Anything with as many moving parts as a statewide health insurance plan can be difficult to understand. Thankfully, the Colorado Health Institute, a health-policy research organization, is releasing a series of independent analyses on ColoradoCare, the first of which was posted in April at coloradohealthinstitute.org.
Here's how it answers some prominent questions:
Who would be covered?
Titled "ColoradoCare: An Independent Analysis, How It Would Work, How It Would Be Financed and Questions to Ask," the report notes ColoradoCare would automatically cover everyone with a primary residence in Colorado, including those who can't afford insurance and immigrants who lack documentation.
Federal insurance programs like Medicare and Veterans Administration coverage would remain in place, and ColoradoCare could provide supplemental coverage for people in those programs. That means about 83 percent of Coloradans, or about 4.4 million people, would be eligible for primary coverage under the program.
Private insurers would still be allowed to provide plans in the state — much as private schools compete with public schools. Their role, however, would likely to be minor, as Coloradans would still have to pay taxes for ColoradoCare, whether they choose to use the plan or not.
What would it cover?
Amendment 69 would require ColoradoCare to cover: primary and specialty care; hospitalization; prescriptions and durable medical equipment; mental health and substance abuse treatment; emergency and urgent care; preventive services; chronic disease management; rehabilitation treatment and equipment; pediatric services to include oral, vision and hearing; lab services; maternity and newborn care; and palliative and end-of-life care.
The plan would not include deductibles, but some services would require copays.
What still needs to be worked out?
If passed, ColoradoCare would seek federal waivers allowing it to supplant Medicaid and Child Health Plan Plus. Money now going into those programs would instead go to ColoradoCare.
ColoradoCare would also need a federal waiver to shut down the state's health exchange marketplace, Connect for Health Colorado. Any subsidies and tax credits the marketplace's customers currently receive would be absorbed by ColoradoCare.
ColoradoCare would not immediately take effect if voters approve it, and would likely take until at least early 2019 to begin offering benefits. Interestingly, ColoradoCare could charge a .09 percent startup tax for up to three years before it begins offering benefits, with the tax split between employees and employers in traditional jobs (the latter would pay two-thirds of the tax).
Who would be in charge of it?
ColoradoCare would be a political subdivision of the state, much like a city or a school district.
It would be run by a 21-person board that would decide on the benefits package; set rates to be paid to health providers; hire managers; create a central purchasing authority for services, drugs and medical equipment; set copays; help create a medical records system that maintains patient privacy; manage board elections; create a model to keep ColoradoCare financially stable; fund an office to investigate fraud and abuse; and approve the system's budget. That budget is estimated at $38 billion annually —more than the rest of the state budget combined.
"If it were a private company," the report notes, "ColoradoCare would rank about 80th in the Fortune 500, just behind New York Life Insurance and ahead of well-known companies such as American Express, Twenty First Century Fox, 3M, Sears, Nike and McDonald's."
Any person at least age 18, who has lived in the state for the past year, could vote for the board and vote on tax increases needed to fund the operation.
ColoradoCare, not the state, would run elections for board members, who would serve four-year terms. There would be three board members elected from each of seven districts across the state. The board would be able to remove any board member by a majority vote, and also fill any vacant seat without a vote of the people.
How would it be paid for?
A 10 percent payroll tax would pay for ColoradoCare. Traditional employees would pay a 3.33 percent tax, while their employer would pay a 6.67 percent tax.
Employers now required to provide a health plan for their employees under the Affordable Care Act would no longer be required to do so, as ColoradoCare would supplant the ACA's mandates.
Other forms of income, such as self-employment, interest and dividends, capital gains, business income that's reported on personal tax forms, and real estate income, would be taxed at the full 10 percent.
There are some exceptions to the tax. Up to $33,000 in retirement income or Social Security benefits for individuals, or up to $60,000 for couples, would be exempt from ColoradoCare taxes.
Any income above that would be subject to the 10 percent tax. Additionally, high earners would only pay the 10 percent tax on income below $350,000 for an individual, or below $450,000 for married couples who file taxes jointly.