Maybe you’re considering a move to “Colorful Colorado” and curious how healthcare reform is viewed in your potential new home. Or, maybe you’re an established resident wondering what goes into your state’s top third “healthiness” ratings.
Either way, this guide will help provide an overview of public health and the ACA in the Centennial State. We take a look at how Colorado measures up against other states in several national studies and briefly summarize the Affordable Care Act’s reception and rollout in the state.
Colorado health ratings
Colorado ranks 12th on the Scorecard on State Health System Performance 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 among the Top 5 for nine measures in the categories of prevention and treatment, avoidable hospital use and cost, and healthy lives. See Colorado’s 2014 scorecard for the state’s ranking on individual measures.
Colorado scores even higher in America’s Health Rankings for 2014. The state ranked eighth and had the lowest rates of diabetes, obesity and physical inactivity among the 50 states. A disparity in health status by education level and high rates of low birthweight and binge drinking 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. Two of the five House Democrats who voted in favor of the ACA have since been replaced by Republicans. Since their election, Reps. Scott Tipton and Cory Gardner have repeatedly voted to repeal the ACA. Gardner defeated Udall in his 2014 re-election bid. Ken Buck, a Republican, won Gardner’s seat in the House. Colorado’s U.S. House delegation will include four Republicans and three Democrats in 2015.
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.
How has Obamacare helped Colorado?
Colorado’s uninsured rate dropped 5.8 percentage points from 17 percent before the 2014 ACA open enrollment period to 11.2 percent by the end of 2014. The state was one of the 10 states with the greatest reduction in uninsured that year.
By mid-2015, the state’s uninsured rate decreased to 10.6 percent, better than the national uninsured rate of 11.7 percent but slightly higher than the 8.9 percent uninsured rate in other states that both established a state-run exchange and expanded Medicaid.
Colorado enrollment in qualified health plans
According 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 will not offer coverage in 2016. 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.
New Health Ventures and Time Insurance Company also left the state’s individual market—Time exited the market nationwide. Three carriers entered Colorado’s individual market for 2016 and will sell off-exchange plans: Golden Rule in the individual market, and Aetna Health and Aetna Life in the small group market.
For 2016, a total of 20 carriers will offer Coloradans individual and/or small group plans either on or away from the Connect for Health Colorado exchange. There will be 1888 individual plans available through the exchange, up from 176 in 2015. Rate increases for exchange-based individual plans range from 4 percent to 30.8 percent.
The state will cancel all non-ACA-compliant health plans by the end of 2015.
Colorado and Medicaid expansion
Colorado is among the 30 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 August 2015, Colorado Medicaid enrollment had increased 63 percent to about 1.3 million. From before ACA Medicaid expansion to August 2015, the state saw the nation’s fourth largest 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.
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 bring universal healthcare to the state and would be 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. If voters support ColoradoCare and the measure is enacted, Colorado will become first state to adopt a single-payer system.
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. Thirty-seven percent of Colorado Medicare beneficiaries have Medicare Advantage plans instead of traditional Medicare plans, compared with 32 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.