Mar 22, 2017

Bethany Pray currently serves as CCLP's Deputy Director. 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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Stability fund not a fix for Colorado

by | Mar 22, 2017

A risk pool with plenty of healthy people creates a stable insurance market. Under the Affordable Care Act, the stability of the individual and small-group market depends on the individual mandate bringing those healthy people to the table, and on a set of risk adjustment mechanisms that were hampered after Congressional opponents of the ACA reduced the programs’ funding.

Although the authors of the American Health Care Act of 2017 (AHCA) oppose an individual mandate, they clearly agree with the designers of the ACA that risk adjustment mechanisms will be needed to keep insurance affordable, and have offered the Patient and State Stability Fund as a solution.  In fact, such mechanisms may be needed even more under the AHCA because repeal of the mandate to purchase insurance will increase adverse selection, meaning people are more likely to purchase insurance only when sick.

The big question is whether the $100 billion Patient and State Stability Fund has any chance of helping lower premiums, as was forecast by the Congressional Budget Office. As far as Colorado goes, the answer is very likely no, even though the amount targeted for Colorado’s use would ostensibly fall between $100 million and $199 million in 2018. That sounds like a lot of money, but there are two reasons that the Fund won’t function as described in Colorado.

First, the amount of funding targeted for Colorado would be insufficient, even if every dollar given us from the Fund were devoted to reinsurance, a program that helps reimburse carriers for very expensive enrollees. Alaska has a reinsurance program that costs $55 million a year and is widely seen as effective – but with a population seven times the size of Alaska’s, one would expect Colorado to need a reinsurance program with at least $300M in annual funds. A reinsurance program with insufficient funding would be ineffective in stabilizing premium prices, or in keeping carriers from exiting the market.

Second, and what’s worse, Colorado may never be able to access much, if any, of the Fund. Receipt of federal Fund dollars is contingent on the state matching those funds, beginning with at least a 7 percent contribution and ending with a full 50 percent contribution in 2026. Depending on the amount Colorado is eligible for, that means as much as $100 million from the state budget in 2026. The ACA, in contrast, required issuers — rather than states — to contribute to the risk adjustment funds. In the event Colorado is unable to overcome TABOR restrictions to locate funding, the state might receive nothing at all from the Patient and State Stability Fund.

Bethany Pray

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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.