Dec 23, 2016

Bethany Pray serves as CCLP's Chief Legal and Policy Officer. Her areas of expertise include regulatory analysis and advocacy for Medicaid and commercial coverage, access to behavioral health benefits, Medicaid eligibility and much more.Staff page ›

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Don’t repeal health coverage without replacing it

by | Dec 23, 2016

The November election has thrown open the door to changes to health care coverage, both in the private market and in Medicaid. In the last four years, millions of Americans have been able to obtain health coverage for the first time, but as demonstrated by enrollee surveys, many people don’t like the high premiums, high out-of-pocket costs and narrow provider networks in currently available plans. According to the Colorado Health Access Survey, more than four of five uninsured Coloradans say that insurance costs too much.

However, a post-election survey also shows that a significant majority of Americans likes certain aspects of what they’re getting now through the Affordable Care Act (ACA). Regardless of party affiliation and candidate preference, they support the ability to get free preventive care with their health plan (at least 75% ), the ability to keep their kids on their plans until age 26 (at least 83%), the availability of financial help such as premium tax credits and cost-sharing reductions to purchase and use their coverage (at least 68%), access to coverage regardless of a person’s medical history (at least 63%), and the Medicare payroll tax increase for upper-income Americans (at least 62%) which helps keeps Medicare solvent.

It would seem obvious that any “replacement plan” for the ACA should meet the public calls for more affordability and access while maintaining key protections. Unfortunately, to date, no replacement is in the offing. Instead, it appears the first option on the table is a backdoor repeal of the ACA through the mechanism of budget reconciliation. Through that procedural maneuver, the Senate would strip funding from the ACA and start the unraveling of the current health care system.

The funding that in 2017 will give eligible Coloradans an average insurance subsidy of $358 per month and lets many pay less for coverage than they did in 2016 would disappear, along with the federal funds that make it possible for thousands of working Coloradans to get health care through the Medicaid expansion. With funding and mandates gone, many will exit the exchanges and individual market, leaving behind sicker and wealthier customers, and driving premiums even higher.

The clear limitation of that backdoor budgetary maneuver is that it is specific to budget items and can’t be used to put a better health care law in place. It’s as if Congress heard that you didn’t like the only grocery store in town and scheduled a date to demolish it – without a replacement plan. You and your neighbors will likely go hungry while Congress vets the options, get permits, designs and builds a new store, hires staff and stocks it with food. (Meanwhile, the few folks in town who can afford to will fly in all their meals and do fine).

Tom Price, newly nominated to lead the Department of Health and Human Services (HHS), has given general indications of how he envisions our future health care system, but his proposals would help the wealthy, not middle- and lower-wage earners. As an example, expanding access to Health Savings Accounts (HSAs), favored by Paul Ryan and Tom Price, only help consumers if they have the luxury of setting cash aside each month. Indeed, many Americans simply lack the income for such savings. In fact, only a third of Americans with incomes under $40,000 could come up with enough cash to pay for even one $400 emergency expense. Only half of Americans saved any money in 2015.  In contrast, a majority of those who have made HSA-deductible contributions report incomes over $100,000, and they reap major benefits: the money deposited into an HSA reduces taxable income, interest on the account accumulates tax-free, and no tax is paid when the money is used on medical expenses. With HSAs, more money will flow to those who already have it.

Another possibility is the re-establishment of high-risk pools, though Coloradans familiar with Colorado’s pre-ACA state high risk pool, Cover Colorado, are familiar with its many deficits — including high costs to consumers, six-month exclusion periods for those with pre-existing conditions, a lifetime maximum benefit that cuts off those with greatest need and significant net program losses. As a rule, such programs have not been sustainable over time.

Evidence suggests that yet another potential change, giving carriers the right to sell plans across state lines, also wouldn’t provide Coloradans with more affordable coverage. Because carriers could base plans outside of Colorado, Colorado regulators would be unable to enforce state-legislated consumer protections. The National Association of Insurance Commissioners (NAIC) predicted that such a change would reduce availability of insurance. And the conservative Heritage Foundation expressed doubts that the approach would reduce prices.

No backdoor repeal – no defunding through budget reconciliation – should take place unless Congress can show the American people a plan that keeps what people like about the ACA and our health care system, while working on efforts to improve coverage and make it more affordable. Coloradans want better, more affordable coverage, not less access to care.

You can make sure your views are heard by letting your Senators and Gov. Hickenlooper know that you want to hear about the new plan first, before anything is taken away through a backdoor repeal.

– Bethany Pray

Recent articles

CCLP’s 2024 legislative wrap-up, part 2

CCLP's 2024 legislative wrap-up focused on expanding access to justice, removing administrative burden, supporting progressive tax and wage policies, preserving affordable communities, and reducing health care costs. Part 2/2.

CCLP’s 2024 legislative wrap-up, part 1

CCLP's 2024 legislative wrap-up focused on expanding access to justice, removing administrative burden, supporting progressive tax and wage policies, preserving affordable communities, and reducing health care costs.


To maintain health and well-being, people of all ages need access to quality health care that improves outcomes and reduces costs for the community. Health First Colorado, the state's Medicaid program, is public health insurance for low-income Coloradans who qualify. The program is funded jointly by a federal-state partnership and is administered by the Colorado Department of Health Care Policy & Financing.

Benefits of the program include behavioral health, dental services, emergency care, family planning services, hospitalization, laboratory services, maternity care, newborn care, outpatient care, prescription drugs, preventive and wellness services, primary care and rehabilitative services.

In tandem with the Affordable Care Act, Colorado expanded Medicaid eligibility in 2013 - providing hundreds of thousands of adults with incomes less than 133% FPL with health insurance for the first time increasing the health and economic well-being of these Coloradans. Most of the money for newly eligible Medicaid clients has been covered by the federal government, which will gradually decrease its contribution to 90% by 2020.

Other populations eligible for Medicaid include children, who qualify with income up to 142% FPL, pregnant women with household income under 195% FPL, and adults with dependent children with household income under 68% FPL.

Some analyses indicate that Colorado's investment in Medicaid will pay off in the long run by reducing spending on programs for the uninsured.


Hunger, though often invisible, affects everyone. It impacts people's physical, mental and emotional health and can be a culprit of obesity, depression, acute and chronic illnesses and other preventable medical conditions. Hunger also hinders education and productivity, not only stunting a child's overall well-being and academic achievement, but consuming an adult's ability to be a focused, industrious member of society. Even those who have never worried about having enough food experience the ripple effects of hunger, which seeps into our communities and erodes our state's economy.

Community resources like the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, exist to ensure that families and individuals can purchase groceries, with the average benefit being about $1.40 per meal, per person.

Funding for SNAP comes from the USDA, but the administrative costs are split between local, state, and federal governments. Yet, the lack of investment in a strong, effective SNAP program impedes Colorado's progress in becoming the healthiest state in the nation and providing a better, brighter future for all. Indeed, Colorado ranks 44th in the nation for access to SNAP and lost out on more than $261 million in grocery sales due to a large access gap in SNAP enrollment.

See the Food Assistance (SNAP) Benefit Calculator to get an estimate of your eligibility for food benefits.


Every child deserves the nutritional resources needed to get a healthy start on life both inside and outside the mother's womb. In particular, good nutrition and health care is critical for establishing a strong foundation that could affect a child's future physical and mental health, academic achievement and economic productivity. Likewise, the inability to access good nutrition and health care endangers the very integrity of that foundation.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides federal grants to states for supplemental foods, health care referrals, and nutrition information for low-income pregnant, breastfeeding and non-breastfeeding postpartum women and to infants and children up to age five who are found to be at nutritional risk.

Research has shown that WIC has played an important role in improving birth outcomes and containing health care costs, resulting in longer pregnancies, fewer infant deaths, a greater likelihood of receiving prenatal care, improved infant-feeding practices, and immunization rates

Financial Security:
Colorado Works

In building a foundation for self-sufficiency, some Colorado families need some extra tools to ensure they can weather challenging financial circumstances and obtain basic resources to help them and their communities reach their potential.

Colorado Works is Colorado's Temporary Assistance for Needy Families (TANF) program and provides public assistance to families in need. The Colorado Works program is designed to assist participants in becoming self-sufficient by strengthening the economic and social stability of families. The program provides monthly cash assistance and support services to eligible Colorado families.

The program is primarily funded by a federal block grant to the state. Counties also contribute about 20% of the cost.


Child care is a must for working families. Along with ensuring that parents can work or obtain job skills training to improve their families' economic security, studies show that quality child care improves children's academic performance, career development and health outcomes.

Yet despite these proven benefits, low-income families often struggle with the cost of child care. Colorado ranks among the top 10 most expensive states in the country for center-based child care. For families with an infant, full-time enrollment at a child care center cost an average of $15,140 a year-or about three-quarters of the total income of a family of three living at the Federal Poverty Level (FPL).

The Colorado Child Care Assistance Program (CCCAP) provides child care assistance to parents who are working, searching for employment or participating in training, and parents who are enrolled in the Colorado Works Program and need child care services to support their efforts toward self-sufficiency. Most of the money for CCCAP comes from the federal Child Care and Development Fund. Each county can set their own income eligibility limit as long as it is at or above 165% of the federal poverty level and does not exceed 85% of area median income.

Unfortunately, while the need is growing, only an estimated one-quarter of all eligible children in the state are served by CCCAP. Low reimbursement rates have also resulted in fewer providers willing to accept CCCAP subsidies.