DENVER — It's like déjà vu all over again.
A political ad is running for the second year-in-a-row, and just like last year, it's airing even before the bill it opposes gets introduced.
Colorado's Health Care Future is airing an ad in opposition to a bill that could create a state-run health insurance option.
Colorado's Health Care Future is a branch of Partnership for America's Health Care Future Action.
It's a group supported by insurance companies and hospitals nationwide.
We put the claims to a Truth Test.
CLAIM: "State politicians want to create a one-size-fits-all government health insurance system called the state government option."
VERDICT: No. The claim itself debunks this. It's not "one-size-fits-all" if it's an option.
To know what the state option could mean, let's first break down how you currently get health insurance.
The majority of people get health insurance through their employer.
People 65 and older qualify for Medicare.
Medicaid is for people earning less than a specific dollar amount. Currently, for an individual that amount is $1,415 per month or $16,980 a year. For a family, the limit is $2,904 per month or $34,848 per year.
The individual marketplace, which includes Connect for Health Colorado, is for people who don't have employer-sponsored insurance or for people who earn more than Medicaid allows.
Child Health Plan Plus (CHP+) is for pregnant women and children age 18 and younger. There is an income requirement. Individuals have to earn less than about $30,000 per year. A family of four qualifies if they earn less than $63,000 a year.
About 8% of people in Colorado get their insurance through the individual marketplace.
The bill about a state option targets those people.
CLAIM: "It gives politicians greater control over your health care."
VERDICT: No. Not as an individual. It would, however, provide legislated criteria that health insurance providers must meet for people who get their insurance through the individual marketplace.
Even if this bill were to pass, you would still be able to choose where you get your health insurance.
For health insurance providers, it creates an ultimatum that must be met by the start of 2025.
The bill tells health providers that they must do both of the following:
- Lower premiums 20% by the start of 2025 for people who get their insurance through the individual marketplace
- Have at least two providers offer coverage through the individual marketplace in every zip code.
Currently, there are 10 counties that don’t have two options in most zip codes.
- Eagle, Jackson, Logan, Moffat, Phillips, Rio Blanco, Routt, Sedgwick, Washington and Yuma counties.
If those two criteria are not met, then the state would start to offer the "Colorado Option."
Under the Colorado Option, a board of nine people would set the rates that health care providers would be reimbursed for specific services.
The nine-person board would be appointed by the state's next governor, which could still be Gov. Jared Polis (D). The appointees would need to be confirmed by the state Senate, which is currently in Democratic control by a margin of 20-15.
CLAIM: Threatening the coverage you already have. And increasing costs."
VERDICT: Maybe. Depending on how insurance providers respond to receiving limited reimbursement from state-insured patients, rates could increase for other customers.
If health care providers are limited in what they're reimbursed for certain services for people covered by the "Colorado Option," those health care providers could choose to increase rates on other plans to help make up what is lost elsewhere. Those providers could also reduce costs or eat the losses.
Colorado's Health Care Future cites a report from FTI Consulting that states "hospitals would experience a reduction in revenues due to rate setting under the state government option…of the hospitals at higher risk of closure under the state government option proposal, over 40 percent serve communities with significant racial and ethnic minority populations, threatening to exacerbate health disparities within communities and across the state."
The report is heavily based on last year's version of the state health option.
It also includes an acknowledgement at the end: "This work was supported by the Partnership for America’s Health Care Future Action."
Partnership for America's Health Care Future is the group that paid for the political ad under the local name "Colorado's Health Care Future."
Bottom Line: Colorado's Democratic lawmakers are attempting a carrot/stick approach that is very much an ultimatum. "Do this or face that." If the bill were to pass, it forces health care providers to make a decision: lower premiums and provide coverage in areas not currently served or risk more people getting insurance under a program with limited reimbursement.
This wouldn't directly impact people who get their insurance through their employers, but if health care providers sought to keep their bottom lines the same or growing, while also facing lower reimbursement rates for those on the individual market, it's possible private insurance rates could increase. If those rates did increase, it would be a choice made by the providers, not because the legislation required an increase.
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