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Colorado and Health Reform

In liberal fashion, Colorado is one of the states that has forward with each of the preferred methods of health care reform under the Affordable Care Act. The state was given the same options as every other: whether to improve and increase the Medicaid program, and how to establish a health insurance exchange — on the state level, as a partner with the federal government, or leaving it entirely to the feds. Colorado chose to operate and set up its own exchange and also to add a new group to the state’s Medicaid program, which allows thousands more adults throughout the state to get coverage.

Many other reforms have been adopted by Colorado health insurance companies and medical providers over the past few years. As the state passed its own Healthcare Affordability Act in February 2009, those in power are already privy to the coverage needs of Coloradans and ready to conform to the federal law. Insurers in Colorado, separately from the ACA, already eliminated gender from rate restrictions, which made coverage available to men and women for the same cost for the past several years. This is part of the federal law which will affect every state by 2014. However, there are still quite a few ways the individual market and overall coverage options in the state will change as a result of Obamacare.


Changes to Colorado Health Insurance: 2010-2013

Colorado insurers may have a less strict policy for rate restriction but they were still permitted to rescind policies before the ACA entered the legislation. If an insurer in the state was suspicious, but had inadequate information, that a person who suddenly became ill had lied on their application, they could cancel a plan at any time without the policyholder’s consent. Now, this practice is illegal, unless the plan member actually has lied, not paid premiums, or tried to scam their insurer.

Additionally, insurers cannot set a lifetime maximum for coverage, which may not seem important to young, healthy Coloradans, but once you’ve accumulated many thousands of dollars in health care as an older, sick person, this feels very significant – especially with the rising cost of care. Annual maximums have also been elevated and will not be permitted by 2014. Premium rates will also be evaluated each year by the state insurance department to ensure rates are reasonable. If an insurer increases premiums more than 10 percent in one year, further action must be taken.

Dependents on their parent’s plan in Colorado can keep their coverage up to age 26, as a result of the ACA. Regardless of the young adult child being married or living away from home they can keep their coverage through a group or individual plan, as long as they don’t have the option of insurance through an employer. Also, children with pre-existing conditions received the right to be insured by any private carrier without the concern of rejection. People up to age 18 who are sick cannot be declined no matter what their health problem may be. Adults with conditions will get the same privilege in 2014, and in the meantime were able to purchase comprehensive coverage through the PCIP, which was federally run in Colorado. PCIP coverage only lasts until the end of 2013 so that everyone buys a plan on the private market or through the exchange.

Colorado insurers are also now required to follow the 80/20 rule, or 85/15 for some, which states all companies must spend 80 percent of money brought in from member premiums on healthcare and plan improvements, rather than internal costs. Each year the federal government and the state insurance department evaluate companies to ensure their compliance. If they do not follow this guideline, the insurer is required to mail our checks to all of their members for what they should have spent, or they must reduce premiums. In 2012, Coloradans received about $27,452,769 in rebates, averaging $227 per household insured privately.

Preventive care is also covered for every insured Colorado resident at no cost through the new health law, which includes screenings for prostate, colorectal, breast, and cervical cancer, flu shots and other vaccinations, and routine exams for people of all ages. Additional preventive services were added for those whose plans renewed in August 2012, notably for women’s health, such as contraceptives and prenatal screenings.


Health Reform in Colorado: 2014 & Onward

The healthcare law will make it possible for all individuals with pre-existing conditions in Colorado to get insured, through any private company. Health plans are required to increase premiums only for risks of age and tobacco use, not health status or occupation. Therefore, if you’re a cancer survivor who now works in construction, you would only get rated up for the age group you belong to and whether or not you smoke.

Private health plans will also have to include a set of benefits, selected by the state, to be covered under certain plan types. These essential health benefits will be chosen based on what the people of Colorado use most often, likely to include maternity and infant care, emergency, and hospital care, among at least seven other categories.

To support the individual mandate, which requires all Americans to get insured or pay a penalty, the Colorado Health Benefits Exchange (COHBE) will provide an additional form of coverage. The exchange is a marketplace which connects people to the insurance plan for which they are qualified, where you can apply for Medicaid or another plan. As members of the Board of the Exchange represent some of the state’s top health plans, it is designed to “foster a competitive marketplace for insurance and shall not solicit bids or engage in the active purchasing of insurance. All carriers authorized to conduct business in [the] state may be eligible to participate in the Exchange.”

Colorado’s Exchange is one of the most organized in the nation, though it also feels rushed in the implementation process, like others. However, the exchange will connect people to coverage with a unique way to reduce premiums through subsidies. These tax credits will be available to health plan applicants who earn a certain amount and want to afford a policy. A preliminary way of determining if you qualify for this assistance is the Health Reform Subsidy Calculator, which also approximates the cost of coverage through these plans.

Colorado Medicaid has changed to include adults without children earning up to 133 percent of Federal Poverty Level, which will help about 160,000 residents get covered. Medicaid expansion was finalized in 2013 despite much Republican opposition, with SB 13-200 approved as an official state law. Adding a new eligibility group allows needy, low-income people who do not have families or a disability the same right as those that do. This is a large population in need of coverage, and despite the fear of being too costly, the federal government has provided funding to assist the state in making this possible.



Understanding Obamacare

Connect for Health Colorado

HCPF: Medicaid Expansion

Colorado.gov Health Care Reform





1. Healthcare.gov. How the Health Care Law is Making a Difference for the People of Colorado.

2. The Henry J. Kaiser Family Foundation. State Exchange Profiles: Colorado.