1. ColoradoCare Amendment 69 Covers Everyone Saves Billions Designed in Colorado for Coloradans www.ColoradoCareYes.co 1 Senator Irene Aguilar, M.D.ireneaguilar.md@gmail.com

2. Where we’ve been

3. Average Annual Premiums for Single & Family Coverage, 1999-2012 3 * Estimate is statistically different from estimate for the previous year shown (p<.05). Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2012. $15,745

4. Government Insurance  4 Million CO Medicaid = 560,722 CHP + = 69,008 Government Insurance  4 Million CO Medicaid = 560,722 CHP + = 69,008 2011: 48.6 Million Uninsured 2011 Colorado: 829,180 uninsured 16% of population 2011 Colorado: 829,180 uninsured 16% of population

5. The Affordable Care Act

6. Uninsured/Underinsured 6 2015: Uninsured decreased from 14.3% to 13.9%! Colorado Health Institute 2015 Survey

7. Federal Poverty Levels

8. 2016 153,583 Enrollees

10. Uninsured/Underinsured 10 Under-Insured has increased from 13.9% to 16.4% Colorado Health Institute 2015 Survey

11.  Rising Health Care Costs  Complicated, opaque, payment system  Profit driven, not outcome driven  No incentive to care for Colorado’s most complex, costly population ACA: Areas for improvement 11

12.  Rising Health Care Costs  Complicated, opaque, payment system  Profit driven, not outcome driven  No incentive to care for Colorado’s most complex, costly population ACA: Areas for improvement 12

13. 13

14. 14

15.  Rising Health Care Costs  Complicated, opaque, payment system  Profit driven, not outcome driven  No incentive to care for Colorado’s most complex, costly population ACA: Areas for improvement 15

16. 16 Same Surgery, Different Price

17. Excessive Administrative Costs Source: Bureau of Labor Statistics; NCHS; Himmelstein/Woolhandler analysis of CPS Growth 3000% 2500% 2000% 1500% 1000% 500% 0 19701980199020002010 17 Administrators Physicians

18. Same Drug, Higher Price 18 Price as a Percentage of US Medicare Price

19.  Rising Health Care Costs  Complicated, opaque, payment system  Profit driven, not outcome driven  No incentive to care for Colorado’s most complex, costly population ACA: Areas for improvement 19

21. Hospital Profits Margins & Occupancy Rates 21 http://www.bizjournals.com/denver/news/2015/10/13/denver-area-hospitals-earn-record-profit- margins.html?utm_source=Colorado+Health+Market+Report+10.29.2015&utm_campaign=Colorado+2015&utm_medium=email

22.  Rising Health Care Costs  Complicated, opaque, payment system  Profit driven, not outcome driven  No incentive to care for Colorado’s most complex, costly population ACA: Areas for improvement 22

23. Analysis based on 2013 Fee-For-Service Medicare claims and 2014 commercial payer claims in the Colorado All Payer Claims Database (CO APCD, www.comedprice.org). Prices reflect median paid “episode” amounts (initial procedure payments AND 90 day post-acute payments), using the Centers for Medicare & Medicaid (CMS) Comprehensive Care for Joint Replacement (CJR) methodology (https://innovation.cms.gov/initiatives/cjr). www.comedprice.org Commercial payments are up to 317% more than Medicare

24. ColoradoCare:  Everyone contributes & Everyone benefits  Savings from reduced complexity and bulk negotiation  Prioritize care of complex, high cost patients The Solution 24

25. ColoradoCare:  Everyone contributes & Everyone benefits  Savings from reduced complexity and bulk negotiation  Prioritize care of complex, high cost patients The Solution 25

26. What It Costs: Employees Employees pay 3.33% of their income instead of current health care premiums, deductibles and other out of pocket expenses 26 In place of current health care premiums, deductibles and other out of pocket expenses.

27. What It Costs: Employers  Employers will pay 6.67% of payroll to provide a platinum level benefit for all their employees 27 Consistent cost. Also covers the medical portion of workman’s compensation

28. On $50,000 Income $278 Your employer pays $278 monthly $139 You pay $139 monthly On $100,000 Income * $556 Your employer pays $556 monthly $278 You pay $278 monthly 28 For Example: *Capped at $350,000 filing individually, $450,000 filing jointly

29. Non-payroll and Self Employed Income 29 10% Pay less than10% of Personal income* *This is a state tax which is a deductible expense on federal and state taxes with an effective impact of 5.577% to 8.537% depending on your tax bracket.

30. Retired Coloradans Medicare continues with ColoradoCare as a Supplement  Individual income filers - Social Security Income and retirement income is exempt up to $33,000  Joint income tax filer- Social Security Income and retirement income is exempt up to $60,000  Other income (non-retirement) subject to a premium tax of ≤10% 30

31. For Example 31 Couple with $100K annual Social Security & Retirement Income  Will pay about $3,080 ColoradoCare annual premium versus  Current Medigap Plan with Rx $4,800

32. Comprehensive Benefits, a Platinum Plus Plan  Primary and specialty care  Hospitalization  Prescription drugs  Medical equipment  Mental health & substance use services  Emergency & urgent care  Preventive & wellness service  Chronic disease management  Rehabilitative services & devices  Pediatric care including oral, vision, & hearing services  Laboratory services  Maternity & newborn care  Palliative & end-of- life care  Some adult oral health benefits 32

33. Benefit Terms  No Deductibles  No Co-pays on Preventive Care  Modest Co-payments for other services (with hardship waivers available to insure access to proper care)  Beneficiaries temporarily living or traveling in another state will receive emergency coverage 33

34. ColoradoCare:  Everyone contributes & Everyone benefits  Savings from reduced complexity and bulk negotiation  Prioritize care of complex, high cost patients The Solution 34

35. Source: Kaiser Family Foundation (http://www.kff.org) analysis. *Produced by: Larry Levitt, MPP, Anne Jankiewicz, and David Rousseau, MPH Health Coverage with Affordable Care Act 35

36. Health Coverage with ColoradoCare Get a Smart Card and Choose a Provider Are you a Colorado Resident? 36

37. 37 Pharmaceutical Spending per Capita, 2012 Adjusted for Differences in Cost of Living * 2011. Source: OECD Health Data 2014. Dollars ($US)

38. ColoradoCare:  Everyone contributes & Everyone benefits  Savings from reduced complexity and bulk negotiation  Prioritize care of complex, high cost patients The Solution 38

39. 39

40. ColoradoCare Governance 40  Interim 3 year appointed 15-member Board of Trustees  21-member non-partisan elected Board of Trustees will oversee ColoradoCare (3 from each of seven districts)  Coloradans are the shareholders

42.  Be a Colorado resident-owned system  Cover every Colorado resident  Ensure comprehensive, high quality, platinum plus, accessible and affordable life time health care  Collect premiums from Coloradans based on income  Cost significantly less than our current system ColoradoCare would: 42 Summary

43. ColoradoCare Would Put Colorado On A Fiscally Sustainable Path Savings by “bending the cost curve” by reducing administrative share and restraining drug price inflation

44. 44 Health Care Spending per Capita by Source of Funding, 2012 Adjusted for Differences in Cost of Living * 2011. Dollars ($US) Source: OECD Health Data 2014. 8,745 6,080 4,811 4,698 4,602 4,288 4,106 3,997 3,289 3,172

45. IOM: Best Care at Lower Cost 9.8% 7.2% 27.5% 17% 13.7% 24.8% INSTITUTE OF MEDICINE 2012: US Health Care Annual Waste $ 765 Billion

48. 48 Thank you for coming