State looks at ways to deal with uninsured

Insuring the uninsured would be one step in curing the nation’s financially ailing health care system, a Colorado industry analyst said Tuesday. But adding to the ranks of the insured could create other problems, said Jim Hertel, president of the Healthcare Computer Corp. of America.

As the number of insured patients increases, so will the usage of services, Hertel said during the annual address to local industry representatives about the state of health care. About 50 people attended the spring Colorado State-of-the-State presentation that looked at the uninsured and the industry’s response.

“Two components drive health care costs — the volume of services delivered and the cost of each service. There will be an increase in demand for services as we get more people insured,” Hertel said. “It’s important for them to learn how to appropriately use insurance and not abuse their coverage.”

Among the ailments plaguing the health care industry are rising insurance costs, increasing numbers of uninsured patients and the question of who should pay for health care, experts say.

The only way to keep health care costs down is to educate people about disease management and prevention, said Colorado Insurance Commissioner Marcy Morrison, who attended the presentation.

“If people take better care of themselves, we can look at other options besides how to get more care,” she said. “We read a lot about diet and exercise, but we have to ignite the public to put two and two together. Disease management and prevention are the key, and as state insurance commissioner, I’m pushing that issue hard to bring down costs.”

A pilot program to initially cover about 300 of Pueblo’s 13,000 uninsured who are employed and earn less than $12 an hour is about to launch, which Morrison cited as an example of a new approach to an old problem.

Pueblo hospitals are contributing $200,000 apiece to the community-owned and operated program, which includes participants taking responsibility for staying healthy.

Commercial insurance companies also are offering more affordable plans with higher deductibles or limited coverage for small-business owners and employees, part-time workers who don’t qualify for traditional plans and the unemployed, Hertel said.

“Unfortunately, the uptake on these plans hasn’t been as significant as many in government and health care policy would like. As a result, we’re seeing continued pressure to create some form of government-sponsored health care coverage that would go beyond what’s currently being provided by Medicaid and Medicare.”

Colorado’s number of uninsured has grown from about 647,000 in 1999 to today’s estimate of about 770,000, or 16.3 percent of the state’s 4.7 million residents, according to U.S. Census Bureau figures. Of those, 175,000 are children.

Colorado lawmakers are deciding whether to mount a major effort to enroll 115,000 of the uninsured children in Medicaid and the state-sponsored Child Health Plan Plus program, which has about 50,500 children enrolled.

About one-third of the uninsured either can’t afford health insurance or are not insurable because of previous or existing health conditions. Another third are eligible for government assistance, such as Medicaid, but aren’t enrolled. And the last third don’t want to buy it, Hertel said.

To advance health care reform in Colorado, a state-mandated commission is studying ways to expand health care coverage and decrease costs. The “208” Commission, created by Senate Bill 208 last year, will make recommendations to the state Legislature this year.

REVENUE GENERATORS

There are four avenues of generating revenue for the health care industry — employers, employees, out-of-pocket payments from individuals and government payments, said Jim Hertel, president of the Healthcare Computer Corp. of America. Those funding sources pay for the costs associated with health plans, administration, medical expenses, and plan and provider profits.

“Whatever system we develop, it will have to be based on having employers involved — because that’s where the money is,” Hertel said. “The approach has to be able to pay the bills — but the private sector won’t be able to take care of this alone.”

COLORADO HEALTH CARE

- Population: 4,642,589

- Residents covered by Top 10 health plans: 3,380,651

- Employed population: 2,416,752

- Medicaid clients: 377,747

- Uninsured population: 770,000

- Medicare clients: 529,442

- HMO members: 973,181

- Child Health Plan Plus coverage: 50,498

- CoverColorado (high-risk residents): 5,500

Healthcare Computer Corp. of America