Legislators react to 208 Commission's recommendations

State lawmakers on Thursday reviewed recommendations and proposals for making health care more affordable and available to roughly 800,000 Coloradans without medical coverage.

Legislators greeted the effort of the 27-member Blue Ribbon Commission on Health Care Reform with praise and scrutiny, during a joint meeting of the House and Senate Health and Human Services Committees.

Although the legislators applauded commissioners for the 18-month project -- promising to turn much of their work into legislative action -- the costs and viability of the proposed health care reforms also weighed heavily on their minds.

Some also expressed concerns about expanding available government programs and creating new ones.

"It makes me nervous to turn more Colorado dollars over to a system where it's very difficult for us to retain control," said Rep. Spencer Swalm, R-Centennial, referring to the commission's recommendation to cover more Coloradans through federal programs such as Medicaid.

Rep. Ellen Roberts, R-Durango, asked commission chair Bill Lindsay how the state would raise Medicaid reimbursements with its limited funding stream. The federal government matches Medicaid dollars the state provides.

"It's clear that in order to apply all the recommendations, we're going to need a lot more money," Lindsay said. "There's absolutely no doubt about that."

The commission recommends raising Medicaid reimbursements to 70 percent of medical costs in an effort to get more doctors on board with the program, prompting Roberts to question whether that still would be enough.

Lindsay said the commission studied modeling up to 100 percent of costs, but determined it was too expensive.

The commission hopes that streamlining administration of government programs might make the plans more attractive to doctors.

"Our focus was only on physician reimbursements -- it's an effort to show we're working on the problem," Lindsay said. "At the end of the day, our goal is to move reimbursements higher and bring efficiency with it."

Rep. Jim Riesberg, D-Greeley, said he worries that even if the state covers the uninsured, there may not be enough physicians to care for them.

"The huge concern I have is access of care," Riesberg said. "There are many places in this state where even where there's enough money to provide access, there aren't enough doctors."

Lindsay also addressed a question about the commission's recommendation to require all Coloradans to obtain health coverage or pay a tax penalty. But the commission also recommended providing subsidies for those who can't afford coverage -- a costly proposition for the state.

"One of the reasons for focusing on a mandate is because it's the only way to bring young invincibles into the system," Lindsay said, acknowledging that many uninsured people are between 19 and 34. While many are healthy, he said some are "marginally employed and may need some level of subsidies."

Sen. Shawn Mitchell, R-Broomfield, asked Lindsay if it would be "responsible" for Colorado to pursue health care reform, given that a new presidential administration might make it a priority after the November election.

But Lindsay said the state should get a jump on the health care problem.

"Our sense is anything that happens on a federal level is going to take awhile," Lindsay said. "There are some very specific things that we can do as a state right now that probably won't be addressed on the federal level for many, many years. In the opinion of many of us, we just can't afford to wait."

The floodgates for health care legislation are expected to open in February, with at least 48 rumored health care reform bills in the works.

In an overview to legislators, commission member Elisabeth Arenales, health care program director for the Colorado Center on Law and Policy, pointed out that Coloradans spend $30.1 billion on health care annually.

Health care experts believe the uninsured are responsible for rising medical costs, since hospitals and doctors pass unreimbursed expenses back to health insurers, who then pass the bill to employers.

Arenales said in the last 10 years, health insurance premiums and family spending on health care has more than doubled.

"Rising costs mean all of us are in danger of losing coverage," she said. "The status quo isn't working."

While legislators are exploring many of the commission's ideas, Gov. Bill Ritter and legislators from both parties have cautioned that comprehensive health care reform -- including any legislation that involves individual mandates or increased taxes -- probably won't happen this session.

However, an effort to cover Colorado's 120,000 uninsured children by 2010 is picking up some bipartisan support.

Other proposed legislation would give the Division of Insurance more authority to scrutinize health insurance mergers and rate hikes. House Speaker Andrew Romanoff, D-Denver, has said he likes a commission idea to standardize claims forms and to create a clearinghouse to manage administrative work for doctors.

Sen. Bob Hagedorn, D-Aurora, and Rep. Anne McGihon, D-Denver, are collaborating on proposed legislation to provide at least $23 million to public health agencies to prevent disease and promote healthy behavior.

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