Attacking Outrageous Health-Care Costs in Colorado and Beyond

A new report released today suggests ways for the U.S. Congress to fight rising health-care costs. Meanwhile, Colorado Governor Jared Polis just signed an executive order creating what's been dubbed the Office of Saving People Money on Health Care.

Anne Shoup, communications director for Protect Our Care, a coalition in Washington, D.C. (with staff assigned to Colorado), that put out the report, "The Health Care Congress: Cost, Coverage, Consumer Protections," sees these efforts as both timely and complementary.

As Shoup notes, "We're calling on Congress to enact cost-saving measures for people, but it's hard to say what we can actually get done" with a Republican majority in the U.S. Senate and an administration, led by President Donald Trump, that has made dismantling the Obama-era Affordable Care Act a priority. "That's why it's encouraging to see a state like Colorado step forward to find ways to lower costs for its constituents."

The new Colorado office will be overseen by Lieutenant Governor Dianne Primavera, a health-care reformer inspired by her own battles with cancer.

The executive order is accessible below, but its stated goals include "reducing the cost of individual health insurance by working with the General Assembly to authorize a reinsurance program in Colorado; developing proposals for new, lower cost health insurance options; empowering the Division of Insurance to protect consumers and support rural and mountain communities working to lower their health care costs," and "increasing hospital price transparency and establishing programs to reduce prescription drug prices."

These missions echo many of those in the Protect Our Care report, also linked here. And Shoup believes such policies are a big reason why Polis and other backers of health-care reform were voted into office.

"We saw in the election this November that health care was a top priority for voters," she says. "And I think it continues to be. So we wanted to come up with an agenda based on what we were hearing from the American people in regard to what was concerning them about health care. We had been focused on saving the Affordable Care Act and making sure its protections stayed in place, and our agenda continues to do that. But we're also calling for an end of sabotage to the ACA."

To that end, the coalition's action plan concentrates "on what can affect people in their day-to-day lives," Shoup continues. "They want lower costs, so we're proposing different methods that would lower costs, including the cost of prescription drugs, by allowing Medicare to negotiate drug prices."

In addition, "We're calling for an end to what we call 'surprise medical bills.' People may go to a hospital or an emergency room that they think is in their network, and when they discover it's out of network, they end up with a six-figure bill. And we're asking Congress to stop insurance companies from selling junk health-care plans — short-term plans that don't really cover the essential health benefits. We want to lower costs for people but still maintain quality, affordable health care, not lower costs by offering fewer benefits in coverage that isn't there when they need it."

All of this is important for Colorado, too. Shoup estimates that "the ACA has helped 419,000 people in Colorado to gain health-care coverage. And we're still fighting the battle on pre-existing conditions — and 2,350,000 Coloradans have pre-existing conditions. It's something that really affects almost everybody.

"A lot of Republicans are trying to turn back the clock and act like they were always for protecting pre-existing conditions. So it will be interesting to see how Cory Gardner [Colorado's Republican senator has been identified as among the candidates most at risk in the 2020 election] reacts to all of this. As we saw in how 2018 went," she says, referring to the blue Democratic wave that swept the state, "the tide isn't on the Republican side on this. They're going to have to seriously address this issue, or we're going to hold people like him accountable."

Here's a summary of "The Health Care Congress: Cost, Coverage, Consumer Protections," followed by links to the report and the aforementioned executive order.

Summary:

1. Do Everything Possible to Overturn the Federal Court Decision That Struck Down the Affordable Care Act

• Oppose the Texas ruling by a conservative federal judge in the Northern District of Texas that overturned the entire Affordable Care Act by passing a Senate Resolution similar to the House measure that authorizes the House legal counsel to intervene in the lawsuit and oppose the Republican attorneys general, governors, and Trump Administration who are continuing the war on health care through the courts.

2. End the War on People With Pre-Existing Conditions

• Stop insurance companies from selling junk health insurance that allows them to deny quality, affordable coverage to people with pre-existing conditions. These kinds of short-term plans should be limited to three months with no option for renewal.

• Guarantee protections for pre-existing conditions and essential health benefits. Require all health plans to cover the “essential health benefits” included in the law, ensure guaranteed issue and community rating, and prohibit insurance companies from imposing lifetime and annual limits on the amount of care a patient can receive.

3. Lower Costs

• Lower the costs of prescription drugs. Pass legislation to allow Medicare to negotiate drug prices for all beneficiaries; end price gouging by requiring drug manufacturers to give notice and justify significant price increases; and require transparency of rebate amounts.

• End surprise medical bills. 57 percent of Americans have received a surprise bill. Too many people go to a hospital or Emergency Room that is in their network, but get billed for services provided out-of-network, subjecting them to huge bills, as much as six figures. Congress should pass legislation to end surprise medical bills and limit the amount a provider can charge to a negotiated rate.

• Expand financial assistance by expanding the eligibility for premium tax credits above 400 percent of the federal poverty limit and increase the size of the tax credit for all income brackets.

• Expand services before deductibles; examples would include three primary care visits and one specialist visit that are not subject to a plan’s deductible.

4. End Sabotage Efforts

• Fully support Open Enrollment by restoring funding to the pre-Trump levels and making all information about ways to sign up for coverage easily accessible for everyone.

• Oppose waivers that undermine the ACA and allow states to skirt key provisions of the law.

5. Strengthen Medicaid and Medicare

• Improve Medicare’s affordability by adding an out-of-pocket maximum after which beneficiaries would be protected from additional costs; including prescription drugs in the limit on out-of-pocket spending; adding coverage for vision, hearing, and dental; and making cost-sharing more affordable.

• Extend and increase federal funding for Medicaid expansion.

6. Conduct Oversight on Trump Administration Actions That Undermine the Affordable Care Act

• Topics to conduct oversight on include the Trump Justice Department’s decision not to defend all of the Affordable Care Act in federal court, cuts to outreach and navigator funding, rules opening the door to junk insurance, 1332 guidance that allows federal funds to be used to purchase skimpy health plans, relationships between Administration political appointees and regulated industries, the administration’s push to encourage states to impose work requirements on Medicaid coverage, drug prices and pharmaceutical profits.

Click to read "The Health Care Congress: Cost, Coverage, Consumer Protections" and the Office of Saving People Money on Health Care executive order.