The time is now to build a model health exchange
The complexity of purchasing health insurance has become almost overwhelming. What will you need? What’s a fair price? Is the lowest price the best value? How can you evaluate the quality of coverage?
Large employers have human resources departments to sort through the maze of choices, but no such help exists to simplify the choices for individuals and small employers. Brokers do a terrific job, but the panoply of options and the uniqueness of each consumer defy simplification.
For that reason, every serious health care reform effort in recent years has recommended the development of a health insurance exchange to help individuals and small employers navigate a simpler system to get the best value, comparing actuarially equivalent apples-to-apples services offered by different health plans. For the Colorado health exchange, this was a key recommendation of the 208 Health Care Reform Commission, a bipartisan group established by Gov. Owens, and continued by Gov. Ritter.
Such an exchange was also a part of the federal health care bill enacted by Congress in March 2010. Congress debated whether there should be a national exchange built in Washington or a regional exchange in each state, ultimately deciding that states could either build their own exchanges or defer to Washington to build the exchange. Failure to act in a timely way would be a default to the federal government.
The health policy communities in Colorado immediately began to work on the effort to develop a uniquely Colorado market-based system. Dozens of meetings with hundreds of people contributing thousands of hours of analysis culminated in our bipartisan, policy-focused approach.
The effort included Republicans and Democrats, and resulted in legislation, SB 11-200, sponsored by Democratic Sen. Betty Boyd and Republican House Majority Leader Amy Stephens. Every major business organization and chamber of commerce in the state supported the bill. Virtually every stakeholder who had worked on health care reform in the past decade wanted a Colorado health exchange. In addition, consumers, physicians, brokers, hospitals, health plans and an array of health care advocates supported an exchange.
So, of course, the bill was in trouble.
The seeds of the discord were sown in the summer of 2009, when national health care reform went from a public policy discussion to a partisan political divide. Congress enacted health care reform without a single Republican in support, and set the stage for oncoming dissent. Lawsuits were filed to declare the law unconstitutional, and the mantra of Congressional Republicans became “Repeal & Replace.” Many opponents of the federal health care reform law considered that any effort – even good legislation – that might advance the purpose of the enacted law should be opposed.
Such was the case with SB 200. The passions of these well-meaning folks were intense, and Republican legislators were listening. The argument boiled down to this: Wait to see if the U.S. Supreme Court declares the law unconstitutional or if Congress de-funds health care reform. Forgoing a detailed analysis of Supreme Court litigation or Congressional appropriation rules, I will simply note the practical reality: Delay was not an option.
Constructing a workable health insurance exchange that will maximize value for Colorado consumers is not a simple matter. It will require decisions on hundreds of technical, intricate and interrelated issues that will affect the cost and quality of your health care in the years ahead. Consider just a few: Should we merge the individual and small group markets? Should we equalize the cost of insurance throughout the state? If so, since physicians in ski towns generally charge more than physicians in ranching communities; is it fair to have ranchers subsidize resort towns? If not, is it fair to charge individuals in resort towns more than individuals in farming communities? What is the minimum network required for a health plan? What quality measurements are appropriate so consumers know the value of what they are getting? What minimum health benefits should be included for all consumers?
Each of these issues affect what you pay for health care, and there are strong policy arguments on both sides. We simply don’t have the time to wait to see how things play out in D.C. If we do not form a Colorado health exchange structure now to begin the policy analysis needed to get the best answers for Colorado health care reform communities, the federal government will answer them for us, providing a one-size-fits-all approach for Denver, Durango, Dover, Delaware and Dothan, Ala.
Fortunately, SB 200 passed, so our exchange will be designed by the private sector here in Colorado, not by government officials in Washington. More than that, the debate has made us better and stronger. We now have the chance to turn down the heat, turn up the light, and turn out a model of bipartisan, policy-focused health solutions. SB 200 passed with the support of every Democrat in the Senate, plus the Republican Speaker of the House, the Republican House Majority Leader, the Republican chair of the Health Committee, and a number of other Republicans.
The spirit of bipartisan solutions should not end there. Consumers, businesses, doctors, hospitals, brokers and health plans are all at the table, understanding that the hard work is just beginning. As the governor and legislative leadership appoints the board that will oversee development of the health care exchange, they should look beyond the supporters of SB 200.
This Colorado solution was caught in a crossfire of concern over the scope of federal control in health care. Just because that apprehension was misdirected does not undermine the thoughtful input many of the opponents could bring. We need to invite them to join us, as we face the challenge of building the best insurance exchange with the clearest measurements of value in the country. We need all hands on deck.