homeless need universal health care, says Colorado coalition FWD

Tom Boland (wgcp@earthlink.net)
Tue, 26 May 1998 21:26:57 -0700 (PDT)

FWD  The Denver Business Journal - May 18, 1998


     Marsha Austin - Business Journal Staff Reporter

A coalition of Colorado health-care, business and legislative leaders is
crafting a sweeping overhaul in the way the working poor across the state
will get access to medical care.

The coalition's ambitious goal: To give the nearly 600,000 Coloradans with
no health insurance at least bare-bones coverage at a reasonable cost by

The driving forces behind the Colorado Coalition for the Medically
Underserved include The Colorado Trust and Rose Community Foundation, two
huge charities formed by the sale of hospitals to for-profit organizations.
Another advocate is Dr. Gary VanderArc, president of the Colorado Medical

Although he declined to disclose details, VanderArc said the plan is "going
to be universal and involve every segment of society."

The plan formally isn't scheduled for release until July and it will
require passing a number of pieces of legislation to put it into effect. It
hopes to borrow from successful pilot programs in Wisconsin, Minnesota and

But it will be nearly a decade before the plan is fully implemented. And
businesses are likely to balk at any new taxes or other mandates that
increase their own health-care costs in order to subsidize the poor.

But the coalition has enlisted an impressive group of backers including the
Colorado Association of Commerce and Industry, the Exempla hospital system,
Blue Cross Blue Shield and Kaiser Permanente. According to documents
obtained by The Denver Business Journal, many of the initiatives would be
voluntary, not government mandated.

And the Coalition for the Medically Underserved has a powerful argument: At
a time of low unemployment, businesses need all the healthy workers they
can find -- and they need to keep current workers healthy.

Underscoring the plight of employers is the chronic problem of
underenrollment in Colorado health plans.

Large numbers of young people, working poor and Hispanics routinely slip
through the cracks between government programs like Medicaid and
employer-sponsored insurance plans.

Colorado ranked 30th out of the 50 states in the number of non-elderly
uninsured in a 1996 report by the Employee Benefits Research Institute.

A coalition draft report obtained by the Business Journal outlines the
following key provisions:

Expand the health-care system's "safety net" by asking hospital and health
plan boards to formally commit to serving the medically indigent. Some
medical professionals think the hospitals should commit as much as 3
percent of their budgets to frontline prevention efforts at community
clinics, and then pass some of those costs along to people who can afford
to pay.

Give retired physicians who want to provide indigent care reduced licensure
fees and discounted malpractice insurance, or a tax credit, to pay for the
insurance and license.

Require employers to provide health insurance coverage to all employees and
their dependants. As an alternative, businesses might provide everyone with
a voucher for the health-insurance plan of their choice.

Give tax credits to individuals who purchase their own health insurance
outside of the employment setting.

Increase taxes on tobacco products and assure that those revenues, or money
the state is awarded from tobacco legislation, are earmarked to pay for
health care to the underserved.

Provide affordable coverage for families where incomes are more than
$15,600 and less than $28,500 per year. These near-poor families are most
likely not to have health coverage.

"Once the plan is out it is not just going to be another piece of paper,"
said Chet Seward, director of health-care policy for the Colorado Medical
Society. "The teeth will be found in the players involved in the

The coalition evolved from the frustration of physicians like VanDerArc and
former Denver Medical Society President Dr. David Hutchinson, who after
years of fighting a losing battle to serve the poor, felt it was time to
involve people from outside the medical profession.

John Moran, president of The Colorado Trust, agreed to lend financial
support to the effort, and with additional funding from the Rose Community
Foundation, gathered representatives from hospitals, managed-care
organizations, physician groups, state agencies, the state Legislature and
area businesses.

Hutchinson said he and his collegues aren't advocating additional spending
to care for the uninsured, simply reallocating existing funds to focus more
on prevention. People who don't have insurance typically don't seek medical
care until they are seriously ill, driving up the overall cost of health

Sandy Cavanaugh, vice president of community development at Exempla, the
parent company of Saint Joseph Hospital and Lutheran Medical Center, said
paying for more primary care and making sure the uninsured get to existing
clinics is the best way to keep the cost of charity care from getting out
of control.

Private managed-care plans most likely would favor any effort to increase
HMO enrollment -- and reduced costs for hospitals means more attractive
contracts for payors, if the hospitals pass on the savings.

The coalition also supports a measure that would allow insurance companies
to charge healthy subscribers more to reduce premiums of sicker enrollees.

The state Legislature passed a similar measure regarding small group
purchasers several years ago. The statute has kept costs down and allowed
more small businesses to provide health plans to employees by preventing
huge hikes in premiums if an employee is diagnosed with a serious illness.

Dr. Ed Ferrill, a physician who cares for Denver's homeless and working
poor at the Stout Street Clinic, said the coalition may have a hard time
convincing the community at large that universal health-care coverage is a
cost-effective and necessary measure, but said it is the only way to make
sure the people he serves get the medical care they need.

"The only thing that is going to answer the plight of those 43 million
[uninsured nationwide] is universal insurance," Ferrill said. "We may go
there kicking and screaming, but in my heart of hearts I truly believe that
nothing is going to make that number zero unless we follow suit with the
rest of the world and someday realize we need universal coverage."


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