YOUR needs by reclassifying as many state mandated benefits as possible from required insurance coverages to benefit options.  These benefits are priced into every insurance policy that is sold, yet may only be applicable to a small subset of the actual insureds.  Allowing insurance companies to offer these benefits as options, particularly in individual health insurance policies, will better match the coverage purchased with YOUR actual needs and will lower the overall cost of health insurance. 
  • Modify the Colorado income tax code so that those who purchase individual insurance policies receive the same tax treatment as those who have group plans through their employer. 

Equally as important as controlling the cost of health care services and the cost of purchasing health insurance is focusing on a reduction in the need for those services.  While little can be done about the accidental broken arm, the use of alcohol and nicotine are the two leading causes of preventable illness and death.   Research shows that those who use marijuana are more likely to use alcohol and nicotine. The expansion of the marijuana industry within Colorado in recent years will lead to increased health care needs by our citizens in the future.  Research also shows that marijuana users use more opioids nonmedically than do nonusers of marijuana.  90% of adults with substance abuse disorders, including opioid addiction, initiated their substance use in adolescence.  Vaping nicotine is more common than smoking cigarettes and continues to be on the rise among youth.  Colorado has the highest rate of teen vaping in the country.  The citizens of Colorado have to decide which is more important to them long term – continuing to expand the drug economy in Colorado or providing an environment that lowers risk to the long-term health of our citizens. 

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