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Health Law and Policy Update

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Headlines of the week

General Assembly completes 2011 session
The state Legislature wrapped up its 2011 session Wednesday. The Colorado Center on Law and Policy released an analysis of the session, including looks at health-care related bills. Among the unresolved issues is Senate Bill 11-213, to impose premiums on some participants in the Child Health Plan Plus (CHP+) program. See an action alert below asking readers to contact the governor to urge a veto.

Applications available for exchange governing board
The state Office of Boards and Commissions is accepting applications for appointments to the Colorado Health Benefits Exchange Board through May 23, Gov. John Hickenlooper said Wednesday. Some details from the governor's announcement:

The Colorado Health Benefits Exchange Board will have nine members, with the Governor appointing five members and the House and Senate appointing the other four. The majority of the board members will be individuals and business representatives who are not directly affiliated with the insurance industry.

Each person appointed to the board should have demonstrated expertise in two or more of the following areas: (a) individual health insurance coverage; (b) small business health insurance coverage; (c) health benefits administration; (d) health care finance; (e) administering a public or private health care delivery system; (f) purchasing health insurance coverage; (g) health care consumer navigation or assistance; (h) health care economics or health care actuarial sciences; (i) information technology; (j) starting a small business with 50 or fewer employees; and (k) expert in the provision of health care service.

Senate Bill 11-200 establishes the structure and authority for Colorado's exchange board. That measure has passed the House and Senate, and the governor is expected to sign it.

Federal appeals court begins hearings on health reform challenge
The legal dispute over the Patient Protection and Affordable Care Act moved to a federal court in Virginia this week as the 4th Circuit Court of Appeals began hearings to resolve conflicting rulings from lower courts on whether the law complies with the U.S. Constitution.

The U.S. Supreme Court is likely to make the final decision on whether health reform passed last year is constitutional. The cases turn on whether Congress has the authority to require most citizens to purchase health insurance, a key part of the reform law.

"Since the enactment of the Affordable Care Act in March 2010, 31 lawsuits have been filed to challenge it, according to the Justice Department, which is defending the Obama administration," The New York Times reports. "Nine are awaiting action by Courts of Appeals, and nine are pending in federal district courts. The others have been dismissed."

Kaiser Health News maintains a scoreboard with updated information on 26 cases challenging health reform across the country.

Aetna announces premium decrease thanks to Affordable Care Act
The health insurance company Aetna announced plans to lower insurance rates for more than 15,000 consumers in Connecticut as a result of provisions in the nation's health reform law governing medical costs, the Connecticut Mirror reports.

The Patient Protection and Affordable Care Act says insurance companies must spend 80 percent of premium dollars on health care for individual and small-group plans, and 85 percent for large group plans. The portion of premium dollars spent on medical care is known as the medical loss ratio. An Aetna spokeswoman told the Connecticut Mirror the rate decrease reflects lower-than-anticipated medical costs in the state. Premium rates will decline between 5 percent and 19.5 percent later this year.

Vermont passes bill to establish single-payer system
Vermont lawmakers passed a measure May 6 to create a single-payer health system. Gov. Peter Shumlin is expected to sign the bill, which creates an exchange where consumers will be able to compare private insurance plans based on a common benefits package. A five-person board will oversee virtually every aspect of health care in the state, Vermont Public Radio reports. Kaiser Health News compiled a roundup of coverage.

Advancing the debate

The benefits of health reform for Medicare recipients
More than 620,000 Colorado residents enrolled in Medicare will receive free preventive care, wellness visits, discounts on prescription drugs and other benefits this year thanks to the Patient Protection and Affordable Care Act, the White House said in a new state fact sheet.

Fact sheets for all 50 states and the District of Columbia detail how the health reform law resulted in better Medicare nationwide. A blog post on the White House website offers details.

Few uninsured families can afford a hospital stay, report finds
Families that lack health insurance have financial resources that are far short of what's needed to cover the cost of potential hospital bills, the Department of Health and Human Services said in a report released Tuesday.

The report found uninsured families on average can afford to pay for about 12 percent of hospital stays they may experience.

"One of the most enduring myths in American health care is that people without health insurance can get care with little or no problem. Nothing could be farther from the truth," Health and Human Services Secretary Kathleen Sebelius said in a news release. "The result is families going without care - or facing health care bills they can't hope to pay. When the uninsured cannot afford the care they receive, that cost must be absorbed by other payers. This is why expanding access to affordable health insurance under the Affordable Care Act is so important."

The Colorado Center on Law and Policy's research on health care affordability, released in 2009, found families living with incomes of less than 200 percent of the Federal Poverty Level have little if anything to spend on health care after paying for necessary expenses and other financial responsibilities.

CBO reports 300,000 more Americans would be uninsured under House bill
The Congressional Budget Office Wednesday released its analysis of a bill (H.R. 1683) up for consideration Thursday in a U.S. House subcommittee. The bill, reported on last week in the Health Law and Policy Update, would end stability protections currently in place in the Medicaid and CHIP programs. These provisions prohibit states from making policies that restrict eligibility for adults in these program until 2014 and children until 2019. The result would be a reduction in enrollment in Medicaid and CHIP of 400,000 people in 2013, two-thirds of whom are children. Of those, 300,000 would become uninsured and another 300,000 would become uninsured in 2016.

House budget plan would add dramatically to number of uninsured
Federal spending to support Medicaid in Colorado would decline 41 percent during the next decade under a plan that passed the U.S. House of Representatives last month, a new analysis by the Kaiser Family Foundation found.

The research compared the projected results of the House Budget Plan advanced by Rep. Paul Ryan, R-Wisconsin, with projections for federal spending if current law were maintained. The Ryan budget plan would repeal the Patient Protection and Affordable Care Act (ACA), including its expansion of Medicaid set to begin in 2014, and it would cap federal funding available for Medicaid by converting it to a block grant program.

Under the Ryan plan, enrollment in Medicaid in Colorado would drop by nearly half compared with what would happen under current law, leaving hundreds of thousands of state residents without access to medical care, the report found.

"The repeal of the ACA combined with the adoption of the Medicaid block grant would add millions more to the number of uninsured Americans and compromise Medicaid's role as the health safety net in the next recession," said Diane Rowland, executive vice president of the foundation and executive director of the Kaiser Commission on Medicaid and the Uninsured, in a news release.

An April 13 report by the Colorado Center on Law and Policy examined those and other implications for Medicaid in the Ryan budget proposal.

What you can do

Ask the governor to veto Senate Bill 11-213
Senate Bill 11-213 creates new monthly premiums for families in the Child Health Plan Plus (CHP+) program with incomes ranging from 206 percent to 250 percent of the Federal Poverty Level, or about $46,000 to $56,000 a year for a family of four. The new monthly premiums would be $20 for the first child, $10 for each additional child with a $50 maximum premium per month. CCLP opposes this bill for the following reasons:

  • Children will lose health coverage. Departmental and legislative analysis shows 20 percent of children, or about 2,400, in that income category would lose or forgo coverage due to inability to pay. Families in the CHP+ program already pay annual fees and co-payments.
  • The bill increases administrative burdens for families and the government. The department with administrative authority over CHP+ would have to establish new processes and procedures to bill, collect and track monthly payments.
  • Senate Bill 213 does not help balance the state budget. In fact, analysis by the Department of Health Care Policy and Financing predicts that in the first year, this change will actually cost the state money.

The loss of coverage for 2,000 children is too great a cost for Colorado. Please call or write Gov. John Hickenlooper and ask him to veto this bill.

Find more details about Senate Bill 11-213 in previous editions of Health Law and Policy Update, an opinion piece co-authored by CCLP Health Care Attorney Adela Flores-Brennan, and an opinion piece published on The Denver Post's website.

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  

Communications Director
Perry Swanson

Released May 13, 2011