May 29, 2019

Presented by:

Kim Bimestefer, Executive Director, Health Care Policy & Financing

Mike Conway, Insurance Commissioner, Division of Insurance

Stakeholder Meeting

Division of Insurance / Dept. of Health Care Policy & Financing

State Option for Health Care Coverage

Division of Insurance / Dept. of Health Care Policy & Financing

Agenda

• Opening Remarks • Our Quest• Overview of HB19-1004 Proposal For Affordable Health Coverage Option• Other State’s Actions – New Mexico & Washington• Learnings from CO-OPs• Facilitated Discussion

State Option for Health Care Coverage

Division of Insurance / Dept. of Health Care Policy & Financing

• Welcome and Thank You • Our Quest• Maximizing Our Strengths• Beautiful Music• Learning from our History• Governor’s Principles are a Good Guidepost • Value of Diversity of Thought & Collaboration

Opening Remarks

Division of Insurance / Dept. of Health Care Policy & Financing

• High Quality Health Care Access• Sustainable Affordability to Customers @ Different Income Levels• Serve Individuals and Small Employers• Address Uninsured rate, which is not equally spread• Maximize Existing Infrastructure, Don’t Disrupt What is Working• Maximize Innovation• Recognize Fed Challenges in Funding; Affordable to the State• Increase Competition

Opening Remarks: Our Quest under HB 1004

• What else does the bill require us to include in the proposal? • Feasibility and cost of implementing a state option• Identify the most effective implementation of a state option based

on affordability to consumers at various Income Levels• Admin. and financial burden to the state (risk-bearing & solvency)• Ease of Implementation • Evaluate the likelihood of meeting the objectives above• Proposal due November 15, 2019

Overview of HB 19-1004 Proposal For Affordable Health Coverage Option

• Implementation considerations• Identify potential premium levels and cost sharing for a plan that at a

minimum is an EHB compliant plan• Evaluate provider rates necessary to incentivize participation that will

encourage adequate networks and high quality health care delivery• Consider eligibility criteria for individuals and small businesses• Determine any impact to the state budget• Determine impact on the stability of the individual market, the small

group market, and Connect for Health Colorado – including whether the product should be offered on or off C4

Overview of HB 19-1004 Proposal For Affordable Health Coverage Option

• Implementation considerations, cont’d• Determine impact on individuals receiving subsidies• Determine the structure of the plan including who should offer it• Identify expected impacts, if any, to HCPF programs • Investigate funding options including state funds and federal waivers• Evaluate the feasibility, legality, and scope of any necessary federal

waivers• Review information related to Senate Bill 19-004• Create a statewide definition of affordability for consumers

Overview of HB 19-1004 Proposal For Affordable Health Coverage Option

Stakeholder’s Role in Recommendations• Purpose – to advise DOI and HCPF in Recommendations to the

legislature

• Constraints – the recommendations are accompanied by needed legislative changes and any funding requests

• Stakeholder’s responsibilities – be thought partners, identify additional needed input, share with community and bring back feedback

• Timeline – Recommendations finalized by middle of October to be received by legislature on November 15.

• Stakeholder feedback will be used to inform recommendations

Criteria• Stability of the market

• Competition without harm• Affordability to consumers at different income levels• Ease of implementation• Likelihood of success• High quality• Others?

New Mexico Analysis

Source: Manatt Analysis, page 6, January 2019

Washington State – Cascade Care• Signed into law May 2019

• Coverage starts in 2021

• Offered on Exchange

• Hybrid public-private system• State contracts with private health insurers to administer plans,

but will define benefits and negotiate costs

• Goal to offer public option plans in all 39 counties

• New plan includes capping provider reimbursement rates at 160% of Medicare

• Only 4 of 23 ACA CO-OPs still exist today• Two issues that we need to be mindful of as we move

forward• CO-OPs were dependent on federal funding – the loss

of that funding was key to their failures• Failure of CO-OPs disrupted care for hundreds of

thousands of people throughout the country and billions of dollars were lost.

Lessons from ACA CO-OPs

State Option for Health Care Coverage

For more information and updates visit:

colorado.gov/hcpf/proposal-affordable-health-coverage-option

• What should be Colorado’s approach to creating a state option

• Who do you need to hear from?• Data needed?

• What should be the frequency of meetings to get to recommendations by October 15

• Needed workgroups?

Discussion