The Colorado Public Option health insurance plan has passed through the gantlet of legislative approval, implementation and launch. Now it has 35,000 people signed up.
That will forever change the health care industry in Colorado.
For years we have heard cries for “Medicare for All” as a policy platform. The slogan has its appeal. The government program for Americans over the age of 65 has a superficial — and often actual — simplicity that contrasts to the wildly complex private insurance and health care delivery system everyone else must navigate.
That said, it has primarily been a pipe dream. The health care industry is more resistant to change than almost any other in America. From payers to doctors to health care systems to pharmaceutical companies. Oh, and patients. Each are reticent to try something different.
That is why a wholesale replacement of the private health care insurance system meets with such intractable resistance. Just ask Vice President Kamala Harris. She nearly got eaten alive for her answers on the subject during the 2019 Democratic presidential primary debates.
There are plenty of reasons to dislike the employer-based private insurance. It is dependent on your employer’s choice of providers. It is not always portable from one job to the next, a bigger issue in an era when people switch careers and jobs more regularly. The entire cost burden is usually born indirectly by employees as employers leverage the benefit as a reason to reduce salaries.
But any mention of stripping away the private employer-sponsored system is met with loud wailing and gnashing of teeth.
That means incremental change is the only approach. That is exactly what the Colorado Public Option does. It gets a toehold on the path to change.
Maybe Gov. Jared Polis recently read the Pulitzer Prize-winning book The Power Broker by acclaimed biographer Robert Caro. It traces the life and career of Robert Moses, New York’s most powerful public servant of the 20th century. A favorite tactic employed by Moses was putting a stake in the ground when opponents seemed hellbent on opposing his path.
Moses believe that once building began, almost nothing could stop its progress. That sure seems to be what Gov. Polis has done.
Pared back from prior iterations introduced at the legislature, this version nonetheless marks a path toward a new future. It creates the initial infrastructure for more to build on in the future.
It also addresses multiple immediate needs.
Private insurance companies were partially to blame for the Colorado Public Option’s introduction and passage. When those companies left multiple counties in Colorado without any options in the health exchange market, they created the necessity and rationale for a government-guided insurance alternative.
Furthermore, the unmet needs of individuals without immigration documentation has been an ongoing issue. It is far cheaper for the state if those folks can get preventative care through an insurance program than if they seek urgent and emergent care in costly hospital settings.
Those factors all combined to make the first step possible. Now it is operational and supplying coverage to tens of thousands of Coloradans. Furthermore, as its existence becomes more widely known and accepted, it is likely that those numbers will continue to grow. If the services meet expectations, it may become an alternative of choice.
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That is how big changes begin. Small changes that grow and affect the entire system as they do.
There will be huge confrontations to come. A clash of pricing models charged by health care systems is almost unavoidable. The coverage levels of plans offered under the Colorado Public Option will be subject to review and alteration. The role of private supplemental insurance will be examined.
What is certain is that we will not turn back. The stake has been driven into the ground. The Colorado Public Option is a reality going forward.
Mario Nicolais is an attorney and columnist who writes on law enforcement, the legal system, health care and public policy. Follow him on Twitter: @MarioNicolaiEsq.
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