Cary’s Plan for Affordable, High-Quality Health Care for All Coloradans

Colorado deserves a healthcare system that works — a system that promotes health, is affordable and accessible, and protects Colorado’s most vulnerable. But, right now, too many Coloradans lack both affordable coverage and access to care. It is clear Congress is not going to offer any real solutions. In fact, Republicans in Washington will continue proposing policies that would rip coverage from millions. I support a federal single payer system, but until that happens, we can’t sit back, cross our fingers, and rely on a dysfunctional federal government.

Everyone in Colorado should have health care that is accessible and affordable. We’ve made remarkable progress here — 94% of people have health insurance and the numbers look even better for children: 97.5% of Colorado’s kids are covered.

But we risk losing this progress because too many people can’t afford their premiums, deductibles, prescription drugs, and out-of-pocket costs; and too many people simply can’t get the care they need. Universal health care means everyone in Colorado can get the care they need, when and where they need it.

My healthcare platform makes this promise to Colorado — we can do better. My plan offers bold solutions that will help all Coloradans have access to affordable, high quality healthcare services. These are things that we can get done in our state without relying on Congress. We need to ensure all Coloradans have fair and equal access to health regardless of where they live, their race, or their income.

Health care is vital and complex, and affects every Colorado family. Politicians can’t treat this like just another campaign issue. As governor, I will bring together the health provider and patient community to deliver the highest quality and most affordable care for Colorado.

An Affordable, High-Quality Public Option

I am proposing that all Coloradans be able to buy into Medicaid (Health First Colorado) and the health plans available to state employees. Adding these options through Colorado’s health insurance exchange would lower premiums, stabilize markets, and increase choices by creating a public insurance program available to all Coloradans. The Health First Colorado buy-in portion of my plan creates a public option that will offer more affordable and comprehensive coverage when private carriers are too costly or unwilling to provide it. The best solution to fill the gap in coverage, cost, and accessibility in Colorado is a public option, offering more affordable choices without additional taxes, especially for rural Colorado where options are currently so limited.

My plan is an affordable option to increase access to the most cost-effective insurance in the state, encouraging competition, and cutting costs across the healthcare system.

Health First Colorado is cost-effective and efficient. The administrative costs in Colorado’s Medicaid program are less than half the administrative costs of private insurers, resulting in significant savings. Medicaid is one of the largest purchasers of health care in Colorado and offers consumers the benefit of a large pool. Because Medicaid is a publicly administered program, there is no profit margin, lowering costs even more.

In addition to providing a more cost-effective option, Colorado Medicaid is a national leader at improving the quality of care through innovation, coordination, and integration.

My plan also lowers premiums by increasing competition and choice in the marketplace. In many areas of Colorado, there is only one insurance company option. Without competition, there is no incentive for an insurance provider to make its plans more attractive by reducing premiums.

The Health First and State Employee Health Plans’ low administrative costs and large pool of members will result in a more affordable option for every Coloradan.

All Coloradans, regardless of income, will be able to buy into Health First Colorado, the State’s Medicaid program, or plans currently offered to state employees. Giving Coloradans this option means more choices for everyone, especially people in rural Colorado. Currently Coloradans in some rural counties only have one option for insurance. My plan reduces the disparity between regions.

  • All Coloradans will benefit when Coloradans are healthier and there are fewer people uninsured. The uninsured and underinsured cost the healthcare system a lot of money. Those costs are then distributed to all consumers of insurance. Reducing these costs will benefit everyone.
  • People on the individual market: Roughly 8% of Coloradans purchase their policies through Connect for Health Colorado.
  • People who are over 400% of Federal Poverty Level could save on premiums and out-of-pocket costs – The Urban Institute calculated that those earning 400% to 500% of the poverty level pay a median 18.1% of their income in premiums and out-of-pocket expenses.
  • The Underinsured: Many Coloradans have insurance that doesn’t adequately cover the services they need; this plan will provide more expansive coverage at more affordable rates for these people.

Making Care More Accessible to All Coloradans

In addition to ensuring every Coloradan can obtain insurance coverage, we need to make affordable care more accessible. And we need to confront and fix the inequalities that affect all of Colorado’s vulnerable populations, so everyone has fair and equal opportunities to achieve good health.

Colorado is working to control the costs of care, especially in the Health First Colorado program. We need strong leadership in the Governor’s office to execute and expand on this progress, to make sure it reaches everyone.

We need to expand Colorado’s efforts to integrate care and combine behavioral health care with physical health. This approach will improve both and lower overall healthcare costs. Colorado is controlling Medicaid costs through a system of accountable care collaboratives (ACCs). These ACCs have saved about $60 per month for every adult in the program. People who buy into Health First Colorado under my proposal automatically will be enrolled in an ACC. They will benefit from the coordinated services of the ACCs and the ACCs will benefit from a larger population to serve. This will result in better care and lower costs across the system.

Spending more on health care doesn’t mean we’re getting healthier – in fact, it means the opposite: If we were healthier overall, Colorado could spend less on health care. We can reduce what we each pay individually for our own care – and what we pay collectively through insurance for the overall health system – if we helped people stay healthier. We know best practices include:

  • Oral health programs, such as dental checkups especially for kids and expecting mothers, and fluoride programs throughout water systems.
  • Wellness programs in schools. Other states have helped keep children healthier by improving nutrition, promoting physical activity, accessing mental health screenings and treatment for students, securing a safe school environment, providing universal free breakfast to students from preschool through 12th grade, and offering flu shots and immunization for staff and students.
  • Home visitation programs like Nurse Family Partnership and Parents as Teachers, which provide early interventions that may result in long-term, positive effects on health.
  • Public wellness initiatives such as increased public health funding, expanded access to family planning, nutrition education to prevent obesity, immunizations, as well as expanded well-baby care visits.
  • Paid family leave.

In many parts of Colorado, health care is too expensive and there aren’t enough providers. We must ensure every Coloradan can access the healthcare providers and the facilities he or she needs.

  • Rural Healthcare Workforce: Currently, 36 of Colorado’s 48 rural and frontier counties in Colorado are designated as Health Professional Shortage Areas. Twelve of these counties do not have a single licensed psychologist or social worker; six lack a licensed dentist or dental hygienist. Over 150 additional rural primary care preceptors are needed annually to train new Colorado medical school graduates. Colorado currently operates three state-level loan repayment programs for health professionals – including the largest state-level Health Services Corps program in the country. But even this is not enough to guarantee there are enough doctors to service Colorado’s underserved areas. I will expand funding for these types of programs to meet the unmet need throughout our state.
  • Building Rural Healthcare Infrastructure: Rural Colorado suffers from a shortage of facilities, specifically a significant lack of behavioral/mental health facilities, as well as preventative mental health services. I’ve created a model here in Colorado for giving rural communities an equal shot at opportunity: The “Building Excellent Schools Today” (BEST) program provides grants by which the state matches local efforts to build better school facilities. I will pursue a similar model to allow counties and localities to better meet their citizens’ health care needs. Rural areas also have much less access to reliable, high speed broadband. Improving this infrastructure will benefit rural healthcare providers by allowing them to implement e-prescription, telehealth, and other programs that can improve the quality of care in remote regions.
  • Tackling the Opioid Crisis: The ongoing opioid crisis is tearing families and communities apart across Colorado. The overdose death rate has nearly tripled between 2001 and 2015. This epidemic is inextricably linked with the health care system. In order to combat this crisis, we need to increase access to behavioral health services and medication-assisted treatments in our most underserved areas of the state. We also need to help train our front-line health care and law enforcement professionals.

Lowering the Cost of Care

To make healthcare more affordable for everyone, we need to tackle the individual elements of our healthcare system that unnecessarily drive up costs.

The State of Colorado is a large buyer of health care. By leveraging that purchasing power, we can make smarter and cheaper health care purchases that lower costs for taxpayers – and reduce systemic costs for all Colorado healthcare consumers.

People across Colorado face prohibitive prescription drug expenses. Through smarter buying, Colorado can contain these costs. Our state can:

  • Look to the importation of drugs from Canada. We need to push our leaders in DC to stand up to pharmaceutical companies and let Coloradans buy the affordable medication they need.
  • Buy more generic drugs.
  • Provide better purchasing options for consumers, including rebates for mail-order prescriptions and multiple-month prescription dispensing under a single co-payment, which can increase medication adherence and have positive effects on overall health.
  • Purchase brand-name drugs at a discount. The state’s Medicaid program already utilizes a preferred drug list, but we can expand this practice to every time the State pays for medication. We also need to push drug manufacturers for supplemental rebates.
  • Do more bulk purchasing. This includes expanding our membership in multi-state purchasing arrangements.

Our healthcare system needs to be more transparent. Patients should understand how much their healthcare costs and why. We need to expand our support for the All Payer Claims Database and make sure consumers have the information they need to make smart decisions about their own health care. Doctors should be aware of the services their patients receive from other providers so that they work as a team. Finally, we need to push pharmaceutical companies and hospitals to provide more information about their costs so that policy makers and the public can understand why health care has become so expensive.

Our state should invest in proven strategies. As Governor, I will measure outcomes to make sure we’re getting the best bang for our buck. This approach can be applied to individual physicians or practices, groups of providers, or larger healthcare systems such as hospitals, and can be used to achieve measurable outcomes like higher immunization rates, more accurate and efficient care for patients, and reduced readmissions to hospitals.

Far too often, patients are readmitted to hospitals for the same condition. This drives up costs and exposes gaps in our healthcare system. It means a patient’s problem wasn’t properly resolved during the first hospitalization. The Affordable Care Act started addressing this problem at a federal level, but other states have identified additional programs to reduce the risk of unneeded readmissions, improving care and reducing costs. These systems incorporate quality-based payments, coordinated community-based care (like what Colorado is moving toward), effective patient education and outreach. They also analyze data to identify individuals with high risk for readmission due to insufficient housing, transportation, or social support, and then provide these members with up to 90 days of interim housing. Expanding these programs will help lower readmission rates here in Colorado.

Conclusion

It’s easy to say that quality health care is a human right, but our government must deliver on that promise. It’s simply unacceptable that a state as modern and forward thinking as Colorado is stuck with a healthcare system that is too expensive for too many. We can’t wait for Washington to fix health care. We need to lead the way so all Colorado families only have to focus on healing, not finances or impossible bureaucracy, when faced with a health care problem.