Improving health care in Colorado will require us to find ways to hold down costs while making sure more people have health insurance. Amendment 63 will do neither. In fact, it will do the opposite.
But first things first. Even according to its authors, Amendment 63 will have no impact upon federal law. The Supremacy Clause of the U.S. Constitution requires states to comply with federal law as long as that law is deemed constitutional, and Amendment 63 will have no force or effect in determining the constitutionality of any such law.
While Amendment 63 will have no influence on federal law, it will have far-reaching consequences for Colorado. It will move Colorado to a less protected and even less cost-effective health care system where people pay directly for services rather than having health insurance.
Direct payment removes cost-containment measures and the negotiating power of health care consumers. Direct payment might work for those who are rarely sick, but few of us could absorb the cost of a serious and prolonged illness.
Amendment 63 will reduce coverage, decrease access to money-saving preventative care, increase expensive emergency room visits, create endless lawsuits and leave the Colorado taxpayer and insured population to foot the bill. It will obstruct the ability of Coloradans to make decisions about their health care and tie the hands of policymakers whom we elect who want to reduce costs by expanding health care coverage in Colorado.
Colorado’s own bipartisan Blue Ribbon Commission on Health Care Reform stated in 2007 that the only way to lower health care costs for all of us is to get as many people insured as possible.
When people are uninsured, the cost of their care is passed down to businesses and individuals who are insured. An analysis performed in 2007 by the Lewin Group found that in Colorado, 40 percent of the shortfall in hospital payments — about $150 million at that time — was passed on to the insured.
When people are uninsured, they are more likely to delay care or seek care in emergency rooms — the most expensive form of treatment available. Moving routine care out of emergency rooms and maintaining health reduces costs, helps people get well sooner and helps them stay healthy.
Unless we insure more Coloradans, we simply will not be able to get rid of things such as exclusions on pre-existing conditions and lifetime and annual limits on coverage.
This amendment’s language is overly complex and poorly defined legally. In fact, complexity and ambiguity seem to be a part of Amendment 63’s very design.
As a result, it is impossible to predict all the immediate and long-term effects of this initiative. What we can be certain of is that if this language is included in our state’s constitution, it will create the most fertile ground possible for endless lawsuits and court challenges — all paid for by Colorado taxpayers.
No one can say how it will affect health insurance carriers, public insurance programs, the oversight of medical practice or to what degree it may interfere with the relationship between patients and their doctors.
For example, it is not clear how the language of this amendment would affect consumer protections in Colorado that prevent medical providers from charging patients more than what an insurance company would pay.
It may prevent Colorado from setting minimum standards for medical professionals and regulating the procedures they can perform.
It also may prevent the state from requiring people who receive Medicaid and the Child Health Plan Plus to enroll in lower-cost, managed-care plans.
State employees and others enrolled in public health insurance programs might have to be provided with individualized choices of health care plans and providers, and that could add additional administrative and other costs for Colorado taxpayers.
Amendment 63 is not the product of a serious and comprehensive debate about health care and health insurance. It is not about new or innovative ideas in health care. Real and meaningful innovation arises from a deliberate process that involves many stakeholders who then reach broad consensus.
Rather, Amendment 63 is the product of a narrow and partisan agenda.
In the final analysis, Amendment 63 is another complicated and expensive amendment that would needlessly clutter Colorado’s constitution. A political statement has no place in our state’s constitution, especially one that drives up costs, creates unintended consequences and ensures an unending string of legal challenges for the future.
Bob Semro is a policy analyst with the Bell Policy Center who specializes in health and health care issues.