Group tracking effects of federal health care policy in Colorado

Federal health care legislation expanded insurance coverage in Colorado, but didn’t stem rising health care costs or premiums, according to the first in a series of reports tracking the effects of federal policies in the state.

Western Colorado counties had the highest proportions of residents who received subsidies under the Affordable Care Act to buy private insurance. But the West Slope also has faced high premium prices and a lack of insurance carriers.

The Colorado Health Institute is working on a series of reports on how federal health policies affect the state as President Donald Trump and Congress consider various options for repealing and replacing so-called Obamacare. Proposed options include block grants or per capita caps for Medicaid, health savings accounts, high-risk insurance pools and purchasing insurance across state lines.

The institute, a nonprofit organization that provides health care policy analysis, examined the effects of the Affordable Care Act on health insurance coverage in its first report.

One of the biggest effects, the report concluded, was the increase in the number of Coloradans covered by health insurance. In 2013, the year before major provisions of the ACA took effect, an estimated 14.3 percent of Coloradans didn’t have insurance. In 2015, that proportioned had dropped to 6.7 percent.

An estimated 500,000 Coloradans have coverage because of the ACA — about 400,000 through expanded eligiblity for Medicaid benefits and another 100,000 through subsidies to buy private insurance through the Connect for Health Colorado online marketplace.

While every Colorado county saw an increase in Medicaid enrollment through the ACA, metropolitian areas accounted for the largest share of the expansion. Western Slope counties had the highest proportions of residents who received subsidies to buy private insurance.

Colorado experienced a small drop in the number of people insured through their employers, part of a national trend of shrinking job-based coverage.

The ranks of the uninsured have declined under the ACA for every age group, but the most for those under 30. Still adults under 30 remain the largest group of insured in the state, the report stated.

Even as the ACA expanded health insurance coverage in Colorado, the law didn’t stem rising costs for health care or health insurance in the state, according to the report.

It’s not possible to compare individual market prices before and after ACA because of the lack of comparable information before 2014. But national statistics indicate consumers saw discounted prices for health insurance the first few years under the ACA followed by steep increases.

As health insurance carriers suffered losses on the individual market, the number of plans has decreased even as the average price has increased, the report stated.

Rural Colorado — the Western Slope in particular — suffers from a lack of insurance carriers and higher premium prices that reflect the higher costs charged by medical providers in those areas, according to the report.

The Colorado Health Institute also examined what could happen if some provisions of the ACA are repealed and not replaced.

Under the ACA, the federal government has covered the $1.6 billion in additional costs associated with expanded eligibility for Medicaid benefits. That share is scheduled to decrease to 90 percent by 2020.

If Congress were to remove the increased federal match and go back to what was a 50-50 split between the federal and state governments, Colorado would face an additional $780 million — about the same amount as the entire state budget for higher education.