So You Want to Expand Coverage? The Colorado Experience Kelly Shanahan Policy Director Colorado Consumer Health Initiative Health Action 2008 January 25, 2008 Washington DC

Welcome to Colorful Colorado!

(57% CO) (17% CO) (7% CO) (17% CO = 785,000) (155,000 are kids) Coverage Nationally vs. Colorado

Fiscal Environment - TABOR The Taxpayer's Bill of Rights Colorado Constitution Article 10, Section 20 Basic Provisions Voter approval for tax increases Revenue limits Government spending limit –(inflation plus population) Revenue refunds

Good times, bad times & economic recovery The Ratchet Effect Source: TABOR: Ten Years Later, (Powerpoint presentation), Carol Hedges, The Bell Policy Center. (

Source: TABOR: Ten Years Later, (Powerpoint presentation), Carol Hedges, The Bell Policy Center. (

Colorado Health Benchmarks Expenditures per capita RankState spending required to reach US average Total State Spending44$3.31 B Medicaid47$993 M SCHIP32$13.1 M Source: Aiming for the Middle: Benchmarks for Colorados Future, Colorado Center on Law & Policy (June 20, 2007).

Public Program Eligibility

Colorado Blue Ribbon Commission for Healthcare Reform What? Senate Bill (also known as 208 Commission) Why? To come up with recommendations to the Colorado legislature by January 2008 for comprehensive healthcare reform in our state! Who? 27 members appointed by Governor and legislative leadership (consumers, business/industry, health experts) Goal: Increase access to affordable coverage for all Coloradans

2007 February: Formal solicitation for proposals April: 31 reform proposals received May: 4 proposals selected for analysis Summer: –4 proposals modeled for cost and coverage –Commission developed its own 5th proposal Fall: –Public hearings around the state –5th proposal modeled November-December: Recommendations to the Legislature developed 2008 January 31 st : Report due to the Legislature Colorado Blue Ribbon Commission for Healthcare Reform

Formed the CCHI 208 Work Group –Weekly meetings late January – April 2007 –Every week we tackled a different question –Ad hoc groups on specific issues Technical Team –Families USA (Washington DC) –Community Catalyst (Boston) CCHI Proposal: Connecting Care & Health for Colorado

Step 1: Do we work with the existing public- private system we have OR do we wipe the slate clean and start all over? A: Existing system (However, we dont want to tinker, we want major reform!) Step 2: Public programs...?? Step 3: Private insurance…?? risk rating vs. risk pooling cost-shift underinsurance CCHI Proposal: Connecting Care & Health for Colorado

Online Tool Demonstration

Four Proposals Chosen & Modeled

Final Recommendations to Legislature

Lessons Learned for CCHI Great opportunity for consumer groups to Dream big! Think systemically Build consensus Helped us to develop… Consumer Bill of Rights & Responsibilities Guiding Principles for State Health Reform Moving forward, gives us direction legislatively in our coalition-building efforts

Thank You Families USA and Community Catalyst! Colorado Consumer Health Initiative Kelly Shanahan (303)