The bill passed the state Senate Finance Committee on a party-line vote, with Republicans supporting it and Democrats opposed. Supporters of the bill have doubts that the exchange can remain financially viable and point out that having a state-based exchange has not immunized Coloradans from the rising premiums and shrinking choice found in Obamacare marketplaces across the country. For more than three hours, dozens of speakers spoke of gratitude for or grievance with the federal health law — showing how the bill, despite its wonky bones, has become an all-purpose dummy for the bigger health care fight. Another praised the Affordable Care Act for allowing her to receive life-saving treatment. Smallwood said that Connect for Health is running well below once-forecast enrollment figures, and he questioned whether the exchange can survive without current yearly donations from insurance companies, which then receive tax breaks.
Because the cost of CSR is now being added to silver plans, the average proposed rate hike for silver plans was more than 12 percent, while the average proposed increase for bronze plans was less than 1 percent, and the average proposed increase for gold plans was less than 7 percent. If the exact same silver plans are also sold off-exchange, they have to include the cost of CSR in their premiums. But as long as the on- and off-exchange silver plans have a difference in benefits, the cost of CSR can be added only to the on-exchange silver plans.
The two plans would then have different identification numbers in the Health Insurance Oversight System HIOS and could then have differing premiums, with the cost of CSR added to the on-exchange version and not to the off-exchange version.
Insurers have the option of using a different approach to creating a slight benefit difference between on- and off-exchange silver plans, but will need to discuss the proposal with the Division of Insurance before proceeding.
So while the on- and off-exchange silver plans will vary slightly, the differences will be negligible. For people who do qualify for premium subsidies, the subsidies will continue to offset the impact of annual rate increases. Connect for Health Colorado projects that two-thirds of subsidy-eligible enrollees will be able to select bronze plans that are free after premium subsidies are applied.
But now that Colorado is silver loading the cost of CSR forzero-premium bronze plans will be available to many enrollees, due to the much larger premium subsidies and the relatively smaller bronze plan prices. And in some areas of the state, enrollees who select plans from Kaiser, Denver Health, or Rocky Mountain Health Plans may be able to find gold plans that are cheaper than silver plans.
With the acquisition, Colorado Choice plans began to be marketed as Friday Health Plans forand are for-profit rather than non-profit.
Colorado has a state-run exchange, Connect for Health Colorado. Lawmakers in Colorado again rejected a bill to provide state-based premium subsidies to. Connect for Health Colorado is Colorado's official health insurance marketplace and the only place you can apply for financial help to lower your monthly costs. Apr 17, The bill would direct state agencies to recommend a plan that would compete with plans and those offered on Colorado's healthcare exchange.
Pueblo has gone from having two insurers in the exchange to three, Boulder has gone from having four to five, and Grand Junction from two to three. But in Grand Junction, subsidized enrollees who keep the same plan from to ended up with an average premium increase of 38 percent. However, if they were willing to switch to the lowest-cost plan at the same metal level, they saw an average after-subsidy premium decrease of 56 percent. This is a perfect illustration of how a new insurer entrant can disrupt a market, and how the effect can be both good or bad, depending on your perspective.
Friday Health has taken over the benchmark plan spot in Grand Junction, with rates that are lower than the benchmark would otherwise have been. That means everyone in that area who receives premium subsidies is getting smaller subsidies in than they would otherwise have received.
If they opted to keep the same plan they had inthey may have seen significant average net premium increases, due to the smaller premium subsidies.
But if they opted to switch to a lower-cost plan in the same metal level offered by Friday Healththey saw a sharp reduction in their premiums for But for people with pre-existing conditions, provider networks and drug formularies play a role in determining the feasibility of switching to a new plan.
The provision requiring that the state conduct an actuarial study and only submit the waiver if the proposal would not reduce total premium subsidies or increase average premiums was also an amendment the initial bill would have just directed the state to seek federal approval to expand access to catastrophic plans. The state contracted with Wakely for the actuarial analysis, and the results were published in November Wakely concluded that total premium subsidies would likely increase by no more than 6.
This is because healthier people would be expected to migrate to lower-cost catastrophic plans, leaving a less healthy population in the metal-level plans.
That would lead to higher premiums for the metal-level plans, and since premium subsidies are based on the cost of the benchmark silver plan, subsidy amounts are expected to be higher. The ACA only allows waivers to be approved if doing so would not increase federal deficits. Information about S. Brokers were not previously allowed to charge any sort of fee, and have historically only been compensated via commissions from insurance carriers with enrollees paying the same price for their coverage, regardless of whether they use a broker or not.
But insurers are increasingly opting to eliminate broker commissions, resulting in fewer brokers who are willing to work with individual market clients in the group market, insurers still pay commissions. The Colorado Division of Insurance proposed regulations for broker fees here and herewhich became effective August 8, InColorado enacted S. The legislation included mentions of the possibility of high-risk pools, reinsurance, or a hybrid of the two. Lawmakers in Colorado considered a reinsurance bill inas well as a bill that called for conducting a study about Medicaid buy-in and another that would have created a state-based premium subsidy for people affected by the subsidy cliff in high-cost areas.
In the election, however, Democrats gained control of the House. So starting inColorado will have Democrats in the majority in both chambers of the legislature, and a Democratic governor Governor-elect Jared Polis will assume office in January The legislation would have instructed the Colorado Department of Insurance to seek federal approval for a waiver to secure pass-through funding for a reinsurance program. But funding for the reinsurance program would also come from a fee assessed on Colorado health insurers, including those in the individual and group markets, as well as insurers that provide stop-loss or excess coverage to self-insured groups — and that state funding was the sticking point for the bill.
With the demise of H. The premium subsidy would have been available for bronze, silver, and gold plans sold through the exchange, and there would have been a special enrollment period from June 1, to August 1,to allow people to newly enroll in a plan through the exchange with the state-based subsidies.
Apr 23, The bill directs state agencies to recommend a plan to compete with private plans and those offered on Colorado's health care exchange. Apr 23, Colorado lawmakers OK bill to develop public health insurance option plans and those offered on Colorado's health care exchange. Apr 16, Colorado Senate Advances Public Option Health Insurance Bill insurance plans and those offered on Colorado's health care exchange.
The House passed the measure, but a Senate committee indefinitely postponed it in early May. The only real difference for consumers is that the bill would have provided assistance for people whose insurance premiums exceeded 15 percent of their income, while the bill would only have provided assistance to people whose premiums exceed 20 percent of their income.
When H. Minnesota implemented a similar state-based financial assistance program inin response to rapidly rising health insurance premiums. No changes to Colorado health coverage options would have directly resulted from H. The House passed H. Open enrollment for coverage in Colorado began November 1,and ended January 12, This was nearly a month longer than open enrollment in states that use HealthCare.
By the time open enrollment ended,people had enrolled in medical plans through the exchange. As of Mayeffectuated enrollment stood at, which was about 86 percent of the initial enrollment volume. Connect for Health Colorado published their official enrollment report for in March, available here. Colorado continues to be a state where a larger-than-average percentage of the enrollees pay full price versus the national averageand where bronze plans are the most popular option, as opposed to silver plans in most states.
And thepeople who had signed up by March 2, included people who enrolled in February due to a special enrollment period triggered by loss of other coverage Humana and UnitedHealthcare terminated plans for about 20, people in Colorado at the end of ; they all had a special enrollment period in early So enrollment for by January 12 was higher than it had been on January 31,but a little lower than it had ended up after the dust settled with the enrollment extension and the special enrollment periods for people whose plans terminated at the end of The slightly lower overall enrollment compared with enrollment by early March, could be partly due to the shorter enrollment period, but also partly due to the fact that Colorado had insurers apply the cost of CSR to all plans, on and off-exchangerather than just silver plans most states took the approach of applying the cost of CSR only to silver planswhich protects most enrollees and provides additional benefits to somedue to the larger premium subsidies that result.
Those individuals had no way of getting around the added cost of CSR foras Colorado insurers added that cost to all plans.
Rate and plan filings are typically due by mid-May in Colorado, but the Colorado Division of Insurance pushed back that deadline to June 19amid the uncertainty surrounding the insurance markets.
Rate filings were made publicly available on July All seven insurers that offer individual market plans in the exchange in committed to remaining in the exchange inalthough Kaiser was the only insurer that planned to remain in the small group SHOP exchange in In the individual market, insurers initially proposed an average rate increase of Despite a robust review, regulators were only able to make a slight reduction in the proposed overall average rate increase, getting the average down to Most of the approved rates were very similar to what insurers had proposed, although the DOI made some significant changes to the rates that were filed by Bright Health and Cigna.
But those rate filings were based on the assumption that funding for cost-sharing reductions would continue in The Division of Insurance noted in September that they had backup rates that would be used if CSR funding were to be eliminated. As a result, the backup rates were implemented in Colorado.
The Division of Insurance noted that the overall average rates would increase by 6 percentage points over the already-approved rates. Ultimately, the average rate increase in Colorado was Colorado was one of only four states where the cost of CSR was added to plans at all metal levels, rather than being concentrated only on plans at the silver metal level.
The individual mandate has been repealed altogether as ofbut is still in place in The rates that were approved in September were based on the assumption that cost-sharing reduction CSR payments would continue to be made to insurers. They indicated that they would only implement the backup rates if CSR funding were to be definitively cut off — as opposed to just ongoing uncertainty, which had already triggered many states to have insurers add the cost of CSR to their premiums.
Colorado health insurance exchange bill
But unlike other states where insurers have loaded the additional premiums only on silver plansColorado insurers were instructed to submit supplemental filings that spread the cost of CSR across plans at all metal levels. The largest additional average increase that any Colorado insurer filed was 14 percent; the other filings were for smaller average increases, with an average of 6.
Hence, the backup plan included adding the cost of CSR to premiums for plans at all metal levels. As a result, the Colorado Division of Insurance implemented the backup rates and Connect for Health Colorado began the process of loading the new rates into their system.
And CSR plans continue to be available to eligible enrollees, as is the case nationwide. For people who get premium subsidies, the subsidies grew in to offset all or most of the additional premium increase necessary to cover the cost of CSR. In Colorado, 35 percent of enrollees did not receive a premium subsidy inas opposed to only 16 percent nationwide. However, formore people in Colorado are receiving premium subsidies. Her pleas were echoed by Connect for Health Colorado in a joint letter signed by most of the state-run exchanges and then-Governor Hickenlooper in a bipartisan letter written by several governors.
A Kaiser Family Foundation analysis of proposed rates finds that for a year-old non-smoker, the second-lowest-cost silver plan in the Denver area is 12 percent more expensive in before any premium subsidies are applied than it was in This analysis is useful in terms of projecting how much premium subsidies will change for the coming year, since the subsidies are designed to keep pace with the cost of the second-lowest-cost silver plan.
This is because the poverty level has increased slightly, and the percentage of income that people have to pay for their coverage has decreased slightly. So for people who receive a premium subsidy, the rate increases for are being offset by larger subsidies. This is the case for the majority of exchange enrollees, although Colorado has a much larger percentage of its exchange enrollees who pay full price than most states.
Earlier inreports that Anthem was evaluating whether to remain in the exchanges in had caused concern in several states, including Colorado, that have areas where Anthem is the only participating exchange insurer.
But Anthem has announced impending exits from some other states over the summer, despite filing rates for those states earlier in the spring. A full Anthem exit in Colorado would have caused significant problems, as there are 14 counties in western Colorado that have only Anthem as an option in the exchange in In early June, Governor Hickenlooper was considering the possibility of enacting regulations similar to recent New York regulations that would bar insurers from state managed care contracts if they stop offering coverage in the exchange.
In OctoberConnect for Health Colorado debuted their new Quick Cost and Plan Finder tool, designed to help enrollees compare plans and out-of-pocket costs. Open enrollment for coverage ran from November 1 to January 31, and enrollment ended up well above prior year totals. Connect for Health Colorado reported thatpeople enrolled in medical plans for by February 5, including stand-alone dental plans, there are a total ofenrollees.
Open enrollment had ended on January 31, but Connect for Health Colorado gave people until February 3 to finish enrolling, if they had begun the process by January In addition, people whose plans ended at the end of December had until the end of February to enroll in a new plan loss of coverage is a qualifying event that triggers a day special enrollment period.
Mar 12, Jared Polis named health care as a top priority in his first-ever State of Colorado Health Benefit Exchange and engage with stakeholders to. The bill requires the department of health care policy and financing and the division of insurance in the department of regulatory agencies (departments) to.
As a result, enrollment continued to grow throughout February. Connect for Health Colorado reported thatpeople enrolled in medical plans through the exchange by March 2, in addition to 3, stand-alone dental enrollments a total of 28, people enrolled in dental plans, but most of them also enrolled in medical plans.
In Colorado, the total wasAnd the Colorado enrollment report as of March 2 includes all of the people who enrolled in February due to loss of coverage at the end of Even with the lower total on January 31, enrollment in Connect for Health Colorado was more than 7 percent higher than it had been during the open enrollment period. Nationwidethere was an average decline in enrollment among states that use HealthCare. The decline in states that use HealthCare. By the end of November, the number of enrollments was 23 percent higher than it had been at the same point a year earlier.
High enrollment volume continued in December, particularly leading up to the December 15 deadline to enroll in a plan with a January 1 effective date. The exchange reported that on December 14, there were 10, plan selections, and another 12, on December On September 20, the Colorado Division of Insurance released the approved rates for plans. In the individual market, the Division of Insurance announced that premiums will increase by an average of The Colorado Department of Insurance reviewed rate filings throughout the summer for the carriers that proposed plans for In the individual market, seven carriers filed rates for on-exchange plans, down from ten in During the rate review process, rate hikes were adjusted — both up and down — for nearly every carrier.
For the seven carriers that are offering plans in the exchange forproposed and approved average rate increases are as follows:. In the small group market, five carriers filed rates and plans for coverage in the exchange.
Their proposed rate changes were much more modest than the proposed rate increases in the individual market.
Proposed and approved rate changes are as follows:. At the end ofHumana and UnitedHealthcare exited the individual health insurance market in Colorado, both on and off-exchange. United exited the exchanges in most of the states where it participated inand Humana exited several states. There were 10, Colorado residents with individual market coverage including on and off-exchange through UnitedHealthcare, and 9, with individual coverage from Humana.
In total, that amounts to about 4. Golden Rule, which is a UnitedHealthcare subsidiary, continued to offer individual market plans outside the exchange; United and Humana both continued to offer plans in the group market in Colorado. Roughly 10, people in other areas of Colorado needed to enroll in new coverage foras their RMHP coverage ended at the end of Anthem continued to offer HMO plans throughout Colorado in and continues to do so as ofbut they discontinued their PPOs at the end of All of them had to select a new plan for They still had access to Anthem plans, albeit HMOs.
A special enrollment period applies when coverage is terminatedand it has different effective date rules. So all of those folks had until December 31 to pick a new plan with a January 1 effective date. Although some of the already-established health insurers in Colorado exited the market or reduced their offerings, Bright Health Insurance was approved by the Colorado Department of Insurance to offer individual plans on and off the exchange in The individual market in Colorado had been dominated mostly by Kaiser Permanente, Anthem Blue Cross Blue Shield, and Cigna, so there was plenty of room for a new carrier to enter the market and cause a shake-up in market share.Transforming Health Care: Understanding the Affordable Care Act and What Might Come Next
However, the experience of Colorado HealthOP detailed below is a cautionary tale about right-sizing premiums and growth. Bright is the first new carrier to enter the exchange in Colorado since the exchange opened for business in the fall of The other seven counties appear to have coverage county-wide though.
They are continuing to offer coverage in those eight counties in Open enrollment ended on January 31, but there was a special enrollment period SEP — through the end of February — for people who lost coverage in Colorado at the end of December more details below.
Colorado lawmakers OK bill to develop state insurance option
Total enrollment for including SEP enrollment in February was about 19 percent higher than thepeople who enrolled in QHPs through the exchange during the open enrollment period. As of mid-Maythe exchange confirmed by email that effectuated enrollment was atThis is significantly higher than theeffectuated enrollment number in the most recent Connect for Health Colorado dashboard report from April.
The discrepancy was due to a lag time in reporting from carriers between plan selections and effectuations initial premium payment. The exchange released their August enrollment report in Septemberand although it showed cumulative enrollments continuing to increase, the reports never break out the actual number of people who currently have in-force individual market coverage through the exchange. TipperRep.
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Became Law. The motion passed on a vote of Activity Vote Documents Adopt amendment J.
The motion passed without objection. Refer House Billas amended, to the Committee of the Whole. Activity Vote Documents Adopt amendment L.
Refer House Billas amended, to the Committee on Appropriations. Senate Amendments. Aye: 45 No: 19 Other: 1. Aye: 53 No: 11 Other: 1. Third Reading. Aye: 46 No: 17 Other: 1. Committee of the Whole. AMD L. Aye: 16 No: 42 Other: 6. Aye: 19 No: 16 Other: 0. Aye: 16 No: 19 Other: 0. Second Reading. HOU Appropriations.
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