bill co-sponsor, presented HB21-1232. The bill directs the Commissioner
of Insurance to develop a standardized health insurance plan that may be
offered by health insurance carriers. Carriers are encouraged to
offer the standardized plan, and required to set goals for reducing premiums.
The Colorado Option Authority is created as a nonprofit public entity
to offer health insurance if carriers do not meet premium reduction goals.
Standardized health insurance plan. By January 1, 2022, the commissioner
must establish, by rule, a standardized health insurance plan that can
be offered by private health insurance carriers in the individual and small
group markets. The plan must offer coverage at the bronze, silver,
and gold coverage levels, and include all essential health benefits. The
plan may be updated annually.
Beginning January 1, 2023, insurance carriers are encouraged to offer the
standardized plan in any zip code where they currently offer coverage in
the individual and small group markets. Each carrier that offers
a standardized plan is required to set a goal of offering the plan at a
premium rate that is below the 2021 rate for health insurance plans offered
by the carrier in that respective market by at least 10 percent in 2023
and 20 percent in 2024. Cost-shifting from the standardized plan
to another plan that requires state approval is prohibited.
Colorado Option health insurance. The Colorado Option Authority
is created as a nonprofit unincorporated public entity to operate as a
health insurance carrier. The Authority must offer individual and
small group market health insurance (referred to as the Colorado Option)
if all carriers fail to meet the premium rate reduction goals described
above. Implementation and operation of the Authority is contingent
upon federal approval and receipt of federal funds.
The Authority is defined as an instrumentality of the state; except that
debts and liabilities of the Authority do not constitute debts and liabilities
of the state. The Authority is not a state agency. It is governed
by a 9-member board appointed by the Governor and confirmed by the Senate.
The board must appoint an advisory committee to make recommendations
concerning the Colorado Option.
and reimbursement. Health care providers are required to accept
patients who are enrolled in any Colorado Option plan offered by the Authority.
Failure to do so is deemed grounds for professional discipline. Providers
will be reimbursed according to a schedule established in rule by the commissioner.
The reimbursement schedule must be designed to achieve at least 20
percent premium reductions for 2025 plans relative to plans offered by
carriers in 2021. The schedule may account for circumstances of hospitals
and providers that serve uninsured individuals or those covered by other
public health insurance plans; these providers may be reimbursed at modified
rates or exempted from the reimbursement schedule. The schedule must
be available to other health plans, as determined by the commissioner.
Federal waiver. The commissioner must seek a State Innovation
Waiver from the federal Department of Health and Human Services to implement
the bill and to identify savings to the federal government attributable
to the bill. Upon approval of the federal government, a portion of
the savings generated may be passed through to the state. This pass-through
funding may be used for the establishment of the Authority and for the
Colorado Health Insurance Affordability Enterprise to increase the value,
affordability, quality, and equity of health care coverage in Colorado.
Repeal. The Authority is repealed if a national public option
program is established that meets or exceeds premium reduction goals defined
in the bill.
The sponsors discussed a powerpoint with the committee which can be found
in Attachment A.
Additional handouts distributed to the committee can be found in Attachment