Health care

Conversations as well as legislation
reflect Colorado’s continuing needs

Now that the federal Affordable Care Act has withstood a challenge in the U.S. Supreme Court, states must begin work in earnest to implement its provisions. There is much groundwork done to get health-insurance exchanges up and running, and the Colorado Legislature has taken up a provision to provide Medicaid coverage to more low-income Coloradans. In passing measure, along largely partisan lines, the Senate rightly recognized that investing in health-care coverage is less expensive than paying for the treatments of those who cannot afford it. While not free, it is a worthwhile expenditure.

Senate Bill 200, sponsored by Sen. Irene Aguilar, D-Denver, will extend Medicaid coverage to adults who earn up to 133 percent of the federal poverty level – $15,282 for a single person. This would affect an estimated 187,000 of today’s 800,000 uninsured Coloradans, to the tune of $1 billion next year. That is no small sum, of course, but neither is it an entitlement cornucopia offering Cadillac coverage to all who seek it. Instead, it is an appropriately gauged effort at bringing down the state’s health-care costs by extending coverage to those least likely to afford it on their own, and therefore most likely to be unable to pay for any health services they seek – likely long after any preventive or routine care could have offset a more serious health condition.

For the first several years of the expanded coverage, the federal government will carry the costs, with the state gradually stepping in to pick up the tab. The money for the coverage will come from a tax already being levied on hospital services.Despite claims that Medicaid is ineffective and rife with fraudulent or improper spending, as state Sen. Ellen Roberts, R-Durango, cited as a concern, the efficacy of preventive care and regular access to doctors is well-supported. For those earning $15,000 a year or less, insurance coverage to provide such access is simply not attainable. If there are improvements to be made in how Medicaid is administered, that should be discussed and addressed, but the program is proved to be an effective means of covering those with limited incomes. Senate Bill 200 deserves passage; it will improve health care for many Coloradans and has the potential to save the state money in the long run.Aguilar, who is a physician, has upped the ante on health-care coverage by proposing a measure that would provide universal coverage to all Coloradans. She killed the bill last week when it became clear she did not have the votes to move it, but the conversation was an important one. Even with the expanded coverage that SB 200 would provide, hundreds of thousands of Coloradans will not have insurance. Aguilar’s measure would have changed that by levying a payroll-based tax on Colorado employers and workers to cover a basic set of health-care services. The notion was not wildly popular, but Aguilar raises an interesting question of how best to care for those who still lack coverage. There is more work to do in answering that question, and solving the conundrum of how to simultaneously bring down the cost of health care while expanding the universe of those who have access to it. Senate Bill 200 is a start, as was Aguilar’s failed measure.