Jan 4, 2017

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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News Release: Colorado Health Policy Coalition urges Congress to develop a comprehensive health care framework

by | Jan 4, 2017

GOP healthcare plan: what it would mean for Colorado

On March 6, 2017, House Republicans’ unveiled a healthcare proposal, the “American Health Care Act,”
that would radically reduce the ability of middle- and lower-income Coloradans to access affordable
healthcare through Health First Colorado, Colorado’s Medicaid program, and the private market.

The basics:

The bill uses the budget reconciliation process, a process that is available once per annual budget cycle, to
address funding aspects of the ACA and the federal Medicaid program. Most ACA taxes are repealed, to
the tune of a loss of over a trillion dollars over ten years, raising questions about how the program will be
paid for. The bill could get through the House and Senate as soon as April. The bill needs only a majority to
pass and cannot be filibustered.

Key changes to private insurance: cost and access

Cost of Premiums

  • Cost of premiums are likely to go up for all Coloradans
    • The ACA mandated that all Americans get coverage or pay a penalty. That requirement, for both individuals and employers, would end retroactively on 12/31/15. Healthier and younger people will be more likely to skip buying insurance if they don’t have a penalty, resulting in a sicker risk pool. Because the needs of the risk pool are greater, premium costs will rise.
  • The cost of premiums will go up even more for older Coloradans.
    • Currently, carriers can charge those over 64 no more than 3 times what they charge those under 30.
    • Under the House Republicans’ plan, they could charge older Coloradans 5 times as much.
  • If someone loses coverage for 63 or more days, cost of premiums will go way up.
    • Under the plan, someone who lost coverage for 63 or more days in the last 12 months would have to pay a 30% monthly surcharge, on top of regular premium payments, for a full year. This could mean that health care would be permanently unaffordable.

Availability of Assistance

  • For 2018 and 2019, Coloradans would still be able to get premium tax credits, subsidies that help with monthly premium payments for those under 400% of the federal poverty level (FPL), and cost-sharing reductions, subsidies that reduce deductibles and cost-sharing for those under 250 FPL.
    • The amount of assistance now varies, and lower-income people get more assistance.
  • Starting in 2020, advanceable tax credits would be available, but much reduced.
    • Tax credits would be available to each person in the household — ranging from $2,000 a year for those 30 and under to $4,000 for those 60 and over.
    • Those with more income would get the same amount as those with less. A 30-year-old who makes $70,000 a year would get $2,000, just like a 30-year-old who makes $25,000 a year.
    • Coloradans who live in regions with more expensive insurance would not get more financial assistance to help with those extra costs. Coloradans in the higher-cost areas, including many rural counties, would have to pay more.
  • Health Savings Accounts would be expanded, to allow people to put more of their own money aside, tax-free, for health costs.
    • That’s no help to people who need all their available income to cover housing, food, education and other basic needs. It would instead serve as a tax break to wealthier people.
  • Short-term funding would be provided to states for additional programs like high-risk pools and help with cost sharing – but states would have to put in state dollars to be eligible for the funding.

Key changes to Medicaid: the adult expansion and everyone else

Ending additional funding for the Medicaid expansion

  • Currently, Colorado covers just 5% of the cost of covering an adult in the expansion population, a category that includes adults without dependent children, as well as parents and caretakers who make over 68% FPL. Federal funds cover the rest.
    • The plan would take away that extra federal funding for the expansion population as of 2020, so new enrollees – and anyone who was enrolled but had a break in coverage – would be covered only at the 50% federal matching rate.
    • Colorado’s additional costs to keep the same number of enrollees covered at the lower matching rate would be close to $1 billion per year, based on caseload reports.

Limiting Medicaid payments through a per capita cap structure

  • Medicaid expenditures by the state of Colorado would no longer be matched by federal funds.
    Currently, if Health First Colorado, Colorado’s Medicaid Program, covers a child’s $10,000 hospitalization, Colorado pays half and the federal government pays half. Under the current formula, federal funds increase with need.

    • The per-capita cap structure provides that states get a fixed amount per enrollee, with the amount set for the four categories: children; parents and caretakers; elderly, blind and disabled individuals, and adults without dependent children.
    • If any of those categories of people has greater need – because, for example, the older population is living longer and a higher proportion need nursing care, or because of a disease outbreak – Colorado would get no additional money.
    • The per-capita cap amount won’t reflect current needs. When the new structure starts in 2020, the base amounts will be derived from our expenditures in 2016. Because of medical inflation, covering everyone in 2020 is likely to be a lot more expensive than in 2016.

Limiting Medicaid through other changes

  • Children would be covered only up to 100% FPL, instead of 133% FPL. Those over 100% FPL could hypothetically get CHIP, but we don’t know the future of that program, either.
  • The plan would drop the three-month retroactive eligibility now available to Medicaid applicants.
  • The plan would not give any additional time to applicants to collect documents to show legal residency or citizenship.
  • And more.

The bottom line

To keep people covered, Colorado would have to come up with billions more per year in funding.

PDF version available here.

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.

CCLP testifies in support of Clean Slate updates

Bethany Pray, CCLP’s Chief Legal and Policy Officer, provided testimony in support of House Bill 24-1133, Criminal Record Sealing & Expungement Changes. CCLP is in support of HB24-1133, as it is one of our priority bills.

HEALTH:
HEALTH FIRST COLORADO (MEDICAID)

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.

FOOD SECURITY:
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)

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.

FOOD SECURITY:
SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC)

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.

EARLY LEARNING:
COLORADO CHILD CARE ASSISTANCE PROGRAM (CCCAP)

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.