5 Things Colorado: HCPF report, Topical Agenda, Veteran health coverage


Eli Kirshbaum


Next week, we will release our list of about 60 speakers curated for you at our upcoming 2021 Colorado State of Reform Health Policy Conference. It’s a very smart group of folks at work to improve the health care system for folks in Colorado.

We’ll be virtual this year again. I know we all want to be back in person. But we’re just not out of the woods yet. We are currently on track for about 350 attendees. But, it’s not a party without you! We’d love to have you with us.





With help from Eli Kirshbaum

1. HCPF report blasts hospital profits

A recent HCPF report shows Colorado hospitals had a 15.6% profit margin in 2018 — higher than any other state and 9% above the national average. The report attributes this to increasing consolidation among hospitals in the state, which are then able to use higher-than-average prices to reinvest in expanding their presence and increasing their market share. The report says their increasingly high share of the market allows them to raise prices further to make up for the cost of expanding.

HCPF also found that 28% of Colorado hospital costs in 2018 were overhead costs, meaning this money went to administrative and capital expenses like employee salaries. This is almost 3% above the national average for such costs in 2018. “If Colorado hospitals incurred overhead at the national rate, operating expense would be $474 million less than what it was based on 2018 discharges,” the report said.

2. Topical Agenda now available!

In case you missed it, we recently released the Topical Agenda for the 2021 Colorado State of Reform Health Policy Conference coming up on Oct. 20th! Using a thorough stakeholder engagement process, we curated this event’s agenda to reflect some of the most pertinent issues in state health policy.

We’ll host expert-led discussions on topics ranging from the state’s public option initiative to health equity to the current state of prescription drug policy. Be sure to register soon so you don’t miss out on these valuable conversations!


3. State begins work on Prescription Drug Affordability Board

Colorado has begun the implementation process for its recently approved Prescription Drug Affordability Board. The state began accepting applicants for the board in August, and Gov. Polis is required to appoint its five members by Oct. 1. The board will hold its first meeting in November and it must appoint members to its 15-person stakeholder Advisory Council by Jan. 1, 2022. In April 2022, the board will begin setting upper payment limits (UPLs) on high-cost prescription drugs.

At a recent webinar, Insurance Commissioner Conway said Colorado’s affordability board has key differences that set it apart from similar boards in other states, including having broader UPL enforcement authority and more decision-making independence. While the bill is set to sunset on Sept. 1, 2026, Conway thinks the legislature will vote to extend it after seeing the board’s impact. “It’s fully my expectation that the PDAB board is going to pay huge dividends for the state, so I think it will be extended,” he said.

4. Nearly half of all Colorado veterans aren’t enrolled in VA health insurance

45% of the approximately 314,000 eligible Coloradan veterans aren’t enrolled in VA health insurance coverage, according to a recent analysis from CHI. While 97% of the state’s veterans have some sort of health coverage, these individuals could be missing valuable, veteran-focused VA services including stipends for nursing home care and reduced care costs for disabled veterans.

CHI identified four main barriers to veterans enrolling in VA coverage: an overly complex enrollment process, a lack of awareness of health insurance eligibility, difficult-to-access VA facility locations, and a lack of trust in the VA. The analysis recommends simplifying the enrollment system, educating veterans more about their benefits, improving access to VA care, and building trust between veterans and the VA.


5. Another five years for reinsurance

CMS renewed the 1332 waiver for Colorado’s reinsurance program last month, allowing the state to continue operating the program through 2026. Reinsurance has lowered health insurance premiums in the state considerably since its implementation. In 2021, premiums decreased by around 1.4% compared to 2020, and were an average of 20.8% less than they would have been without the program.

DOI released preliminary individual plans and premium information for 2022 in July, which show a predicted 24.1% savings on premiums for 2022 (compared to what rates would be without reinsurance). These, however, only reflect the rates that health plans have requested, not what DOI has approved. DOI plans to release approved 2022 plans and premiums in mid-October 2021.