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Our View of Graham Cassidy Heller Johnson

The Colorado Nonprofit Association opposes 2017 federal healthcare bills that clearly  fail to align with the Colorado Health Policy Coalition's principles.

Colorado Nonprofit Association supported implementation of key elements of the Affordable Care Act (ACA), namely the Colorado Health Insurance Marketplace (SB 11-200) (i.e. Connect for Health Colorado), Medicaid expansion (SB 13-200), and the Small Employer Health Credit

Patient Protection and Affordable Care Act

We supported these policies because we believed they would reduce the number of uninsured Coloradans, help more nonprofits provide affordable coverage for their employees, and reduce the cost shift of uncompensated care to private insurance.

According to the Colorado Health Institute, 1 in 10 Coloradans (554,000) benefit from the ACA, Colorado has also reduced its uninsured rate from 14.3% in 2013 (741,000) to 6.7% in 2015 (353,000) due to Medicaid expansion and the Marketplace. The ACA has also helped reduce the cost of uncompensated care in Colorado from $2.3 billion to $1.1 billion in 2015.

This spring, Colorado Nonprofit Association joined the Colorado Health Policy Coalition (CHPC) and signed on to its commonly held principles regarding federal health care reform. 

Our View

Graham Cassidy Heller Johnson

Based on these principles, we have concluded that the Senate amendment to the American Health Care Act of 2017 (H.R. 1628), known as Graham Cassidy Heller Johnson, is not consistent with the principles in the following areas:

Cost shift (#4): GCHJ does invest funding to lower costs and improve the quality of state healthcare systems through the grant program (#7) but shifts considerable costs to most states. GCHJ would reduce federal funding to Colorado from projected ACA levels by amounts ranging from $944 million to $6 billion between 2020 and 2026.

Cutting back on Medicaid eligibility, benefits, or administrative costs may be more politically feasible than asking voters for a tax increase or cutting from other areas of the general fund. 

Affordability (#1): Because the amount of new grant funding depends on a state’s coverage of low-income residents, most of Colorado’s grant funding will likely be spent on Medicaid consumers. Under the per capita allotment, funding would be less than the current federal match for Medicaid or the enhanced match for expansion populations.

Medicaid would have less value for Colorado’s consumers, particularly in rural areas, if benefits are cut or out of pocket costs are increased to fill funding gaps in Colorado. For individual and employer-sponsored plans, state funding may not be available to help those who previously benefitted from the ACA’s subsidies and credits. 

Consumer protections and vulnerable populations (#1 & #5): If Colorado chose to waive some or all the federal consumer protections, this would increase costs and reduce quality of coverage for many consumers on individual and employer-sponsored plans.

If Essential Health Benefits are waived, coverage could be reduced or eliminated for consumers with certain pre-existing conditions unless those conditions are covered by Colorado law. If rating rules are waived, insurers can increase rates based on age or health status. Waivers could help bring down overall rates but older and sicker consumers would most likely be the ones who pay more.

Appropriate access and market stability (#2 & #3) : Although CBO’s score of GCHJ has not been completed yet, Colorado’s uninsured rate would likely increase due to individuals and employers dropping coverage. This would increase overall healthcare costs by reducing use of preventive care and increasing use of emergency care. Ensuring balanced risk pools by including healthier consumers would become more difficult.    

Process (#1 to #3): Rather than coming together to address common concerns (e.g. rising healthcare costs, lack of carrier choice in some counties, etc.), the Senate is rushing to pass the bill by September 30 with limited public input and no bipartisan support. To benefit from the block grant program, "every state would be expected to create new health insurance coverage programs from scratch," according to the Kaiser Family Foundation.

As a result, the National Association of Medicaid Directors indicated that the vast majority of states would be unable to "operationalize the block grant component by January 1, 2020." For these reasons, we don't view GCHJ as a carefully considered replacement for the Affordable Care Act.