Health care splits guv race
Polis wants universal, and Stapleton wants catastrophic coverage
For Eagle County resident Bobby Bank, the cost of health insurance is incomprehensible. Bank, like many Coloradans who live in the mountains, faces some of the highest health insurance premiums in the country.
“Everyone in Colorado should pay the same price,” he said. “I should be able to buy the insurance you get.”
So it’s with keen interest that he and others are watching the state’s gubernatorial race, in which both candidates — Republican state Treasurer Walker Stapleton and Democratic U.S. Rep. Jared Polis — have pledged to bring down health care costs.
While many issues separate the candidates, the starkest contrast may be in their approaches to improving the health care system.
One of Polis’ marquee campaign promises has been establishing universal coverage for Coloradans. A longtime supporter of “Medicare for all,” Polis is among a handful of Democrats across the country running on such a promise. The Democrat has also released a bevy of additional proposals, including a 100day health care road map for the first year in office.
The Stapleton campaign’s ambitions have been more tempered. The Republican issued three priorities for health care, including seeking a federal waiver to allow insurance companies to sell plans inside Colorado that would only cover “catastrophic” events.
Each campaign has criticized the other. Stapleton’s camp has demanded Polis explain how he would pay for a singlepayer system, which by one measure could double the state’s budget. Polis’ team charges that Stapleton’s plan would kick thousands of people off the state’s existing Medicaid program, which has expanded and become more popular since the Affordable Care Act, or Obamacare, was put in place.
Health care reform is incredibly complex and politically volatile, with Colorado families’ literal and financial health at stake. As one doctor told The Denver Post: “If it was easy, someone would have already done it.”
Here’s a deeper dive on both candidates’ positions:
So, does Polis have a specific plan — and budget — to move to establish universal coverage?
No. Polis’ ultimate goal is to make sure Coloradans don’t have to worry about the cost of health care. How he gets there is still an open question — one he embraces, his campaign says.
He has floated a few ideas, including creating a multistate consortium to work together to create a new system that’s large enough to expand coverage and keep costs low.
For this idea to come to fruition, Polis will not only have to negotiate with multiple state governors, but with their respective states’ legislative bodies and, of course, Colorado’s own General Assembly. It will take an immense pool of political capital from dozens of lawmakers in states that are more conservative than Colorado.
“I don’t think heavily Republican Kansas is about to jump on board with this,” said Andrew Friedson, an assistant professor of economics at the University of Colorado Denver.
Michelle Lujan Grisham, the Democratic gubernatorial candidate in New Mexico whom Polis has suggested as a possible ally in the fight, has said the numbers for single payer “don’t work.”
What’s more, even if Polis can muster the political capital needed in a few states to put something together, it might not benefit Colorado. The state has some of the healthiest residents in the nation. If Colorado partnered with other states where residents are less healthy, that could drive costs up here.
Another option that Polis is floating is creating a system where individuals may buy in to either a Medicaid package or the state’s employee health care program. The Polis campaign believes this would come at no additional cost to the state, because individuals would be paying 100 percent of the premiums. An analyst for the Colorado Health Institute said most public options proposals are designed so there are no additional costs to the state. However, no public option is currently offered in another state.
A recent poll by Healthier Colorado, a nonpartisan health care advocacy organization, found that 75 percent of Coloradans support expanding the state’s Medicaid system, currently confined to lowincome adults and children, to individuals with “limited or expensive” health insurance.
The bottom line: Polis can’t say how much it would cost to provide universal care to Coloradans because there isn’t a clear strategy yet. His campaign said Polis will not move forward with any plan that increases costs for the average Coloradan and limits options.
Is Polis offering any specifics?
Yes. While Polis’ long term vision to create a singlepayer system is ambiguous, other health care proposals in his 100day road map are more concrete. In fact, several have been considered by the Colorado legislature and other states before.
Take, for instance, his call for a reinsurance program. Such a program, like the one Alaska, Minnesota and Oregon put into place, helps reduce the risk to insurers covering highcost claims. Polis also wants to take Colorado’s nine insurance zones, which set different prices for residents living in different parts of the state, and make them one. This would drastically reduce costs for folks in the state’s mountain and Eastern Plains communities. There’s been bipartisan support on this issue in the past, but lawmakers have been hesitant to go all the way because premiums could rise slightly for individuals along the Front Range.
Would Stapleton’s plan kick thousands of individuals off Medicaid?
Overall, Stapleton health care proposals, including that for Medicaid, are very focused on controlling health care spending.
He lays out a plan for an outcomesbased approach to Medicaid, which his campaign argues will curb the cost of the program and free up government money for other areas, such as education and roads. Stapleton also proposes creating a task force to improve the administration and monitoring of Medicaid, which he argues will reduce wasteful spending, abuse and fraud.
In recent interviews, Stapleton has said it’s the government’s “moral imperative” to protect Medicaid and the people on it. But through the extra monitoring he is proposing there’s a risk individuals could be squeezed out, even if it’s indirectly, according to health care experts
The extra scrutiny could unintentionally drive up costs or create barriers that make it too much of a hassle for people to continue with Medicaid, experts said.
“We may also deny benefits to people who really need them,” Friedson said about the plan. “It’s exceedingly difficult to tell who is who.”
How would Stapleton’s waiver proposal affect the state’s health insurance marketplace?
Stapleton has said one of his other goals is to increase insurance coverage options, including seeking a federal 1332 waiver that would allow Coloradans to buy shortterm or catastrophic health care plans. He says in his proposal that the options must cover preexisting conditions and allow young adults to stay on their health care plans.
The idea behind this proposal is that coverage on the individual market can be expensive if you don’t qualify for tax credits, especially as premiums on the individual market — both on and off the state’s health insurance exchange — have increased. (This year, insurers proposed one of the smallest hikes — just under 6 percent — in years.)
Options such as a catastrophic health plan, which have high deductibles, can offer cheaper monthly payments, but they don’t cover routine health care costs. Instead, the plan is there in case of a health emergency.
These types of plans could be a solution for some people but could also throw instability into the state’s health care market if the people who buy the plans are also the healthiest individuals in the state.
It’s unclear how many residents would be interested in such plans, so it’s uncertain how the waiver would affect the market, said Joe Hanel, managing director of communications for Colorado Health Institute.