Kefalas, Dems tackle single-payer health insurance

By Richard Haugh

Legislators may soon consider the merits of a single-payer system for delivering health care — a concept that was rejected in 2007 by a blue-ribbon health care commission appointed by Gov. Bill Ritter.

Rep. John Kefalas, D-Fort Collins, has introduced House Bill 1273, dubbed the Colorado Guaranteed Health Care Act. HB 1273 is sponsored in the Senate by Joyce Foster, D-Denver. The bill has 16 House and three Senate sponsors, all Democrats.

Kefalas’ bill would create a 23-member Colorado Health Care Authority to study how a single-payer system of health care delivery could be funded and administered separate from state government and not subject to administrative control by the state.

The health care authority would seek gifts, grants and donations to fund its study. If it can’t find funds by July 1, 2011, the plan would die. With funding — and approval from the Legislature — the authority would create the Colorado Health Care System and seek the necessary federal and state waivers, exemptions and agreements needed to launch the program.

Kefalas knows his bill is likely to be controversial, but thinks it’s important that it be considered.

“No matter what happens, we know there’s support, and we’ve elevated the discussion,” he said. “It’s helped bring a lot of people to the table.”

However, there’s a potential complication in Kefalas’ plans: House Speaker Terrance Carroll, D-Denver, assigned the bill to the Business Affairs and Labor Committee. That surprised Kefalas and others, who expected it to go to the Health and Human Services Committee. Since then, consideration of the bill has been postponed several times. It is now scheduled for a
hearing in Business Affairs on
March 18.

“Business Affairs certainly is not as friendly for this sort of sweeping reform, which would affect the insurance industry,” said one observer familiar with the legislation who asked not to be named. “In Business Affairs what rings is, ‘What’s the cost?’ and ‘How do we save money?’”

In fact, business interests are not warm to Kefalas’ bill. The Colorado division of the National Federation of Independent Business has been asking Kefalas to include the group in preliminary discussions of the bill. But that didn’t happen, said Tony Gagliardi, NFIB’s Colorado director.

“We have been at the table every step of the way urging them to include us,” he said. “But we have been asked for no input whatsoever.”

Gagliardi said his group — and Colorado business interests in general — wants to work with Kefalas, but opposes the bill as introduced.

“We just can’t support a single-payer health care system,” he said. “With the involvement of government, you’re taking away the flexibility employers have to design a plan for their employees.”

While the bill was introduced more than a month ago, Kefalas is working on several changes that he says will incorporate the interests and concerns of the business community, which generally has opposed a single-payer plan. Kefalas said he has been talking with the South Metro Denver Chamber of Commerce, among others.

“Ultimately, 1273 might see some dramatic changes, where we’re looking more at a hybrid that incorporates a proposal from some business groups,” Kefalas said. “We still haven’t come to any conclusions.”

Few observers expect single-payer legislation to gain any more traction this year than it has in past years. A single-payer system was one of several options considered in 2007 by the Blue Ribbon Commission for Health Care Reform (dubbed the 208 Commission after its enabling legislation), launched by Ritter to study changing Colorado health care.

Steven Summer, president and CEO of the Colorado Hospital Association and a member of the 208 Commission, said the commission studied the single payer proposal and decided it wasn’t something that could be done at the state level. Instead, he recommended keeping tabs on any health reform efforts to come out of Washington.

“All the impediments exist at the federal level to doing this right,” Summer said. “You can’t consolidate at the state level things that are clearly left to the federal government.”

Kefalas said that although his plan is similar to the single-payer option considered by the 208 Commission, he is trying to take the concept to a higher level. “They did a lot of good work, and we’re not going to reinvent the wheel,” he said. “We’re just going to study it much deeper, more focused, and look at specific steps for implementation.”

Others see states playing a big role in any federal reforms of health care. For 20 years, states have been laboratories on health coverage and access, said Pamela Hanes, president and CEO of the Colorado Health Institute, in Denver.

“In the event the federal government really does take on health care reform, the states have moved forward in ways that can help deal with coverage issues,” Hanes said. “And states can do it in ways that work within their political cultures.”

With startup cost in the billions of dollars and the state facing a total of nearly $1 trillion in projected budget shortfalls this year and next, critics say the Kefalas bill faces tough going.

Tom Russell acknowledges that with the state’s fiscal crisis, now may not be the best time to introduce such a sweeping bill. But he says just because there’s no money doesn’t mean reformers should stop thinking.

Russell, a law professor at the University of Denver, is a vice president with Health Care for All Colorado, a Lakewood organization with members that include consumer advocacy groups, faith-based groups, labor unions and others. Health Care for All Colorado provided input during drafting of
the bill.

“There’s enough money being spent in health care that if we spend it right, there’s enough to get everybody covered,” he said. “Even in a year with no money, we still have big ideas.”