Hashing out health insurance | News

Hashing out health insurance | News

State Insurance Commissioner Mike Conway was in town Tuesday to meet with a wide-ranging group that included San Miguel County Commissioner Hilary Cooper, Tri County Health Network Executive Director Lynn Borup, other TCHNetwork staff, representatives from Telluride’s business community and other local entities.

Cooper and TCHNetwork invited the commissioner to Telluride for the gathering, which focused on a trio of initiatives at state level that have been recently set in motion as the result of legislation passed earlier this year.

All three initiatives aim to lower the cost of and improve accessibility to health insurance and healthcare in Colorado, in particular in rural areas like the Western Slope, which suffers from some of the highest health insurance and healthcare costs in the nation.

“It was a good opportunity to update people here on what’s happening at the state level,” Cooper said, adding that the meeting also allowed Commissioner Conway to get local feedback.

The first initiative that the group looked at on Tuesday related to the ability of communities to form nonprofit health insurance cooperatives made up of employers and individuals. The cooperative then negotiates prices directly with regional healthcare providers and insurers, which in turns lowers costs for cooperative members. The concept has existed under state law for some time, but the 2019 legislation has given cooperatives more power in their negotiations.

According to Cooper, Commissioner Conway was closely involved in the establishment of Peak Health Alliance, a cooperative in Summit County, and walked Tuesday’s group through its establishment. One of the first steps undertaken, she said, was to find out how much Summit County residents had been spending on healthcare previously.

“In some cases, they were paying 800 percent of Medicaid reimbursement rates,” Cooper said.

Cooper and TCHNetwork’s Borup described the conversation on cooperatives as promising, although each pointed out that Summit and San Miguel counties are quite different, given Summit County’s superior size and proximity to Denver, and the fact that San Miguel County residents’ network of healthcare providers stretches from Durango to Grand Junction and beyond.

Still, Borup said, a logical next step would be to invite Peak Health Alliance representatives to Telluride for a more targeted discussion with regional healthcare providers, who weren’t in attendance on Tuesday.

“There are probably a couple of key stakeholders that could sit around the table and understand what Peak Health Alliance did, so that we could understand if it can work in our community and who would be willing to support the data analysis that will be required,” Borup explained. “But it’s very encouraging that we have a pathway, a template to follow, which the Division of Insurance (DOI) has supported … It’s going to be a longer haul, but it’s encouraging.”

Next up, Cooper said, Tuesday’s gathering learned about a DOI study that seeks to examine how a so-called “public option” in Colorado might work.

The study was authorized by bipartisan legislation co-sponsored by Rep. Marc Catlin, R-Montrose, whose District 58 includes San Miguel County. The measure directed the DOI to study the costs, funding sources, necessary federal permissions, eligibility and implementation issues around a possible state-based public option health insurance plan that would compete with existing private insurance plans and those offered on Colorado’s healthcare exchange.

Now, the study is underway and Commissioner Conway is traveling the state to both explain the initiative and gather information from healthcare providers, insurers, members of the public and other stakeholders.

“Mike did a presentation,” Cooper said. “He explained that he doesn’t know what it will look like yet and they welcome all ideas. They want to come up with something that will reduce costs and make healthcare and health insurance more affordable. He opened the discussion up to listen to local ideas, what should be included, how people would pay for it.”

According to Cooper, feedback ranged from making healthcare genuinely affordable, (as opposed to simply more affordable) to how to give San Miguel County’s undocumented community access to health insurance.

“We would be excited — depending on what it looked like,” Borup said of a public option. “For example, right now in our region we only have one provider in the individual marketplace and I always think competition is good. It’s healthy.”

She added that the DOI and proponents of a public option “have a huge road ahead of them. They have to determine what the benefits would be, what the infrastructure would look like, what the provider network would be … they have a million questions to answer in a very short time in order to get the traction they need. Again, I think it’s very encouraging and I think the DOI is poised to be successful. You have a commissioner who is very motivated to figure out solutions.”

The meeting subsequently turned to a third initiative launched by recent legislative activity.

Referred to as a reinsurance program, the state initiative recently received federal approval to begin using Medicare reference-based pricing for providers in the individual marketplace and also provide insurers with reinsurance payments to assist in covering the more expensive claims filed by their individual policyholders.

As a result, individual policyholders in the region that includes San Miguel County can expect a 30 percent reduction on average in the cost of their plans in 2020, according to the DOI.

Cooper had advocated for the legislation as part of Counties and Communities Acting Together (CCAT), a nonpartisan, independent organization that looks to influence what happens in the statehouse.

Like Cooper, Borup welcomed the reinsurance program, although she added a caveat.

“We haven’t seen a rate decrease for a number of years so it’s a step in the right direction,” Borup said.

Borup went on to explain, however, that the discounts will apply to those who pay for their individual plans in full and cautioned that consumers who are receiving subsidies may not see a discount.

Cooper described the meeting Tuesday, which was held at the Wilkinson Public Library and attracted about 20-25 people, as a “good first step”.

She continued, “In my experience, we always find a better solution when local stakeholders can get together and build a program that is going to serve us, and then propose that program to the federal or state authorities. Locally developed solutions get better results. Now, I hope we move the conversation forward.”

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