5 Things Colorado: Medicare Rx reform, ED utilization, Cost of care increase


Eli Kirshbaum


This month’s newsletter includes data on Medicaid beneficiaries’ ED utilization, insight on how federal legislation to lower Medicare Part D prescription drug prices would benefit Coloradans, and more.

Thanks for reading!

Eli Kirshbaum 
State of Reform


1. Report shows Coloradans would benefit from Medicare Rx cost reform

A new report from the Kaiser Family Foundation says over 113,000 Coloradans on Medicare who rely on prescription drugs stand to benefit from legislation introduced by Democrats in the US Senate. The provisions—embedded into a reconciliation bill—would allow the federal government to negotiate Medicare prices for certain expensive medications, eliminate the requirement that beneficiaries pay 5% coinsurance for their medications after they’ve reached their catastrophic coverage limit, and more.

With nearly 19,000 Medicare Part D-enrolled Coloradans without low-income subsidies having spent $2,000 or more on drug expenses in 2020, the effort’s provision to cap out-of-pocket spending on covered drugs to $2,000 would benefit many older Coloradans who rely on medications. 725,000 Colorado enrollees received a Part D-covered vaccine in 2020, indicating that the bill’s elimination of cost-sharing for adult vaccines covered by the program would be a significant benefit.


2. Thank you to our Convening Panel!

We held our Convening Panel meeting for the 2022 Colorado State of Reform Health Policy Conference last week to gather valuable input from numerous stakeholders who are well-seasoned in state health policy issues. We want to extend a big thank you to everyone who participated and offered their input on panel topics and speakers.

From here, our team will develop a Topical Agenda detailing the schedule of panels for the November 2nd conference. So, keep an eye out for the agenda’s release during the next few weeks! Please don’t hesitate to reach out if you have any input you’d like to make while we finalize the event’s panel topics.

3. 25% of Medicaid members rely on ED for care

New emergency department utilization data from the Department of Health Care Policy and Financing shows that between March 2019 and March 2021, an average of 1 in 4 Medicaid beneficiaries visited the emergency department each year. The department tracked nearly 1.5 million visits, and also found that 4% of Health First Colorado members visited the ED 6 or more times annually, accounting for around 21% of all ED visits.

The results demonstrate the importance of primary care, as HCPF found 5% of ED visits were potentially preventable and due to conditions that could have been treated in primary care settings over time. HCPF also found that ED utilization rates for unhoused Medicaid members were 6 times higher than for those with housing.


4. State to choose recipients of broadband expansion funding

The Colorado Broadband Office closed its Letters of Intent submission period for recipients of Advance Colorado Broadband program grants, which aim to expand and improve the state’s broadband infrastructure. Over $500 million in funding million will come from federal programs like ARPA’s Capital Projects Fund and the Enabling Middle Mile Broadband Infrastructure Program.

CBO says it will begin accepting official applications for funding in early 2023. “The COVID-19 pandemic highlighted our need to be able to work, learn, and access critical services virtually. High-speed internet is critical to advancing Colorado’s technological and economic growth,” said Brandy Reitter, the office’s Executive Director.

5. Updating Medicare’s physician fees is a challenge again

In the wake of rapidly rising inflation following a complicated history of federal policy, physicians across the US are expressing disapproval over Medicare reimbursement rates. In his most recent piece, State of Reform columnist Jim Capretta overviews the history of Medicare reimbursement policy and evaluates Congress’s likely path for addressing the inadequate reimbursements provided to physicians as the cost of providing care increases.

With “notably low” reimbursement levels outlined by Congress in 2015, mandatory cuts to Medicare spending through the PAYGO and the BCA programs, and a record 8% inflation rate, Capretta says physicians face increasingly significant cuts to Medicare reimbursement. “Given the many challenges involved, the most likely path forward is the one that Congress has been on for some time: annual ad hoc adjustments to address immediate pressures without any clear plan for finding, much less implementing, a more enduring solution,” he writes.