Colorado: Address Universal Coverage, Costs, and Health Disparities

Recent activity in the legislative and executive branches is spurring efforts in Colorado to expand health coverage and reduce health disparities. Evidence suggests that both initiatives could help to contain health care costs.

On May 15, Governor Bill Ritter (D) signed Senate Bill 242 to codify in statute the state's Office of Health Disparities and create three new initiatives for the office: 1) an Interagency Health Disparities Leadership Council; 2) a Minority Health Advisory Commission to identify the causes and develop solutions to health care disparities; and 3) a health disparities grant program.[1] These provisions are seen as a way to improve public health and, at the same time, contain costs. Recent research suggests that eliminating health disparities related to diabetes alone would save Colorado taxpayers more than $80 million each year. By providing better access to care, Colorado hopes to help residents control their conditions and reduce the need for expensive, and potentially avoidable, services.

In particular, the health disparities grant program will provide communities with state funding to develop strategies focused on the prevention, early detection, and treatment of cancer, cardiovascular disease, diabetes, and pulmonary disease among minority populations. According to SB 242's sponsor, Senator Peter Groff (D), Colorado's minority and rural residents have higher mortality rates and higher levels of disease and disability, compared with white and urban residents, and that the costs of caring for these groups, as well as the uninsured, falls on insured residents in the form of higher cost-sharing. [2]

In addition to creating the grant program, the Office of Health Disparities will:

• publish reports documenting health disparities;
• educate the public on racial and ethnic health disparities and cultural competency;
• build capacity within communities to extend their public health systems;
• develop strategies to improve minority health statewide;
• promote diversity in the health care workforce; and
• improve interpretation and translation services in the public health system.

Before leaving office after the 2006 election, Governor Owens (R) signed into law Senate Bill 208, establishing the Blue Ribbon Health Commission, which has since received support from Governor Ritter. The Commission—which operates through volunteer commissioners chosen by Governors Owen and Ritter, as well as select state senators—is charged with studying a number of health care reform proposals to expand coverage and reduce health care costs, modeling the effects of the proposals, and then presenting one proposal to the state's General Assembly for consideration. Currently, the Commission is analyzing four proposals, chosen from 31 plans submitted by organizations across the state:

• two plans would require an individual mandate to have health coverage (submitted by the Colorado State Association for Health Underwriters and the Committee for Colorado Health Solutions);
• one plan would establish a single-payer system administered by the state (submitted by Colorado Health Care For All); and
• another plan would expand state health insurance programs and establish a purchasing pool (submitted by the Service Employees International Union).

The Lewin Group has been modeling these proposals to determine their effects on cost and coverage. This summer, the Commission's proposals committee has been hard at work developing a consolidated, or "fifth" proposal. The committee has been developing answers to key questions identified at their June meeting:

1. What will be the role of the individual in obtaining or paying for care?
2. Will there be an individual mandate?
3. What will be the role of employers?
4. What will be the role of government?
5. Will there be an expansion and/or reform of the Medicaid and SCHIP programs?
6. Will portability or continuity of coverage be ensured?
7. Will there be subsidies to ensure affordable coverage?
8. What will the minimum benefits be?

These questions will help the committee develop the framework for this fifth proposal. The committee is expected to have a detailed proposal ready to present to the full Commission for approval at its September 10th meeting. The proposal will then go to The Lewin Group for detailed analysis of cost and coverage implications, with final results due back to the Commission by November 15.

Public hearings will be held on the consolidated proposal and analysis throughout the fall, with a presentation made to the state legislature in January 2008. According to Anita Wesley, commission project coordinator, "The Commission is focused on getting the best information to the General Assembly as they move into the next phase of health care reform. The Governor and Legislative leaders are very supportive and interested in making something happen in terms of improving coverage and containing health care costs."

References
[1] The Office of Health Disparities was officially created in 2004 under the Colorado Department of Public Health and the Environment. Prior to 2004, work in this area was done through a grant to the Colorado Turning Point Initiative, part of The Robert Wood Johnson Foundation's national Turning Point Initiative.
[2] April M. Washington, "Laws Address Health Issues, Foster Care, Meals for Kids," Rocky Mountain News, May 16, 2007.

For More Information Contact: Mauricio Palacio, Director, Office of Health Disparities, (303) 692-2329. Anita Wesley, Project Coordinator, Minority Health Advisory Commission, [email protected].