Public Option, State Efforts
Colorado State Option Withdrawal and USofCare’s Outlook Moving Forward
With the novel coronavirus pandemic disrupting usual business across all sectors, the legislative process is certainly not immune. Unfortunately, the whiplash between confirmed COVID-19 cases in Colorado and the General Assembly’s necessary, but an abrupt recess resulted in a detour in one of USofCare’s primary state engagements this year: creating a state coverage option to provide Coloradans with more affordable health care.
Last week, bill sponsors of the Colorado Affordable Health Care Option announced that they would be withdrawing the legislation from consideration when the General Assembly reconvenes later this month. While this may be an expected development during the most unexpected period in recent memory, it still feels jarring. Just eight weeks ago, the Colorado Option passed its first committee with its next committee hearing already scheduled. Now, like other states across the country, Colorado leaders are focusing all of their energy on ways to address the public health and economic crisis facing their constituents.
Colorado: a Case Study
The Colorado Option is the product of bipartisan direction from the General Assembly and robust stakeholder engagement, policy development, and actuarial analysis. The legislation would have created an additional coverage option, estimated to save people up to 20% in premiums, offer more choice, and provide more services before people meet their deductible. Although it presents a solution that addresses the state’s specific needs, strengths, and limitations, Colorado’s diversity of geography, culture, and population are representative of many places in America. As such, the Colorado Option became a proxy battle for health care reform across the country: Any outcome in Colorado could provide a proof point for other states facing similar challenges. Ultimately, for United States of Care, the Colorado Option legislation reflected a thoughtful process that, while controversial to some, aligns with our principles and interests in advancing state-driven reform to ensure everyone has access to health care they can afford.
Even without pandemic interference, stakeholders knew getting this legislation to the Governor’s desk would be a challenge: transformative changes are seldom easy to deliver. Before legislation had even been introduced, outside interests launched a robust opposition campaign. By April, $2.7 million was committed for negative advertising buys for cable, social media and news outlets, which was greater than the state’s projected fiscal cost of the legislation itself.
The need for relief is palpable. USofCare’s public opinion findings underscore the desire by people across the state to address the cost and the value of insurance offerings available today. By working in partnership with thought leaders, advocates, and policymakers on the ground, we saw a ripe opportunity to make Colorado the second state in the nation to create a new coverage option.
- Center the issue on people’s needs. When USofCare conducted public opinion research in Colorado, we prioritized including participants from rural parts of the state to ensure that their needs were reflected in the stakeholder engagement process. When the bill was introduced, supporters elevated the voices of people, not industries or seasoned lobbyists. “I pay $18,000/year to access health care. That’s not affordable. I also cannot find a plan that would cover the primary care provider I have been seeing for the past 28 years,” Shawn, a Colorado consumer.
- Build a diverse coalition. Our experience in other states has demonstrated a material value in being strategic, creative, and proactive about coalition building. In Colorado, the band of supporters who are advocating in favor of the Colorado Option represent multiple stakeholders: self-employed workers and small business owners, a rural county commissioner, patients with chronic illnesses, consumer advocates, nurses, doctors, faith-based organizations, and others. While these people represent different backgrounds, experiences and geographies, they are all united behind a common goal of providing more affordable health insurance coverage to Coloradans.
- Use language that people understand. Public policy can be riddled with jargon, and health care in particular often resembles alphabet soup. When the Colorado Option is described in language that is easy to understand, it has broad support that crosses partisan lines. In addition, when educating the public and policymakers, we found it most effective to highlight the components of the policy that directly speak to challenges people identify with. For example, public opinion research conducted by USofCare in November of 2019 found that Coloradans across the political spectrum liked that this plan could improve access to services, such as primary care visits, before a deductible is met.
- Keep all stakeholders at the table. Hospitals are trusted, important stewards of local communities, yet an uncomfortable truth is that Colorado hospitals have extreme price variation in their rates across the state, and the second highest profit margins in the country. The Colorado Option legislation aims to strike a careful balance between addressing those rates in order to save people money, and allowing hospitals – particularly rural and independent hospitals – to remain competitive or even do better under the new proposal. Supporters and bill champions never stopped working to find consensus with the provider community. From our perspective, it will be critical to continue this work to prepare for 2021.
For many who have championed and supported the development of this policy, hitting pause in 2020 is not where stakeholders want to be. The sense of purpose and urgency is unquestioned, and many have already signaled their intent to keep moving forward. Bill sponsors Sen. Kerry Donovan, Rep. Dylan Roberts, and Rep. Chris Kennedy announced their intention to re-introduce legislation to create a state coverage option next year.
At United States of Care, we may be disappointed by this year’s turn of events, but we are not disheartened. COVID-19 sheds a bright light on the need for more affordable coverage for families. We remain committed to Colorado and our partners in addressing this challenge in 2021.