Colorado’s New Health Care Commission: Unfinished Business
By Julian Kesner, The Colorado Trust
In January 2008, The Colorado Blue Ribbon Commission for Healthcare Reform—more commonly known as the “208 Commission,” after the 2006 bill number mandating its creation—presented its findings and recommendations to the Colorado General Assembly. The 27-member commission, comprised mostly of health care industry experts and stakeholders, was charged with “studying and establishing health care reform models to expand health care coverage and to decrease health care costs for Colorado residents.”
More than six and a half years later, the Colorado Commission on Affordable Health Care met for the first time last month. Also created by legislative mandate, this time in 2014, four of its appointees were members of the 208 Commission, and many of the same organizations and agencies are also represented. Insurance executive Bill Lindsay, who chaired the 208 Commission, was appointed interim chair of this new committee.
At first glance, it may seem this is a case of Colorado history repeating itself. Yet in reality, this second commission is more about unfinished business than a case of déjà vu.
In reviewing the 208 Commission’s final report, it’s not difficult to separate goals that were (or are) being achieved from those that have yet to be substantively addressed. Many of the coverage concerns from six years ago don’t exist anymore, due in large part to health care reform at the federal level. While an estimated 17 percent of Coloradans lacked health care insurance in 2013, that rate is already down to 11 percent—the fifth largest drop nationwide following Affordable Care Act (ACA) implementation. The rate is likely to continue falling.
Yet the second overarching aim of the 208 Commission—to lower health care costs—remains as elusive as ever. After a brief slowdown in increases last year, due at least in part to sequestration-related economic drag, health care costs are on track to grow 5.6 percent nationwide in 2014, and then six percent annually from 2015 to 2023. The good news: This is much slower annual growth nationwide than from 1990 to 2008, and Colorado’s average annual percent growth in health care expenditures per capita is historically lower than most states. The bad news: It’s still more than enough for health care costs to consume more and more of our gross domestic product.
We need to remember that health care spending is not simply or only about the cost of insurance premiums. It’s true that Colorado is going to see cheaper individual premiums next year for some policies sold on its state exchange. Yet more and more plans feature higher deductibles, larger copays and narrower networks, offered by carriers that are rumored to be losing bargaining power with increasingly large hospital systems (health economist Austin Frakt, PhD, recently remarked on the last issue: “Researchers have generally found that hospital consolidation has increased price without commensurate increases in quality”). None of that promises to lead to anyone’s definition of “affordable” anytime soon.
It will be intriguing to see what this latest health care commission can achieve at the state level, especially given that ACA rollout is still underway (The Trust published a 2010 issue brief comparing 208 Commission provisions to federal efforts). There’s already more price transparency than ever before, thanks to the 208 Commission-recommended (and Trust-supported) All Payer Claims Database. We need to know the cost of something before undertaking meaningful efforts to change its price. Yet we’re still in the early stages of sorting out potential versus realized cost-reduction effects due to price transparency.
“There’s a boatload of money in health care.” That’s what Steve ErkenBrack, president of Rocky Mountain Health Plans and a member of both of these commissions, was quoted as saying at last month’s meeting. The question remains as to who exactly is willing to part with some of that money, and to what extent. Whatever ideas are proposed by commission members, it’s unlikely they’ll be unanimously received or result in bipartisan legislation.
Probably the only notion commission members are likely to agree on: Not wanting to create and/or serve on a third such commission a few years from now. Let’s hope that is motivation enough to achieve meaningful results for Coloradans.
