You don’t need a medical degree to know that our health care system is broken.
Millions of Americans remain uninsured. Many cannot afford to pay their medical bills even if they have insurance, yet the health-care industry is growing and profiting more than ever. The rising cost of health care is a crisis facing Colorado families and small businesses.
Unfortunately, we have treated our health care system as though it is a patient in the emergency department. For years we have bandaged and stitched it together, to keep people from falling through the cracks. But that is expensive and unsustainable.
We can do better if the Colorado legislature passes House Bill 1232, the compromise version of the Colorado Option for health insurance.
As emergency physicians, we see how the cost and complexity of health insurance shapes the choices many Coloradans make. Many do not have insurance because they simply cannot afford it. Others bounce between jobs and cannot afford COBRA payments to extend their employer-arranged coverage.
So, every day, patients come to the ER because they cannot afford to see their doctor or refill their medications, and resort to using the ER for primary care.
The health care system not only prices out people with low-income, the uninsured, and people of color, it also leaves people with private insurance scrambling to pay their medical bills. According to the Kaiser Family Foundation, in 2020 the average U.S. family premium was $21,342 per year. Once you add copays, deductibles, and out-of-pocket costs, many Coloradans face an impossible choice: pay for health care or other basic necessities.
The leading cause of bankruptcies in America is also directly linked to health care. Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall. Even when people have insurance, it is not usable because the out-of-pocket costs are out of reach.
The compromise version of HB 1232 brought major health care industry groups to taking neutral positions, and includes significant provisions that are very beneficial to doctors and private practice providers. Thus we are stunned that certain medical specialist groups are still opposed even when this will help their patients and their practice.
Meanwhile, the profit margins of Colorado’s hospitals are among the highest in the nation, according to the Colorado Business Group on Health. This mirrors the growth in profits at the national level among some of the largest health insurance companies, including UnitedHealth Group, Humana, Anthem, and Cigna. Their revenue pays for the million-dollar TV ads and government lobbyists to thwart any changes that threaten their bottom line.
This pandemic has been a wake-up call. Now is the time to act.
The Colorado Option created by the bill would expand access to health care and make it more affordable for all Coloradans. Health insurers would be required to reduce premiums by 18% over three years and offer a standardized health plan in every Colorado county on the individual and small group market.
The plan would be developed with input from people across the state and tailored to address the racial and historical health disparities felt by Coloradans.
The Colorado Option would make health insurance more transparent. It would be easier for people to understand which services are covered when they see their doctor or go to the hospital.
All essential health benefits required by state and federal law, including hospital coverage and preventative care, would be included in the plan. Even better, there would be additional pre-deductible services above and beyond those required that would help lower out-of-pocket costs and expand access.
If the health care industry fails or refuses to lower costs, under the legislation they would be held accountable. A public hearing process to establish affordable insurance rates, adequate provider networks, and ensure real cost savings for Coloradans has been included in the updated version of the bill.
This bill would finally bring real transparency and accountability to our health care system and would actually lower the driving costs of health care.
A society is not just measured by its wealth, but by the health of its people. When people can get health care when they need it, not only when they’re facing a life or death situation, we all benefit.
HB 1232 would give every Coloradan the opportunity to live a healthy life, and now is the time to pass it.
Kristen Nordenholz, M.D., M.Sc., is an emergency physician in Aurora. Her views as expressed in this essay are her own and she is not representing her employer. Stanley Siefer, M.D., is a retired emergency physician in Englewood.
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