Colorado Medical Society

President’s letter: Advocating for health insurance coverage that works

Tuesday, January 24, 2017 05:22 AM

A range of salient health insurance policy debates will likely occur in the 2017 Colorado General Assembly and 115th U.S. Congress due to macro-economic and political influences including the presidential election outcome, the prospective political backlash from anticipated double-digit increases in health insurance premiums in the individual market, the political engagement of the health plans being litigated by the U.S. Department of Justice, the budget pressures generated by a growing Medicaid-eligible population and backlash from a perceived “crowd-out” of other infrastructure funding needs, and unresolved network adequacy and access issues from 2016 Division of Insurance (DOI) rulemaking.

The legislative and executive branches of state government are two years into a debate over policy solutions to address the consequences of narrow networks. Narrow networks in highly concentrated insurance markets create a powerful and unfair advantage over providers. A good-faith mediation last summer between the Colorado Association of Health Plans (CAHP) and CMS failed when a few insurance companies insisted that CAHP discontinue discussions. The DOI recently finalized a series of rulemakings on some but not all network adequacy issues, such as finding a consensus on surprise medical bills and excess charges. Resolution of inequities in the current multi-payer system is critical so interactions between providers and insurance companies can turn to a focus on value rather than market share and volume.

As approved in the 2017 CMS work plan, your medical society will take full advantage of the post-election public policy environment to aggressively advocate for incremental changes in the multi-payer system, both public and commercial and at the state and national level. We aim to reduce barriers to cost-effective, quality care and increase your professional satisfaction. To achieve this, CMS will:

The Colorado Medical Society has a long history of supporting health insurance coverage for all Coloradans. This is not a new debate and we are experienced in approaching the issue with a focus on physicians and our patients. We also understand that we are only one advocacy organization in a complicated network of interests and no reform proposal will satisfy all of our goals for fair coverage. Navigating this realm requires agility and flexibility by the Colorado Medical Society, which is fortunately supported by the new CMS governance model and Central Line virtual engagement platform. I look forward to working with all of you this year and gaining your insight and perspective.