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Health Law and Policy Update: Hospital Payment Assistance Program to begin August 8

This week's updates

What's New

Hospital Payment Assistance Program to begin August 8
The Hospital Payment Assistance Program, which was created by SB12-134 will take effect on August 8 giving uninsured patients the opportunity to understand and responsibly pay their hospital bills, without the fear of being sent to collections or going into bankruptcy. The Colorado Consumer Health Initiative and the Colorado Center on Law and Policy released a new summary of the Hospital Payment Assistance Program as well as an information sheet for consumers.

The Hospital Payment Assistance Program:

  • Requires hospitals to make information about discount programs and charity care available in hospital waiting areas and on hospital websites. Patients will also receive this information while they are in the hospital and it will be included with their hospital bills. The information must be communicated in a clear and understandable manner and in languages appropriate to the communities and patients the hospital serves.
  • Requires hospitals to offer to screen uninsured patients for the discount program established by the bill, as well as any other financial assistance or charity care programs offered by the hospital. This determination must take into account all federal, state, and local government requirements. The bill will also require hospitals to offer reasonable payment plans to uninsured patients and allow for thirty days to pass after a missed payment before initiating collection proceedings.
  • Limits the amount that low-income uninsured patients (250% of Federal Poverty Level or below) will be required to pay on a hospital bill to not more than the lowest negotiated rate paid to the hospital by a private insurer. 250% of the Federal Poverty Level represents an income of $27,925 annually for an individual or $57,625 for a family of four.

The Hospital Payment Assistance Program represents a major advancement in protections for uninsured Coloradans and we hope will reduce the burden of hospital debt for low income individuals and families. Uninsured patients who do not have the bargaining power of large insurance companies or public programs are charged much higher prices for hospital care than those with insurance. Public programs and private insurers negotiate lower prices with hospitals. Uninsured patients are the only group that pays the full listed prices for hospital care. These higher prices are a significant hardship for working families that already struggle to afford medical care, forcing many patients to go into debt, or even declare bankruptcy.

Affordable care act reduces costs of prevention related services for women
Under the Affordable Care Act, new and renewing health plans will be required to provide women with the following eight prevention-related services without charge:

  • an annual well woman visit,
  • birth control, including oral contraception and IUDs,
  • HIV screening and counseling,
  • sexually transmitted infection counseling,
  • screening for gestational diabetes,
  • breastfeeding consultation and supplies, including breast pumps, and
  • screening and counseling for domestic violence.

This change took effect as of August 1.  

With these new preventive services in place, millions of women will be able to get the care and services they need to lead healthy lives and to prevent disease.  Read more from the U.S. Department of Health and Human Services and Families USA.


Our colleagues at CCHI and guest bloggers wrote about the benefits of the new changes and produced this video.  


Colorado group awarded loan to start a health insurance co-op

Last week the U.S. Department of Health and Human Services awarded the Colorado Health Insurance Cooperative, Inc. a $69.4 million loan to help start a new health insurance co-op that will be offered to small businesses and individuals in the Colorado Health Benefit Exchange.  The Denver Business Journal reported that these low interest loans for creating co-ops, or Consumer Oriented and Operated Plans, were made available to eligible organizations through the Affordable Care Act.  Co-ops are nonprofit organizations that sell health coverage and are consumer directed.  The co-op will increase the availability of affordable coverage in the Exchange.  For more information on co-ops under the Affordable Care Act, see the fact sheet prepared by HealthCare.gov.

Advancing the Debate

Medicaid expansion may lower death rates
A recent study conducted by Harvard researchers and published in the New England Journal of Medicine indicates that Medicaid expansions were associated with a significant reduction in mortality.  The study compared data from three different states-New York, Maine and Arizona-that expanded their Medicaid programs since 2000 to adult populations, which are not typically covered under Medicaid.  The study sample specifically included adults between the ages of 20 and 64.  The study compared mortality rates of this population between five years before the Medicaid expansion and five years after the expansion.  Once adjusted for economic factors and population-specific factors such as age, sex, etc., the researchers found that the Medicaid expansions were associated with an approximate 6.1 percent decline in deaths (19.6 deaths per 100,000 adults).  The study compared mortality rates in the states that expanded Medicaid with neighboring states that did not and found that neighboring states actually saw mortality rates increase over the same time period.

This study underscores the importance of ensuring that all Americans have access to quality, affordable health coverage.  As we discussed in a recent Health Law and Policy Update, Colorado should carefully study and consider all the benefits of the Patient Protection and Affordable Care Act's Medicaid Expansion.  The benefits to the health care system, the Colorado economy, and uninsured Coloradans greatly outweigh the costs.

Report shows large numbers of Americans experience gaps in health care coverage
A new report from The Commonwealth Fund found that 89 million Americans (36.3 percent), ages 4 to 64, were uninsured for at least one month between 2004 and 2007.  The researchers specifically found that these 89 million individuals include:

  • 12 million people who were continually uninsured;
  • 11 million who gained coverage at some point;
  • 11.5 million who lost coverage;
  • 14 million who experienced a single gap in coverage; and
  • 6 million who had a temporary spell of coverage and were otherwise uninsured.

According to the report, more than a quarter of the individuals who were uninsured between 2004 and 2007 lost insurance more than once.  These gaps in coverage are often due to the loss of or change in employment and changes in family circumstances.  Provisions of the Patient Protection and Affordable Care Act (PPACA) will likely result in a reduction in the number of individuals that experience gaps in health care coverage.  This will be due in part to the requirement that the newly established health insurance exchanges-which are where individuals will receive premium assistance in the form of tax credits to purchase insurance- must be at least minimally connected with state Medicaid agencies.  Thus, when an individual experiences a change in employment, income or other family circumstance, they will be directed to the health coverage that meets their needs (be that Medicaid or commercial coverage through the exchange).  As implementation of PPACA continues in Colorado, it is essential that these systems are designed in a manner that ensures individuals remain covered when their circumstances change.

Health Law and Policy Update is issued weekly by the Health Care Program of the Colorado Center on Law and Policy. Previous editions are available on CCLP's Web site.

Health Care Director

Elisabeth Arenales 

Health Care Attorney

Adela Flores-Brennan 

Health Care Attorney

George Lyford

Rice Fellow

Emily Wattman-Turner

Follow CCLP's Health Care Program on Twitter, @cclpjusthealth.