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MA Health Reform Impact: Check Out Colorado

MA Health Reform Impact: Check Out Colorado

August 17, 2006

Wonder if MA health reform has influenced other states? Exhibit A: a Colorado gubernatorial debate on health care. Democrat Bill Ritter and Republican Bob Beauprez show the influence Massachusetts has had. Click here for the full account in the Rocky Mountain News. Some excerpts below:

About 770,000 Coloradans are uninsured - 17% of the population. Health insurance premiums are rising at three times the rate of inflation. And Medicaid is the fastest- growing part of the state budget. With the stage set, the Rocky Mountain News asked gubernatorial candidates Bill Ritter and Bob Beauprez how they would reform health care if elected governor. ...

Q: Who are your health care gurus?

Ritter: Joan Henneberry and Sue Williamson at the Denver think tank Policy Studies Inc. Barbara Yondorf, senior program officer at the Rose Community Foundation, has helped talk me through this. I have talked to former Oregon Gov. Dr. John Kitzhaber. I met with John McDonough, executive director of Health Care For All, the group that helped craft the Massachusetts Health Plan legislation. I've also met with CEOs of health insurance companies, hospitals, doctors and members of the Colorado Medical Society.

Beauprez: I consider Dr. Patty Gabow, CEO of Denver Health, one of my very good gurus. I've grown rapidly fond of Dr. Michael Salem, CEO of National Jewish. I have an exceptionally good staffer in Jake Allen in my congressional office. A number of doctors, including a radiologist, Dr. Steve Brown, and Dr. Jack Kletcher, who heads the Colorado Medical Society's political action committee. As a member of the House Ways and Means Committee, on a regular basis we've had Secretary Leavitt in front of us. I have a personal relationship with Dr. Mark McClellan, head administrator for the Centers for Medicare and Medicaid.

Q: How would you take on Medicaid?

Ritter: Certainly the rate of increase in Medicaid spending has outstripped every other category. So it is a big budgetary pressure. There are things you can do to address Medicaid spending, to address prescription drug purchasing that Owens decided not to do. But you can't do it piecemeal. Look at what Massachusetts did: They went to the federal government, received a waiver, then they combined all their state dollar spending - Medicaid, state employees and money for businesses, and they said, we're going to have a statewide health plan. They didn't do it piece by piece by piece.

Beauprez: We need to make Medicaid consumer-driven. And South Carolina and Florida provide some great models. It's what most of us, who have an employer- based system, use: a defined contribution. They tell patients, "Here's your contribution based on your needs." Then, suppose your defined contribution is $1,000. You can use it to buy health insurance. But if you adopt a wellness program, a preventive care program, or get into job training, that's worth some more. And if you end up with some change in your pocket, we'll split it with you. Now we're really changing the paradigm.

Q: What can we learn from Massachusetts?

Ritter: Colorado should be looking to create its own universal coverage plan. The genius of the Massachusetts plan is shared responsibility. I've committed to a planning process that brings everybody with an interest in trying to solve this to the table. People say that sounds vague because we can't offer a specific answer. But even the architect of the Massachusetts plan said, "Don't think you can take our plan and transfer it to Colorado. Commit to a process that has transparency in it, and that's ultimately how you get to a Colorado plan." And if you have to take on interest groups to get there, that's part of being a leader.

Beauprez: We'll know in hopefully a little while. You want to see some results. The effort is noble if the effort is to give everyone you can insurance coverage. Gov. Mitt Romney himself has told me he has a problem with the mandatory employer contribution. I understand the argument: Like auto insurance, you ought to have to have health care. We ought to have that debate. I'm usually a mandate-light sort of a guy. But I also recognize when you've got in excess of 17 percent of our state's population uninsured - some of them by choice, some by necessity - that you've got a problem.

Q: Is there the political will to take on the uninsured?

Ritter: The problem with the uninsured is they are not people who exercise their political voice, who show up at political gatherings and meet-and-greets. But I don't talk to anybody who doesn't think the health care system is broken. The conversation this year shows that businesses really believe it is in need of fixing. CEOs and large-business people talk about it, as do small businesses. It's really fascinating the number of businesses around the state that are making business decisions around health care costs.

Beauprez: It's a must-do. We're on an unsustainable path, and health care is rapidly getting more and more expensive.The solution is to make health care and health insurance less expensive. It's a free-market approach. If cars are too expensive, somebody comes in with a more affordable product to get the job done. The other option is to say we'll tax somebody. Who? The health care fairy who is going to pay for somebody's health insurance tomorrow? If we are going to become the caretaker of all people, maybe we ought to do that with the autos you buy, the house you live in, the food you eat. I look at solutions I think are consumer-driven. If people are in charge of their own decisions and their own money, we'll all get along a lot better.

Q: What's your take on mandating that employers provide health care coverage?

Ritter: The Massachusetts plan says there has to be some responsibility on the part of employers. It mandated an employer contribution, although small. Employers have to be part of the solution.

Beauprez: I'm not a big mandate fan. It's fine if employers want to provide health insurance, but that should be a choice that they make.

Q: Gov. Owens vetoed a measure that would have allowed women easier access to the morning-after pill. What would you have done?

Ritter: Signed it.

Beauprez: Vetoed it.