More than 40 physicians representing many specialties and geographic areas gathered at CMS headquarters on July 23 to discuss the state’s development of a public option for health insurance. These component and specialty society physician leaders shared information, gathered perspectives, and considered opportunities for collaboration to influence the development of the plan. The group first heard from special guests Kim Bimestefer, executive director of the Colorado Department of Health Care Policy and Financing (HCPF), and Michael Conway, commissioner of the Division of Insurance (DOI), and then held a facilitated group discussion to identify key takeaways and steps moving forward.

The 2019 Colorado legislature passed House Bill 19-1004, which requires the Polis Administration to develop and submit a proposal to the General Assembly by Nov. 15, 2019, concerning the design, costs, benefits and implementation of a state option for health care coverage. Bimestefer and Conway gave a presentation on the bill, its requirements and key questions they are asking in this initial phase of the plan’s development. They are conducting a multitude of stakeholder meetings in July and August with the aim to release a draft report on Sept. 30, collect public comments through Oct. 15 and send the final plan to the legislature on Nov. 15.

The final proposal must include an analysis of the feasibility and cost of implementing a state option, identify the most effective implementation of a state option based on affordability to consumers at various income levels, present the administrative and financial burden to the state, provide information on ease of implementation, and evaluate the likelihood of achieving the purposes of the bill to promote affordable, high-quality care, address the uninsured rate, leverage existing infrastructure, maximize innovation, ensure stability of coverage, and encourage or increase competition.

To do this, the state agencies must determine for whom the public option should be available, what the state should address with affordability (premiums, out-of-pocket costs, etc.), the goals of affordability, and what is meant by “existing state health care infrastructure,” among other questions.

Alan Kimura, MD, MPH, president and managing partner of Colorado Retina Associates, recognized this as a “once-in-a-lifetime” opportunity to innovate. “But we’re against an extremely difficult timeline. How are we going to be able to take advantage of these innovations when they may be unproven?”

Conway agreed that this is the time to innovate because Gov. Jared Polis is committed to bold, innovative solutions in health care. He urged the group not to “hold back” on ideas related to a public option, indicating that all concepts will be considered. Bimestefer referenced Colorado’s Health Care Affordability Roadmap that was created to address high health care costs. “There is no reason the state can’t be the innovation capitol of the country and the world,” she said. “There are a whole lot of things that I walked you through on that roadmap that turns the industry on its head. This is our opportunity.”

Bimestefer went on to tell the group that HCPF is creating reports analyzing Colorado hospitals and pharmaceuticals, and the impact they have on health care costs and quality. “As we’re coming out of this, you have to realize that you [physicians] are the most valuable part of this equation. You control your patient referrals, you control your business or who you are employed by, and you control the prescription pen.”

Leaders representing the full “house of medicine” will continue to hone comments and recommendations to inform the plan’s development as it proceeds. As CMS President Debra Parsons, MD, FACP, said in her invitation to the July 23 meeting, “Physicians in Colorado will be better served if their professional societies are united on the issue of a public option given its potential significant impact on Colorado health care.”

UPDATE: On July 26, Dave Downs, MD, FACP, chair of the CMS Work Group on Health Care Costs and Quality, and Amy Berenbaum Goodman, JD, MBE, CMS senior director of policy, attended a stakeholder meeting in Keystone to present CMS' preliminary recommendations. Downs and Goodman emphasized CMS' goal to support a public option that increases competition in health insurance markets, reduces insurance premiums, facilitates quality improvement and administrative simplification, and inspires physician network participation.

CMS will continue working with physicians to develop and revise CMS' preliminary recommendations before they are finalized by the CMS board of directors and sent to the Administration.

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