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Health Law and Policy Update

This week's updates

Headlines of the week

Exchange board picks Hammer as chairwoman
The Colorado Health Benefit Exchange board on Thursday elected Gretchen Hammer of the Colorado Coalition for the Medically Underserved as chairwoman.

Several board members said Hammer's selection was intended to counter criticism that the board is heavily weighted with insurance industry representatives. Some of that criticism came from the Colorado Center on Law and Policy, which raised questions about whether the board could function given that many members would be ethically unable to vote on key matters given their conflicts of interest. Details are in previous editions of Health Law and Policy Update.

"Hammer said her goal as chairwoman is to bring together the diverse voices on the board and have meaningful conversations about how the exchange can work. She also chaired a series of public meetings the state held in 2010 to learn what state residents wanted from an exchange," the Denver Business Journal reported.

"I may be in a unique position to provide credibility, given the role that I serve at the Colorado Coalition for the Medically Underserved," Hammer said, according to the Business Journal. "That role may give us a unique ability to build trust."

The board agreed to hire the Attorney General's Office to represent it at least during the initial stage of board formation, and it will begin the process of hiring general counsel. Board member Arnold Salazar and former state Rep. Anne McGihon raised questions about whether the board risked the perception of a conflict of interest given Attorney General John Suthers' role in one of the federal lawsuits challenging the constitutionality of the individual mandate. The board agreed to proceed given that the Attorney General's Office has substantial expertise in helping establish and represent entities accountable to the public, and the conflict, if any, was manageable.

The board established a by-laws committee, and heard a reports from the Small Employer Work Group and on the activities of the Marketing Outreach and Enrollment Workgroup. There was also a presentation from the Wakely Consulting Group about the formation of the Massachusetts Connector.

The board discussed its role in commenting on draft federal exchange rules and agreed it ought to provide comments on how the rules might effect Colorado's implementation of an exchange.

The next meeting is 9:30 a.m. to 1:30 p.m. Aug. 22. Details are on the website of the Colorado Health Institute.

Community health centers will more than double their workforce
Colorado's community health centers have launched a campaign to hire 5,500 additional workers by 2014 to accommodate an expected increase in patients as more people obtain insurance under the Patient Protection and Affordable Care Act.

The national health reform law included funding to pay for most of the new positions, Dr. Tillman Farley, medical services director for Salud Family Health Centers in Commerce City, told the Denver Business Journal.

The additional workers will more than double the number of employees at community health centers in the state. Added capacity will be necessary as an estimated 540,000 more Coloradans are expected to have health insurance when the health reform law is in full effect, the Business Journal said.

A study published in July in Health Affairs found Medicaid participants who receive care at Colorado's community health centers are about a third less likely than those with private providers to have emergency department visits, inpatient hospitalizations or preventable hospital admissions. More information about the state's community health centers is available from the Colorado Community Health Network.

Appeals court strikes down individual mandate
An Atlanta-based federal appeals court on Friday struck down the individual mandate to purchase health insurance in the Patient Protection and Affordable Care Act. The decision came on a 2-1 vote by a panel of the 11th Circuit Court of Appeals. Government attorneys are likely to ask for a hearing by the full court. Kaiser Health News compiled a roundup of coverage of the decision.

Leaders pick members of 'super committee'
The deal to raise the federal debt ceiling included establishment of a "super committee" charged with recommending reductions in federal spending of $1.2 trillion over 10 years. The committee will begin meeting after the August recess and must complete its work by Thanksgiving.

Members appointed are:

  • Senate Majority: Sen. John Kerry (D-Ma), Max Baucus (D-Mt), and Sen. Patty Murray (D-Wa)
  • Senate Minority:, Sens. Jon Kyl (R-Ariz.), Pat Toomey (R-Pa.) and Rob Portman (R-Ohio)
  • House Majority: Reps. Dave Camp (R-Mich.), Fred Upton (R-Mich.) and Jeb Hensarling (R-Texas)
  • House Minority: Rep. James Clyburn (D-S.C.), Rep. Chris Van Hollen (D-Md.) and Rep. Xavier Becerra (D-Calif.)

All six Republicans have signed a pledge to Americans for Tax Reform that they will not vote to raise taxes, the Huffington Post reports.

Kaiser Health News compiled a roundup of news coverage of prospects for the committee.

What's new

For-profit insurance companies show large profits in second quarter
Profits at the largest for-profit insurance companies increased again in the second quarter of this year. WellPoint, UnitedHealthcare and Aetna earned a combined $2.51 billion from April 1 to June 30 this year, according to Wendell Potter, a former insurance company executive who now does research and advocacy on behalf of consumers. That increase was more than analysts expected. On a per-share basis, earnings for those companies, which comprise the top for-profit health insurance companies in Colorado, were up more than 17 percent on average compared with the second quarter of 2010.

The top five 2009 Colorado health insurance companies by market share are Kaiser with 26 percent, Anthem (owned by WellPoint) with 16.2 percent, UnitedHealthcare with 15.8 percent and Aetna with 8.3 percent. Kaiser is a nonprofit organization.

UnitedHealthcare, WellPoint and Aetna have raised their profit forecasts for 2011 based on the strong first- and second-quarter performance.

Federal government awards $28 million to community health centers
Two agencies in Colorado are among the recipients of federal grants to create health service delivery sites, the Department of Health and Human Services announced this week. The grants were awarded under the Patient Protection and Affordable Care Act. Money going to community health centers nationwide totals $28.8 million. Colorado recipients include the Denver-based Colorado Coalition for the Homeless and Clinica Campesina Family Health Services in Lafayette. Sixty-seven communities across the nation received awards, which will ensure access to primary and preventive care to 286,000 patients. More information about community health centers is available on the Department of Health and Human Services website.

Kaiser begins new low-cost health insurance program
Kaiser Permanente recently kicked off its "KPStep" program, a lower-cost insurance plan for young families. Monthly premiums will be based on family size and income, and the plan will include a robust primary and preventive care benefit. A Kaiser document provides more information.

Advancing the debate

How increased cost sharing in Medicaid hurts families
Federal and state lawmakers should consider the consequences of increased cost-sharing in Medicaid, particularly as a new review of research shows families that are eligible for the program cannot afford increased costs. Families asked to pay more under increased cost-sharing policies often must forego other, vitally needed spending.

The National Health Law Program this week released a comprehensive compilation of the research on the effects of increased Medicaid cost sharing. Since the 1970s, research has shown increasing co-payments makes it harder for enrollees to access necessary medical care and services, reduces access to primary care and prescription drugs, and increases emergency room use.

What's next

Hickenlooper to discuss health reform at public meeting
Gov. John Hickenlooper will discuss the Patient Protection and Affordable Care Act at a public meeting set for 6:30 to 8 p.m. Wednesday, Aug. 17 at North Middle School, Health Sciences and Technology Campus Auditorium, 12095 Montview Blvd. in Aurora. An announcement said the governor will talk with the public about what the health reform law means to Colorado and communities like Aurora.

What you can do

Schedule a presentation on health reform
The experts on our health team are ready to help community associations and other groups sort out the complexities of health reform. A key issue now is creating the Colorado Health Benefit Exchange, and structuring it in a way that benefits consumers. To schedule a presentation, contact Health Care Program Director Elisabeth Arenales.

Health Law and Policy Update is issued weekly by the health staff of the Colorado Center on Law and Policy. Subscribe by e-mail or read previous editions.

Health Care Director
Elisabeth Arenales

Health Care Attorney
Adela Flores-Brennan

Special Counsel
Ed Kahn

Rice Fellow
Danny Rheiner

Communications Director
Perry Swanson

Released Aug. 12, 2011