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Health Insurance Exchanges

How the Affordable Care Act Affects You

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For the first couple years after the Affordable Care Act was signed into law, everything seemed to be a bit up in the air.  There was almost constant bickering about the subtle nuances of the legislation, along with uncertainty from both sides of the political spectrum insofar as whether or not the law would stand the test of time.  The Supreme Court had to weigh in, and we also had a major election cycle midway between the signing of the law and the enactment of many of its main provisions.

Most of that has settled down now.  SCOTUS upheld the law.  And there was no election upheaval in Congress to tilt the legislative body towards a crowd that would be likely to repeal it.  States – like Colorado – that had been working towards setting up a health benefits exchange can continue to do so without as much worry that their work might be in vain (there had been How the Affordable Care Act, Obamacare, Affects Yousome concern that the law would be tossed after states had invested a lot of time and money in the exchange-creation process).  We are just over a year out now from January 2014, when many of the major provisions of the ACA will go into effect; it seems relatively certain at this point that the ACA will continue to move forward now that some of the potential roadblocks are in the rearview mirror.

Several provisions of the Affordable Care Act – ACA have already been implemented over the past two years:  Young adults can remain on their parents’ health insurance policy until […]

Election Thoughts – Healthcare Reform And Exchanges

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[…] Tim’s article is an excellent primer on the implementation of healthcare reform, specifically in terms of the health benefits exchanges that need to be up and running by October 2013, when enrollment is scheduled to begin (health insurance effective dates wouldn’t start until January 1, 2014, but people should be able to start enrolling next October).  That’s less than 11 months away, and there’s still a lot of work to be done.  Colorado has been working on its health insurance exchange for some time now, and has made a lot of progress so far.  We’re one of the states that has selected a benchmark plan for essential health benefits, and much of the groundwork for Colorado’s exchange has already been done.  But in addition to the nitty gritty logistics of setting up the exchanges, there are still plenty of legal and administrative bumps that will need to be ironed out.  When the ACA was signed into law in early 2010, the implementation of exchanges and the majority of the law’s “teeth” in 2014 seemed like a long way in the future.  That is now just over a year away, with exchange enrollment beginning in less than a year.  And there’s still plenty of work to be done, especially in states that haven’t made much progress on their exchange implementation yet. […]

Healthcare Fact Checking the Presidential Debate in Denver

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I think that political debates would be a lot more fun (and educational) to watch if non-partisan fact checkers were allowed to sit off to the side and hold up “pants on fire” signs when appropriate. But the next best option is the plethora of online fact-checkers who can help us sift through the statements. It’s generally been acknowledged that there were more than a few half-truths and outright lies in last night’s 1st Presidential debate here in Colorado at the University of Denver.

Specifically regarding healthcare and health insurance reform, there are a couple of PPACA-related points that need further comment. First, we have the comment from Romney regarding the “unelected board, appointed board, who are going to decide what kind of treatment you ought to have.” He’s referring to the Independent Payments Advisory Board (IPAB), whose job is to oversee general Medicare spending. They are allowed to reduce Medicare payments to hospitals with high re-admission rates and recommend ways to reduce wasteful Medicare spending through new innovations. But they cannot restrict benefits, alter Medicare eligibility, or make any decisions regarding treatment options. […]

Colorado Health Exchange Gets $43 Million Federal Grant

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Throughout the entire healthcare reform process, Colorado has been one of the states working hardest to make healthcare for everyone a priority. Even before healthcare reform became a national issue, the Colorado Blue Ribbon Commission was actively working on the problem (and many of the recommendations that the Blue Ribbon Commission recommended ended up being quite similar to reforms that subsequently were included in the PPACA).  So it’s not surprising that the Colorado health exchange is moving ahead on schedule to meet the target of being able to start enrolling people and small businesses in the exchange as of October 2013 (January 2014[…]

How Does Health Care Reform Impact HDHPs and HSAs?

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Will HSA qualified health insurance plans and Health Savings Accounts (HSA) still exist after the majority of the remaining PPACA changes are implemented in 2014?  That’s a question that we often hear from Colorado health insurance clients who are concerned about their existing HSA qualified high deductible health plan (HDHP)/HSA, as well as people who are considering an HDHP but uncertain about the future of that type of health insurance.

In terms of direct impact, the PPACA changes very little about HDHPs and HSAs.  There are only two […]

More About Colorado’s Kaiser Permanente Benchmark Health Insurance Plan

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Yesterday’s article about Colorado selecting a benchmark health insurance plan for individual and small group policies sold starting in 2014 has raised a few more questions and I wanted to clarify some details.

This publication from the Colorado Division of Insurance, the Health Benefit Exchange and the Governor’s office is an excellent resource and answers a lot of frequently asked questions.  It was released earlier this summer, before the Kaiser small group plan was selected, so it includes details about all nine options that were considered as possible benchmark plans.  The Kaiser small group plan that was ultimately picked as the benchmark is listed on page 11 as option A, under “one of the three largest small group plans in the state”.

The 2011 Colorado health insurance plan description for the Kaiser policy is here if you’re interested in the plan specifics.  We had a question from a reader who wondered whether chiropractic care would be covered, but it’s listed as “not covered” on the plan description form (item number 30).  It’s important to note that cost sharing details like deductible, coinsurance and copays are not part of the benchmark program.  The concept of benchmark here only applies to the benefits provided by the Kaiser Permanente health insurance plan.  The deductible on the Kaiser health insurance plan is $1200, but that DOES NOT mean that all policies will have to have a $1200 deductible in 2014.  In order to be sold in the exchanges, health insurance plans will have to cover at least 60% of costs in order to qualify for a “bronze” designation.  And there will also be silver, gold and platinum ratings, so there will still be plenty of variation in terms of cost sharing.

If Colorado had not selected a benchmark plan, HHS would have picked one for us.  HHS would have […]

Colorado Selects Kaiser Permanente As Its Benchmark Health Insurance Plan

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Last December, HHS made it clear that they were giving states a lot of flexibility in determining what plan would serve as the benchmark for the state’s “essential benefits” for individual and small group health insurance policies that would be sold starting in 2014.

After months of consideration, Colorado has selected Kaiser Permanente’s small group plan as a benchmark.  This is the largest small group plan in the state, with almost fourteen thousand members, and was selected by a group of officials from the Colorado Division of Insurance, the Governor’s office, and the health benefits exchange.  The Division of Insurance will be taking comments until next Monday before making a final announcement, and you can contact them by email ([email protected]) if you’d like your comments to be considered.

The Kaiser plan covers services in the ten areas that are required by the PPACA (ambulatory patient services, emergency care, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription medications, rehabilitative services, lab work, preventive care/disease management, and pediatric care), which means that it will serve as a benchmark for services in those areas without the DOI having to add additional coverage minimums.  In addition, the Kaiser plan was generally considered to be a good balance between comprehensive coverage and affordable coverage.  It’s not the most comprehensive policy out there (the much maligned “Cadillac plans” offer more benefits), but it provides […]

I Thought Insurance Companies Couldn’t Decline Due To Pre-Existing Health Conditions Anymore?

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One of the most common questions lately: I was declined for health insurance due to a pre-existing health condition. I thought insurance companies couldn’t look at our pre-existing health conditions anymore because of [the PPACA] ObamaCare?”

I’ve written a quick (yet detailed) answer to the question: “I thought they couldn’t decline people because of pre-existing health conditions” here.

Will Tax Credits Be Available In Federally-Run Exchanges?

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[…] Both arguments are interesting, and very convincing. I read Jost’s first, and found myself nodding in agreement all the way through. But then when I read Cannon and Adler’s response, I also found their points to be compelling and hard to refute. This could be the sort of issue that many people would see as splitting hairs, but on an issue as contentious as the PPACA, I can see this debate getting quite a bit of traction over the next year as the exchange implementation process churns along. And it makes me glad that Colorado took the initiative early on (despite a lot of political wrangling) to begin the process of creating our own exchange. I know there are many flaws in the PPACA, and that the yet-unanswered question about how the exchanges will be funded starting in 2015 is a valid concern. But it still seems like a better solution than sitting back and waiting for the federal government to set up an exchange for us that 1) would not be tailored to our state’s specific needs and 2) might make Colorado residents ineligible for much-needed tax credits to help pay for health insurance.

Colorado Health Benefits Exchange Allowed To Submit Grant Application – But It’s Still Controversial

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[…] But Lundberg’s concerns are still quite valid. The problem of long-term funding – and the question of how many people will utilize the exchange – is something that will have to be solved in order to keep the exchange functional after the federal money is used up. There was a big push to create high risk pool health insurance programs in all 50 states as soon as the ink dried on the PPACA (no doubt this was a very good thing for people in states that previously had no high risk pool option at all), but enrollment was a lot slower than expected. The exchange has to be prepared for enrollment numbers that may be lower (or higher?) than anticipated, and make sure that financially the exchange is able to sustain itself regardless of the level of initial participation.

Although the long-term funding question is unresolved at this point, it would seem that the only viable option is to move ahead with the creation of the exchange. They have less than 18 months now to get everything ready to go for January 1, 2014, and it makes sense that the funding problem has to be worked out in tandem with all of the other administrative questions. If they try to fix the funding issues first, they may not be able to get everything else done in the time they have left. If the federal government is giving out grants to states working on setting up their own exchanges, it seems to be in Colorado’s best interest to take advantage of that and at least submit an application for the grant money.

Colorado Health Insurance CO-OP Receives Loan From HHS

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At the end of July, the first of Colorado’s health insurance CO-OP plans got a $69 million loan from HHS as part of a push by the ACA to develop consumer-owned-and-operated health insurance plans (“CO-OP” is short for Consumer Oriented and Operated Plans).   The CO-OP is sponsored by Rocky Mountain Farmers Union and the bulk of the loan from HHS will be put in reserve to fund claims expenses for initial enrollees. As premium dollars are collected, the loan will be paid back to HHS.

Colorado Senator Irene Aguilar introduced a bill last year to create a state-wide Colorado health insurance co-op, but the bill was tabled in May 2011 after passing its second reading in the Senate.

The new CO-OP being created with the loan money will be especially focused on rural areas of Colorado – which are generally underserved in terms of health insurance options.  In addition, residents in rural areas are often already familiar with the concept of co-ops for other services like utilities.  So a Colorado health insurance plan that is owned and operated by its members should be an especially good fit.

The CO-OP will begin marketing plans next fall with policy effective dates starting January 1, 2014, and is hoping to enroll 10,000 Colorado residents in its first year.  Unlike most commercial health insurance plans available in Colorado, the CO-OP will be able to direct profits back into the plan in the form of lower premiums and/or higher quality service rather than sending profits to shareholders.  And while most health insurance carriers that do business in Colorado are multi-state organizations, the CO-OP will be a local plan based here in Colorado (Rocky Mountain Health Plans is another example of a local, non-profit health insurance option for people in Colorado).

The CO-OP expects to be available both through the Colorado Health Benefits Exchange (aka “the exchange”) and also via independent health insurance brokers and agents.  An innovative new health insurance product – especially one that strives to serve populations that are underserved by our current health insurance industry – is good news for Colorado, as it should foster more competition among the existing health insurance carriers in the market.  Congratulations to Rocky Mountain Farmers Union for the approval from HHS for the loan to get the CO-OP going!

John Roberts and the PPACA SCOTUS Ruling

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[…] Now that the ACA has been upheld by the high court, the states can continue their work to create health benefits exchanges with some degree of certainty that they are not wasting their time (Colorado has been making progress on its exchange for well over a year already, but there’s still much to be done).  There is of course an election cycle coming in a few months, and a full legislative year in 2013 that could result in changes – big or small, depending on the political outlook of the next congress – to the existing law.  But the fact that the Supreme Court has upheld the law as legally valid gives it a lot more credibility than it had yesterday.

There has been some surprise in the blogging world that Justice John Roberts sided with the majority on this one.  Many expected him to be of the opinion that the individual mandate and/or the entire ACA were unconstitutional.  But it’s important to note that at the time he was nominated by George W. Bush, his pro-government views were regarded as a positive attribute by conservatives.  Think back to the things that the government was trying to do in the middle of the previous decade.  Wire tapping, TSA expansion, indefinite detainment of suspected enemy combative in the war on terror, etc.  Those were issues where the government was pressing for more control, and conservatives were generally in support of that.  With a new administration led by a Democrat, there are different areas in which[…]

160th Cavalcade Of Risk – Colorado Wildfire Season Edition

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The news in Colorado for the past few weeks has been dominated by stories of wildfires, and there seems to be a new one every few days.  Watching footage of houses burning and courageous firefighters battling the blazes definitely brings to mind all sorts of risk-related thoughts.  We send our best wishes to everyone living in the areas that have been hit by the recent fires, and hopefully Colorado will get some good rain very soon. We’re very thankful for the firefighters and we’ve mixed in historic images of heroic firefighters from the past.

firefighters With that in mind, welcome to the 160th Cavalcade of Risk.  We’ve been participating in the Cavalcade for nearly six years, and we’re always honored to get the privilege of hosting.  The Cav is all about risk, and with that in mind I wanted to share one of the best articles I’ve seen in a long time on the topic of risk.  Mr. Money Mustache lives just down the road from us, in Longmont.  He’s got quite a way with words, and his blog is both informative and entertaining.  This article that he wrote about the illusion of safety is a must-read.

Jason Shafrin, aka The Healthcare Economist, brings us a solemn article about suicide among veterans from the wars in Iraq and Afghanistan.  Sadly, more veterans have died from suicide than from enemy fire.  This article sheds light on the very real need for better mental health support for our armed forces, both during and after their deployments.

In a similar sobering fashion, Julie Ferguson of Workers’ Comp Insider discusses domestic violence at work – both in terms of violence that occurs in workplaces and violence in homes or other2 locations that can result in injury or death for first responders.  Julie describes the four main types of workplace violence – one of which is domestic violence – and explains why employer cannot afford (financially or morally) to ignore the problem of domestic violence in the workplace.

Switching to happier news, in a short – and very sweet – post, Hank Stern of InsureBlog shares a new study that found the secret to health is 3.5 ounces of dark chocolate every day.  Sounds good!  Of course, for optimal benefits, it should probably be combined with all that other stuff we know is good for us… good diet, plenty of exercise, water, sleep, etc.  That includes red wine, right?

Jaan Sidorov runs the excellent Disease Management Care Blog, and gives us his thoughts on pharmaceutical company coupons.  Drug copays are set by health insurance carriers to reflect the greater cost associated with brand name prescriptions, and the higher copays for brand name drugs usually serve as an incentive for patients to opt for lower copay generics.  But if the pharmaceutical company provides coupons that mitigate most of the copay for the brand name drug, the end result is higher cost for health insurers.  But Jaan wonders what would happen if the insurance carriers were to fight back and offer their own coupons?  Whatever the […]

SCOTUS Lead-Up Health Wonk Review, And The Free Market Nature Of The ACA

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[…] Under the ACA, most health insurance carriers, hospitals, medical offices, pharmaceutical companies, device makers, etc. will all remain privately operated, in the free market. It’s true that the ACA establishes some guidelines that the private entities – and individuals – must follow. Individual health insurance will be guaranteed issue by law, and everyone will be required to purchase health insurance (assuming that the individual mandate isn’t overturned by the Supreme Court), with subsidies helping many families cover the cost. But the products that will be purchased – health insurance and healthcare – will still be primarily in the private sector. I think Justin makes some very good points, especially at the end of his article when he talks about the future. The ACA is by no means perfect, and I believe it will need plenty of tweaks over the years, even if it’s upheld in its entirety by the court. But if it’s overturned and we wait several more years to implement a replacement, we might find that it ends up being a far less free-market-friendly approach.

Aetna, Humana and UnitedHealth Vow To Maintain Some Aspects Of ACA, Regardless Of Court Decision

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Much of the healthcare community is eager to hear what the Supreme Court has to say – likely next week – about the ACA. Given how polarized the topic of healthcare reform has been over the past few years, there’s no way that any decision is going to please more than about half of the country, although the court has the option of picking and choosing various parts of the law to uphold or overturn as it sees fit.

Some aspects of the ACA have already been implemented and have proven to be very popular. A few of the country’s biggest health insurance carriers have stated that they will keep some of the most popular ACA provisions – even if the law is overturned. Aetna, Humana, and UnitedHealth have said that they will continue to offer preventive care with no cost-sharing, allow young adults to remain on their parents’ health insurance policy through age 26, and maintain the third-party appeals process that insureds can use if a claim is denied. Humana and UnitedHealth have also said that they will continue to have no lifetime benefit maximums on their policies and ban rescission except in cases of fraud. […]

Will Exchanges Really Be Able To Provide Lower Cost Health Insurance?

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[…] It will be interesting to see how health insurance premiums in both the individual and small group market look in 2014 when the exchanges get underway, and then again in 2015. If we do see a significant reduction in the cost of small group health insurance via the exchanges, I have no doubt that plenty of small businesses will be eager to set up group plans for their employees – we already know that cost is the primary barrier, and that a lot of businesses would like to offer health insurance but simply cannot afford to do so. But I also wonder whether we might see trends in premium increases that are similar to what we have now, even within the exchange. In order to really get a handle on health insurance premiums, we have to find effective ways of controlling healthcare costs first. The ACA included numerous cost-control provisions, but it remains to be seen how effective they will be. The exchanges are a good way for people and businesses to be able to shop for health insurance and coordinate their coverage with their federal health insurance subsidies. But the exchanges cannot address the actual cost of healthcare, which continues to climb much faster than inflation.

A Look At Project Health Colorado

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A relatively new website – Project Health Colorado – is drawing visitors from all across the state who wish to share their ideas about healthcare and healthcare reform in Colorado.  The project is funded byThe Colorado Trust, and has several prominent partners who share the goal of access to healthcare for everyone in Colorado.  You can read more about the goals and vision of the project in this editorialwritten by Christie McElhinney, The Colorado Trust’s VP of Communications and Public Affairs.

The homepage of Project Health Colorado has five questions that visitors which visitors can answer with a simple yes or no.  Overwhelmingly, the current responses indicate that people are not particularly satisfied with the healthcare system.  The first question asks “Is healthcare in Colorado working?” and 71% of the respondents have answered “no.”  71% of respondents have also answered “yes” to the question about whether they’ve ever had to choose between healthcare and other needs.

In addition to asking people what they think of the current healthcare system, the website also has a page where visitors can suggest suggestions for fixing the healthcare system.  The suggestions that have been posted so far run the gamut from single payer healthcare to completely free market healthcare with no government involvement at all.  Some people suggest an increase in individual responsibility (for example, requiring people who are overweight or who smoke to pay more for their healthcare) while others advocate a more collective system where everyone receives healthcare and tax dollars are used to fund it.  The suggestions mirror a lot of the very diverse opinions that have been offered all across the country over the past few years as healthcare reform has taken center stage in our political system.

I agree with The Colorado Trust and their partners on this project that access to healthcare for everyone in Colorado is an excellent goal.  Health insurance for the uninsured population and affordable healthcare for everyone are vitally important in order to improve the overall health and security of the people of Colorado.  However, I can’t help but notice that the questions on the Project Health Colorado homepage are a bit leading, and perhaps biased towards getting simple answers that highlight a desire to have better healthcare without enough focus on the costs of achieving those goals.  There is no question asking […]

Healthcare Costs Expected To Increase By 7.5% Next Year

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[…] Average out-of-pocket exposure on health insurance policies has been steadily increasing over the last several years (in the individual and small group market as well as the large group market).  Choosing a policy with a higher deductible and/or copays is the easiest way to mitigate premium increases, and it’s a popular option among employers and individuals who purchase their own health insurance.  Ten years ago, Jay and I had a health insurance policy with a $1000 deductible per person.  Now we have a $3500 deductible per person, plus an additional $3500 in coinsurance on an Anthem Blue Cross Blue Shield Core Share policy.  If we had stuck with a $1000 deductible all these years, our health insurance premium would be far higher than it is today.

The study Jason references notes that high deductible health insurance policies accounted for 4% of the market in 2006.  Over the next five years, that share increased to 17% by 2011.  My guess is that it will continue to increase as long as healthcare costs keep climbing at the rate that they have over the past decade.  If cost controls succeed at bringing healthcare cost increases more in line with other consumer price increases (projected to be 2% next year) over the next few years, I imagine that the popularity of high deductible health insurance policies will wane a bit.  There will always be people who are drawn to the tax advantages of HSA-qualified health plans, but a lot of individuals and employers who opt for higher deductibles are doing so in order to make their premiums more manageable.  As long as we continue to have healthcare costs that are climbing at a rate that far outpaces inflation and overall consumer price increases, we will likely see high deductible health insurance plans accounting for an ever-increasing segment of the market.

In addition to a shift towards higher deductible health insurance, large groups also have an increasing focus on wellness programs, which might make their employees less likely than the overall population to need healthcare.  This is another possible explanation for why health insurance premiums in the large group market are expected to climb an average of only 5.5% next year, even with an overall 7.5% increase in healthcare costs.

Healthcare Reform After The Supreme Court Rules

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I would say that the impacts she describes would also apply here in Colorado, even though we’re not quite “active” according to the criteria on the State Reforum chart.  The three criteria on the chart that Colorado has not officially met are areas where the state has been making progress already, so I would say that we’re not too far off from getting a score of five or more.  (For example, Medicaid expansion has been a priority here for a few years, and the Colorado Division of Insurance has made changes to bring more transparency and accountability to the health insurance rate increase review process.  Those two issues are part of the criteria on the chart that Colorado has not yet fulfilled).  And given the Governor’s commitment to expanding health insurance coverage to as much of the state’s population as possible, I would say that Colorado will continue to take steps to reform healthcare over the next few years, even if there ends up being little or no federal framework for reform.  But as Sonya pointed out, if the entire ACA is struck down, the state will have to start from scratch on a lot of issues.  In some regards, however, Colorado has already passed laws that address various individual aspects of healthcare reform – things likegender-neutral premiums and maternity care, for example.  Those will not be impacted by a ruling on the ACA, since they are independent of federal law and apply only to health insurance policies sold here in Colorado.

How Individual Health Insurance Measures Up

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[…] So although it’s true that out-of-pocket costs are higher in the individual market (likely due in large part to people opting for policies that are less expensive), if we combine the premiums and the out-of-pocket costs, the total expenses are lower in the individual market ($8,821 in the individual market versus $15,158 in the group market, using Colorado private sector family premiums for the group data). To ignore cost when comparing the policies is to leave out a large piece of the equation.

The Commonwealth Fund study mentions maternity coverage as an example of a benefit that is often not included on individual policies, thus earning them a “tin” rating. In Colorado, maternity is now included on all policies that have been issued or renewed since January 2011 (the data for the study was collected in 2010). But in many states, maternity coverage in the individual market is rare and/or quite expensive as an optional rider. This will change in 2014, and based on our observations of the Colorado individual market over the past year and a half, I would say that the change will be a positive one. But given the fact that so many individual policies did not include maternity coverage in 2010, I’m curious as to what percentage of individual health insurance plans would have earned at least a “bronze” ranking if maternity had been excluded from the data. If we don’t count maternity, how do individual health insurance plans measure up? Most individual plans (assuming they aren’t mini-meds or some sort of limited benefit coverage) in Colorado in 2010 covered complications of pregnancy and charges incurred by a newborn (eg, a premature baby who is in NICU for weeks). But routine maternity care was included on very few individual plans in Colorado prior to 2011. Given that fact, and the fact that all new individual plans in Colorado now have maternity coverage, I’d be curious to see how individual and group plans compare in 2012.

Overall, I think that The Commonwealth Fund study is a good one. It highlights the out-of-pocket exposure that people have in the individual market, and it’s true that the average plan in the individual market has higher out-of-pocket exposure than the average plan in the group market. But to make the comparison without also looking at the premium costs in each market seems a bit disingenuous. If individual health insurance were two to three times as expensive as it is now, it could cover more costs for members with less cost-sharing. But that doesn’t seem like a good solution either.

Despite IT Problems, Report Gives Colorado High Marks On Exchange Progress

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[…] On the upside, the Urban Institute report gives Colorado props for making good overall progress on setting up the health benefits exchange. Despite the political hot seat that health care reform has been for the past few years, Colorado lawmakers managed to work together to create the framework for our health benefits exchange last year. We have a board of directors in place and the state is moving forward as fast as possible to get things in place for the exchange to be up and running in 2014. A lot is still unknown with regards to the future of the ACA, since the Supreme Court still has to issue their ruling in June regarding the legality of the individual mandate. But if the ACA remains in place and the health insurance exchanges become reality across the country, it’s safe to say that Colorado will be ahead of the curve in terms of getting the bugs ironed out.

The Urban Institute report notes that Colorado had a head start on a lot of the reform issues thanks to the 2008 Blue Ribbon Commission Report. Remember back when that was the big news in health care reform in Colorado? Before health care reform became such a divisive topic across the country, Colorado was working to come up with solutions to many of the problems with our health care system. Some of the recommendations of the Blue Ribbon Commission are very similar to the new guidelines in the ACA, and Colorado had been taking active steps for the past four years to implement the Blue Ribbon recommendations. If the ACA remains in place, it should be a bit easier for Colorado to make the necessary transitions over the next few years, thanks to the progress the state has already made on its own.

Lack Of Public Understanding About Healthcare Reform Law

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This article from Public News Service highlights some of the hurdles the ACA faces in terms of public opinion. An attorney with the Colorado Center on Law and Policy notes that more than 50% of consumers think that the healthcare reform law is creating a new government-run health insurance policy. Given the general unpopularity of government-run programs in general, it’s not surprising that the healthcare reform law has struggled in the court of popular opinion. The public tends to be quite wary of new government programs, especially before they’re in place. Once they’re up and running – like Medicare for example -they sometimes get a bit more popular. But proposing a new government program is generally a good way to get people fired up.

If you’ve been paying attention to the mundane details of the ACA, you know that there’s no new government-run health insurance plan. The public option got nixed from the healthcare reform strategy right from the beginning. The law does expand some of our public health programs that already exist (like Medicaid and CHIP). It seeks to insure most of the currently uninsured population via increased enrollment in private health insurance plans and expanded access to public health insurance. The individual mandate and guaranteed issue individual health insurance will hopefully result in far fewer people without health insurance. In addition, the provision that allows young people to remain on their parents’ health insurance through age 26 is helping to cut down on the number of young Americans without health insurance. […]

Will The Colorado Health Benefits Exchange Be Integrated With Public Assistance Programs?

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[…] Last summer, lawmakers in Colorado were concerned that federal requirements that visitors to the exchanges be screened for eligibility for Medicaid, CHIP and federal health insurance subsidies would increase enrollment in Colorado’s safety-net health insurance programs. Given the budget woes that those programs have had, the lawmakers were hesitant to make the exchange a “one stop shop” for public assistance programs. But much has also been said about the importance of integrating the exchanges with public benefits programs in order to close the gaps that people can fall into if their incomes fluctuate between eligibility for federal health insurance subsidies and eligibility for Medicaid. This proposal calls for the exchange and the public benefits programs to be interoperable as of January 1, 2014 and integrated as of December 15, 2015. For the sake of simplicity and protecting the needs of low-income families, it seems that the more seamless we can make the health insurance enrollment process (particularly for those who go back and forth between Medicaid and private health insurance), the better.

It will be interesting to see how the separate/interoperable/integrated scenarios for the health benefits exchange and Colorado’s public assistance programs play out over the next couple years as the exchange is created and implemented.

Health Wonk Review At The Healthcare Economist

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[…] One of the most interesting pieces in this edition comes from Avik Roy, writing at Forbes about the historical relationship between political conservatives and individual mandates for health insurance. It’s a long article, but definitely worth reading. The individual mandate is going to be on everyone’s radar this year (if it wasn’t already) once it gets taken up by the Supreme Court. Roy’s piece gives us a bit of perspective on how political viewpoints regarding an individual mandate have changed over the decades.

Jon Stewart Interview With Sebelius Focuses Mostly On Health Insurance

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[…] I get the point that Stewart and Sebelius were making. They were addressing the aspects of the ACA that most directly impact people, since health insurance tends to be where most of us interact with healthcare costs. And the interview did – very briefly – touch on healthcare costs when Stewart mentioned that one of the reasons wages have stagnated is because “healthcare costs keep going up.” That is a key point, but they seemed to only be addressing it from the standpoint of health insurance premiums continuing to go up. It’s true that the actual check the employer writes each month to cover healthcare is paid in the form of health insurance premiums. But we have to address the root cause here, rather than just trying to figure out how to reign in premiums.

Steward did ask – in his usual joking manner – whether we all need to start exercising and eating better, which also touches briefly on the idea that a healthier nation would have lower healthcare costs. But overall, nearly the entire interview focused on how the ACA will impact health insurance. While that makes for an interesting interview, it also presents the ACA (at least as far as pop culture is concerned) as health insurance reform rather than healthcare reform. While there were definitely aspects of health insurance that needed reform, addressing health insurance as if it’s the crux of the issue is very much putting the cart before the horse.