Legislators talk about health-care reform

By Cherry Sokoloski
North Forty News

When the Colorado legislature convenes this month, health-care reform will be one of the big issues.

The Blue Ribbon Commission on Health Care Reform, formed by the state legislature in 2006, will provide its report to the legislature on Jan. 31. Also called the 208 Commission, the group was charged with finding proposals that could increase the number of Coloradans covered by health insurance and also decrease costs.

In November, the commission came up with a list of recommendations. In brief, the group favors requiring everyone to have health insurance (termed an individual mandate), expanding public programs such as Medicaid and Child Health Plan Plus, and providing subsidies to help some people buy insurance. The commission also wants insurance companies to offer a basic plan to anyone who wants to buy it, regardless of how healthy they are.

Under the Taxpayers Bill of Rights, citizens would have to vote on any reforms that require new or increased taxes.

In December, the North Forty News interviewed state legislators from Larimer County to learn about their philosophies and priorities when it comes to health-care reform, and to ask what they think about the commission's recommendations. Their comments follow, with representatives and then senators listed alphabetically.

All of the local legislators have serious concerns about the idea of imposing an individual mandate to carry health insurance. Several mentioned that it would be difficult to enforce, since the state has been unsuccessful in forcing everyone to buy auto insurance.

All three Democratic legislators from Larimer County lean toward a single-payer type of financing as part of health-care reform. Two of the Republicans are strongly in favor of keeping a system of free-market health insurance. Sen. Steve Johnson said he is going to study all options.

Rep. Randy Fischer

After listening to citizens' concerns at the 208 Commission hearings, Rep. Randy Fischer, D-Fort Collins, said he believes citizens' top two priorities are containment of skyrocketing health-care and insurance costs and retaining choice of private health-care providers, rather than having to go to a government-run clinic.

To reduce costs, Fischer said, the most effective way is to expand the risk pool. To accomplish that, he favors a single-payer system of health insurance, but it would not necessarily have to be government-run. Fischer said a single-payer system would make the risk pool much larger, since it would be comprised of all Colorado citizens. Under the current system, each insurance company has its own, smaller risk pool.

"I'd like to see us move away from private insurance," Fischer said.

A single-payer system would also reduce administrative costs for providers, he noted, since they wouldn't be dealing with dozens of different insurance companies.

Fischer does not favor a mandate for individuals to have insurance. Massachusetts instituted such a mandate and, according to Fischer, it has not resulted in lower premiums or lower administrative costs for providers. In fact, more insurance companies moved into the state as a result of the change, resulting in more paperwork for providers.

Fischer said he believes Colorado should have a public/private partnership for health insurance. "Individuals, businesses and government need to be paying into it," he said. He thinks people need to show personal responsibility for their health care by paying at least part of their insurance premiums.

For those who cannot afford standard insurance premiums, Fischer favors sliding-scale subsidies. "This is essential for reform," he said. "It's important for citizens to know that everyone is paying what they can."

Citizens should have access to "guaranteed, affordable coverage," Fischer emphasized, adequate for covering catastrophic illness and with a strong emphasis on prevention and basic services.

As an engineer, Fischer said, he has been trained to look at how to manage costs. "The current system is totally broken and not sustainable," he said. "I will work as hard as I can for substantive health-care reform."

Fischer predicts that the health-care discussions in this legislative session will be challenging. "We will have to have compromises," he said.

Contact Fischer at 303-866-2917 or randy.fischer.house@state.co.us.

Rep. John Kefalas

Rep. John Kefalas, D-Fort Collins, is on the House Health and Human Services Committee, and he said health-care bills are at the top of the committee's agenda for 2008. He said any type of reform has to focus on prevention and creating incentives for people to have healthier lifestyles. Overall, his goal is access to quality health care for everyone.

Kefalas favors a single-payer financing system as the optimal solution, combined with private providers and consumer choice. However, he said, a phased-in approach may be necessary, and he is also open to other solutions such as insurance reform. Kefalas wants to refer some reform measure to voters in 2008 but said it may be "just a start."

He is especially concerned about small businesses with 50 or fewer employees. "They're the ones who are really struggling," Kefalas said. "If we do (reform) right, it will be good for long-term economic development."

Kefalas is dubious about an individual mandate and would prefer incentives. For example, people could get a break on insurance premiums if they had healthy lifestyles.

He favors expanding public programs like Medicaid and CHP+, and he would like to merge the two programs to increase efficiency. "Other states have done that," he pointed out.

One idea he likes is the notion of people "buying into" Medicaid or CHP+ plans. An expansion of these programs would have to be referred to voters, since it would require an increase in taxes.

Kefalas opposes the idea of providing sliding-scale subsidies for the purchase of private insurance. Many constituents have told him they don't want public dollars used to subsidize private insurance companies. Instead, he prefers expanding the public programs and further regulating insurance companies. He pointed to the 208 Commission's study showing that administrative efficiencies could save $167 million each year in Colorado.

As to a basic insurance plan that anyone could buy, Kefalas said the premise is logical, but he is concerned it would not be comprehensive enough. He wants health-care coverage to include issues like mental illness and substance abuse.

Kefalas will continue to solicit feedback from constituents through his community forums.

Contact Kefalas at 303-866-4569 or john.kefalas.house@state.co.us.

Rep. Kevin Lundberg

Rep. Kevin Lundberg, R-Berthoud, disagrees with many of the 208 Commission recommendations on grounds that they represent more regulation and less choice. "Instead of creating choices we're creating mandates," he said. "That's the opposite direction from my preference."

"Regulations and subsidies won't cure the problem," Lundberg said. "Options and free-market choices will."

Lundberg opposes the 208 Commission's recommendation of an individual mandate to have insurance. "I see a whole extra set of regulations," he said.

He also opposes expanding public programs such as Medicaid. "I support perfecting these safety-net programs to serve the target group they were designed for," he said.

In line with creating more choices, Lundberg will again introduce a bill whereby elderly people on Medicaid could have more options about where they live.

Lundberg doesn't like the idea of sliding-scale subsidies for low-income families. "It's moving further down the road to socialized medicine," he stated. "We need to stop micro-managing the medical industry."

Another bad idea from the commission, in Lundberg's view, is dictating that insurance companies must provide a basic insurance plan to anyone. "It will drive up the cost for everyone," he said. "It's not appropriate for government to guarantee that everyone has health insurance."

However, Lundberg does see a need for fundamental changes in the health-care system. Three factors driving up health-care costs, he said, include advanced technology, paperwork and the cost of defensive medicine.

He has several suggestions for bringing costs down. He favors making better use of nurse practitioners in small clinics. He also likes medical cost-sharing programs, which are similar to insurance but not as regulated. One such company is Medi-Share, a faith-based organization.

Lundberg also points to the Simple Care network of clinics in Colorado, with doctors offering discounted rates to those who pay directly for care rather than using an insurance company. "We have to allow experimentation," Lundberg said.

Lundberg served on the Health and Human Services Committee in the Colorado legislature for four years. He is also a former member of the Colorado Commission for Family Medicine.

Contact Lundberg at 303-866-2907 or replundberg@gmail.com.

Rep. Don Marostica

Rep. Don Marostica, R-Loveland, said the state needs "a complete shake-up of the entire health-care system." If costs continue to rise at their present rate, he said, the current system is "not sustainable."

Marostica said he believes dramatic change can be accomplished within the free-market system. "I'm afraid of government health insurance," he said. "Our health-care system is far from perfect, but it's still the best in the world and we shouldn't take a wrecking ball to it."

The legislator does not like the idea of a mandate for individuals to carry health insurance. He also does not want to expand public programs such as Medicaid and CHP+. "I don't want to raise the poverty levels so more people get a free lunch," he said.

Marostica is willing to look at the idea of subsidies to help low-income people purchase health insurance, but that expense must be made up elsewhere, he said.

He also opposes requiring insurance companies to issue a basic health insurance plan to anyone who wants it. "What will it cost the rest of us who are already buying insurance?" he asked. "Our premiums would have to go up."

As the legislature looks at the health-care issue, Marostica plans to pay attention to these principles: A plan should save money for the state; people who already have insurance should not have to pay more; and the quality of health care should stay the same.

Marostica favors full disclosure from insurance companies and providers, so there would be more competition and consumers could shop for the best deals. He also wants to allow Colorado citizens to buy insurance from other states.

He is also considering a plan whereby the government would provide insurance for catastrophic and end-of-life care, and private insurance companies would cover everything else. This arrangement would drive premiums down, he believes.

Marostica said about 80 percent of constituents who have contacted him favor single-payer health insurance. He has also heard from concerned business people who have said they cannot afford to offer health insurance to their employees, so they would oppose a mandate forcing them to do so.

Contact Marostica at 303-866-2947 or don.marostica.house@state.co.us.

Sen. Bob Bacon

Sen. Bob Bacon, D-Fort Collins, is whole-heartedly in favor of a single-payer plan, whereby the state would provide health insurance for all citizens. In his vision, health-care providers would remain private and people would be free to choose their providers.

"It's not socialized medicine," he emphasized.

Bacon said he favors a single-payer plan because it would cover everyone, it's cheaper for the state and it could offer more services, such as long-term care, dental, mental health and drug rehabilitation. By providing some of these services, he claimed, costs could be reduced in other areas of the state budget, such as prison costs.

Other advantages of a single-payer system, Bacon said, would be an increase in preventive care and thus a reduction in emergency room and critical care. "With cheaper and more comprehensive health insurance, more people would be cared for earlier," Bacon said. "This would have a wider benefit for our economy, since we would have a healthier workforce."

Bacon noted that virtually all communication he has received regarding health-care reform has favored a single-payer plan.

The challenge with single-payer, Bacon pointed out, is that citizens will have to vote to raise taxes to pay for it. It's hard to convince people, he noted, that even though they would pay more in taxes, that cost would be more than offset - for most people - by not having to pay insurance premiums anymore.

"It's impossible to determine how much each individual will save," he noted, although analysis has shown that overall, the single-payer system would save money.

Bacon said he thinks a single-payer system should be implemented on a national basis and that Colorado could become a model for a national system.

"Even though voters may not approve single-payer the first time around, I'm willing to submit a single-payer plan as often as necessary," Bacon said, adding that the legislature could tweak and modify the proposal to deal with citizens' objections.

Bacon said if the ideal plan doesn't happen this year, he would settle for sliding-scale subsidies to help people purchase private insurance. He does not think an individual mandate would be enforceable.

Contact Bacon at 303-866-4841 or bbacon@peakpeak.com.

Sen. Steve Johnson

Sen. Steve Johnson, R-Fort Collins, said he plans to "keep an open mind" about health-care reform until he sees the 208 Commission report in January.

"I don't want to rush and adopt something worse" than what the state already has, Johnson said. He added that it's the financing part of health care that's broken, not the delivery system.

This month, Johnson plans to send out his annual survey to constituents, and health-care reform will be one of the top questions.

Johnson does not like the idea of an individual mandate. Instead, he would prefer incentives for buying insurance, such as lower premiums or a tax break.

As to expanding existing public programs such as Medicaid and CHP+, Johnson said the state has to be careful to target these programs to people who really need them. If the programs are expanded too much, he said, there would be no incentive for people to buy their own health insurance.

He likes the idea of providing sliding-scale subsidies to low-income families, so they can more easily buy health insurance. The idea is "more of an incentive than a mandate," he commented, and preserves the idea of individual responsibility.

Johnson also favors "guaranteed issue," whereby insurance companies would be required to sell a basic plan to anyone who wants it. Noting that the goal of insurance is to spread risk among many, he said this strategy could increase the size of the insurance pool. However, he said, "it can't be the total answer."

Johnson sees both pros and cons to a single-payer financing system. A single-payer system, he said, would provide universal coverage, reduce administrative costs and do away with insurance companies' profit motive and the huge salaries of their CEOs. However, he said, it would be difficult for one state to implement, and the proposal on the table does not provide cost controls.

"I definitely want to get an answer" to the health-care crisis, Johnson said. "I want to refer something to the voters that has a chance of passing, so we need to be in tune with the constituents."

Contact Johnson at 303-866-4853 or steve.johnson.senate@state.co.us.