Colorado has long been a leader in terms of health care reform. Before the ACA implemented reform on a federal level, Colorado had already made maternity coverage mandatory in the individual market, and had banned gender-based premiums.
Lawmakers in Colorado are also tackling the problem of unaffordable health insurance premiums. H.B.1235, a bipartisan bill, passed the Health, Insurance, and Environment Committee in the House on March 31, 2017. The legislation would provide state-based premium assistance to people with income between 400 percent and 500 percent of the poverty level (ie, a little too high for ACA subsidies) who live in the three most expensive health insurance rating areas in the state (the mountains, including Grand Junction, and the eastern plains) and pay more than 15 percent of their income for health insurance purchased through the exchange, Connect for Health Colorado.
Colorado became the second state in the nation to actively pursue single-payer health care, with Amendment 69 appearing on the 2016 ballot. However, voters rejected the push for single-payer by a wide margin (Vermont was the first state to implement a plan to achieve single-payer, but they abandoned that path in December 2014).
Colorado has a state-run health insurance exchange. While there are still seven insurers participating, which is relatively robust compared with much of the country, coverage tends to be localized and plan availability is concentrated in urban areas. In 14 of the state’s 64 counties, those who shop the state’s exchange have a single carrier option (Anthem Blue Cross/Blue Shield) in 2017. The counties with the most options, Denver, El Paso, and Jefferson, have five carrier options each.
Colorado health ratings
A perennial high-performer in many lists, Colorado ranks 6th on the Scorecare of State Health System Performance 2017 — up from 8th in 2015 and 12th in 2014. The scorecard ranks the 50 states and the District of Columbia on numerous health indicators, such as uninsured rates, the percentage of people receiving preventive screenings, childhood vaccination rates, and many other factors.
Colorado was ranked 10th in America’s Health Rankings for 2016, down slightly from the 8th place spot in 2015. The state had among the lowest rates of diabetes, cancer deaths, cardiovascular deaths, obesity and physical inactivity across the 50 states. It had the lowest incidence of obesity, and saw a slight decrease in obesity prevalence from 2012 to 2016 (only one other state, Michigan, had a decrease in obesity prevalence). A relatively high incidence of pertussis, and disparities in health status are among Colorado’s health challenges.
You can also check out the 2015 edition of Trust for America’s Health for a wide range of public health information; see Key Health Data About Colorado.
For a more focused snapshot, see the county-by-county health rankings for Colorado from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
Colorado legislators’ positions on the Affordable Care Act
In the 2010, Colorado Sens. Mark Udall and Christopher Dodd, both Democrats, voted yes on the Affordable Care Act. Colorado’s five Democratic House members also voted yes, while the other two representatives, both Republicans, voted no.
The current Colorado congressional delegation includes Senators Michael Bennett (Democrat) and Cory Gardner (Republican). Bennett supports the ACA, while Gardner opposes it.
As of 2017, Colorado has seven representatives in the U.S. House: three Democrats, and four Republicans. Support for the ACA is split along party lines in the state’s House delegation.
At the state level, Colorado was one of the only states that moved in a bipartisan manner to establish a state-run health insurance marketplace. Gov. John Hickenlooper, a Democrat, signed legislation authorizing the marketplace in 2011. The state marketplace has since been named Connect for Health Colorado. The state also adopted Medicaid expansion under the Affordable Care Act. In the first two fiscal years after Medicaid was expanded, 289,000 people enrolled in Colorado’s expanded Medicaid.
How has Obamacare helped Colorado?
Colorado’s uninsured rate dropped 6 percentage points from 14.1 percent in 2013, to 8.1 percent in 2015. The Colorado Health Access Survey found an even lower uninsured rate – just 6.7 percent – in 2015.
Colorado enrollment in qualified health plans
According to the final 2014 enrollment report from the U.S. Department of Health and Human Services (HHS), 125,402 people enrolled in qualified health plans (QHPs) through Colorado’s health insurance exchange. Sixty percent of those enrolling in QHPs were eligible for premium subsidies.
At the beginning of the open enrollment period, the Kaiser Family Foundation estimated Connect for Health’s market size to be 501,000 Coloradans. Based on that estimate, 24 percent of eligible consumers took advantage of the state marketplace.
During the 2015 open enrollment period, 140,327 Coloradans enrolled in QHPs – 28 percent were new consumers. By the end of July, a few had dropped coverage or failed to make initial premium payments, and effectuated enrollment for exchange-based health plans was 137,372. Ninety percent of enrollees selected nonprofit health plans from Colorado HealthOP, Kaiser Permanente and Rocky Mountain Health Plans.
However, Colorado HealthOP is no longer offering coverage. The nonprofit was a Consumer Operated and Oriented Plan (CO-OP) founded through a $72.3 million federal loan. The CO-OPs formed under the Affordable Care Act are intended to increase competition in the individual and small-group insurance markets while providing consumers with affordable, high quality options. Colorado was one of 22 states that were home to an ACA CO-OP. However, 12 of these CO-OPs, including Colorado HealthOP had announced their closure by early November 2015. And by early 2017, only five were still operational.
New Health Ventures and Time Insurance Company also left the state’s individual market at the end of 2015—Time exited the market nationwide. Three carriers entered Colorado’s individual market for 2016, selling off-exchange plans: Golden Rule in the individual market, and Aetna Health and Aetna Life in the small group market.
Colorado required all grandmothered (transitional) plans to terminate by the end of 2015. There are still grandfathered plans in the state, but all other individual and small group plans are now ACA-compliant.
At the end of 2016, United and Humana exited the individual market in Colorado, but Bright Health joined for 2017. There are seven carriers offering individual health plans through Connect for Health Colorado in 2017.
Colorado and Medicaid expansion
Colorado is among the 31 states and the District of Columbia that have expanded Medicaid under the ACA. The expansion extends Medicaid eligibility to most nonelderly adults at or below 138 percent of the federal poverty level.
Nearly 182,000 Colorado residents qualified for the state’s expanded Medicaid program during the ACA’s 2014 open enrollment period. As of March 2016, Colorado Medicaid enrollment had increased 72 percent to about 1.34 million. From before ACA Medicaid expansion to March 2016, Colorado was tied with Oregon for the nation’s third-largest percentage increase in Medicaid enrollment.
Note that individuals can sign up for Medicaid, or lose coverage, if their eligibility changes, anytime throughout the year, so enrollment totals fluctuate each month.
Learn about Colorado’s Medicaid and Child Health Plan Plus (CHP+) programs at the Colorado Department of Health Care Policy & Financing website.
Does Colorado have a high-risk pool?
Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including Colorado. People with pre-existing conditions were often unable to purchase coverage in the private market, or were only eligible for policies that excluded their pre-existing conditions or charged them premiums that were significantly higher than the base rate.
CoverColorado was created in 1991 to provide an alternative for people who were not able to get comprehensive coverage in the private market because of their medical history.
One of the primary reforms ushered in by the ACA was guaranteed issue coverage in the individual market. An applicant’s medical history is no longer a factor in eligibility, which means that high-risk pools are no longer necessary the way they once were.
CoverColorado stopped enrolling new applicants at the end of 2013, and encouraged all existing members to transition to a new plan by December 23, 2013, in order to have private coverage (or Medicaid, if eligible under the expanded guidelines in Colorado) by January 1, 2014. For those who were unable to secure new coverage by the beginning of 2014, CoverColorado plans remained in force until the end of March, at which point the program ceased operations.
Any members who were still covered by the plan at the end of March were eligible for a 60-day special enrollment period at that point, allowing them to select a new plan, on or off-exchange. For a while, the CoverColorado included a touching Wordle comprised of compliments submitted by members during the final months the plan was operational.
Medicare enrollment in the state of Colorado
In 2015, Colorado Medicare enrollment reached 777,428, which is about 14.5 percent of the state’s population. Nationally, about 17 percent of the population is enrolled in Medicare. Eight-five percent of Colorado’s Medicare recipients qualify based on age alone, while the other 16 percent are on Medicare as the result of a disability.
Medicare pays about $8,727 per Colorado enrollee each year and ranks 28th in overall spending with $5.3 billion annually.
Coloradans who want additional benefits beyond what original Medicare offers can select a Medicare Advantage plan instead. 36 percent of Colorado Medicare beneficiaries had Medicare Advantage plans instead of traditional Medicare plans in 2016, compared with 31 percent of Medicare beneficiaries nationwide.
About 36 percent of Coloradans with Medicare are enrolled in Medicare Part D plans, which provide stand-alone prescription drug coverage. Of all U.S. Medicare recipients, 43 percent have stand-alone Rx plans.
Colorado health reform at the state level
Here’s what’s happening at the state level legislatively with healthcare reform in Colorado:
- As of October 23, 2015, supporters of ColoradoCare gathered enough signatures for the proposal to appear on the 2016 ballot. ColoradoCare would have brought universal health career health care to the state and would have been enacted using a 1332 waiver under the ACA. A 1332 waiver allows states to chart their own course for healthcare reform as long as it covers at least as many people as the ACA would have, keeps coverage affordable and at least as comprehensive as under the ACA, and doesn’t increase the federal deficit. Colorado would have become the first state to adopt a single-payer system if Amendment 69 had passed, but it was rejected by voters by a wide margin.
- S.B. 65, which passed the House in March 2017, would require health care providers to be transparent in their pricing for direct-pay patients (as opposed to those whose bills are paid by insurance plans).
- Health insurance premiums are very high in some areas of Colorado, particularly the mountains and the eastern plains. H.B.1235 was introduced in March 2017 in an effort to provide financial relief to people whose income is too high to qualify for subsidies, but for whom coverage is essentially unaffordable.
Other state-level health reform legislation: