Colorado stakes out major health system reforms

Washington -- Colorado is attempting to join the few states that have adopted overhauls of their health systems.

A commission created last year by the Colorado General Assembly is more than halfway finished with its examination of health system reforms. The Blue Ribbon Commission for Healthcare Reform has already narrowed 31 proposals from the general public down to four and is scheduled to issue a final report to lawmakers by Jan. 31.

Democrats control both chambers of the General Assembly and the governor's office, but it's up for debate whether Colorado can replicate the successes of the three northeastern states that have passed significant packages.

Three of the four proposals under consideration in Colorado would expand Medicaid and the State Children's Health Insurance Program in combination with creating affordable health insurance plans. One of those three would require individuals to be insured. The fourth would create a single-payer system. The proposals would cover between 40% and 100% of the state's 792,000 uninsured.

Voters almost certainly will have their say in the matter. The Colorado Constitution requires any new state or county taxes to be approved by a public vote. But before lawmakers offer a referendum, they could pass reforms, such as an SCHIP expansion, that wouldn't require additional taxes, according to Speaker of the House Andrew Romanoff.

While the Colorado Medical Society hasn't endorsed a plan, it created the Physicians' Congress for Health Care Reform, in part to develop principles by which to measure proposals. To meet the medical society's muster, reforms must provide universal coverage and uniform benefits; ensure a choice of physicians; be administratively simple, accountable and efficient; and be affordable, transparent and sustainable.

The society wants to be a partner in health reform, said Physicians' Congress co-chair Mark Laitos, MD.

Single payer attracting interest

More people have been asking about the single-payer plan than the other proposals -- at least in northern Colorado, the home of family physician Mark Wallace, MD, MPH, the Blue Ribbon Commission's co-chair.

That's partly because a recently released Lewin Group analysis of the four plans concluded that a single-payer system would require $1.4 billion less than the $30.1 billion the public and private sectors are expected to spend on health care in Colorado in fiscal years 2007-08. Meanwhile, the other three plans would cost up to $1 billion more and cover fewer people.

Senate Minority Leader Andy McElhany said the cost differences won't matter. He predicted none of the four proposals will be adopted because of funding competition from higher education and transportation.

But the author of the bill that created the Blue Ribbon Commission said public support for major reform will follow if residents figure out how much is being spent on health care already. "People are paying and not getting access to quality health care," said state Rep. Anne McGihon.

There's debate among the 27 Blue Ribbon commissioners on whether the panel should endorse one plan, Dr. Wallace said. Commission members are working on a fifth plan, although it wasn't clear as of press time what provisions it might include.

One physician's frustrations

About five years ago Monte Uyemura, MD, a family physician in Wray, Colo., needed to vent his frustrations. He was spending more time documenting his work for payment and less time helping patients. So he stayed up for a few nights, writing a health reform philosophy. It mostly sat on his shelf until he heard about the Blue Ribbon Commission's request for proposals. He revised it a bit and sent it in. The 13-page plan is one of six written by physicians.

His plan would make it illegal to sue doctors and for physicians to turn away patients because they can't pay. It would subsidize preventive medicine, encourage contributions to health savings accounts and would make all prices transparent.

Although his plan didn't make the final cut, a commission representative told him his ideas influenced the debate. Dr. Uyemura hopes the panel proposes something to help people in Colorado access primary care instead of putting it off because of cost.