Governor John Hickenlooper has announced that Jim Riesberg (D) will be the state’s new Commissioner of Insurance. Riesberg, who has been serving in the Colorado House of Representatives, replaces John J. Postolowski, who was appointed as the interim commissioner on December 1, 2010.
Riesberg has earned numerous industry awards in his career, including Colorado Medical Society “Defender of the Patient” award.
Colorado is taking steps to create a health insurance exchange as Governor John Hickenlooper signs a bill that would make the effort possible. Colorado is the eighth state to voluntarily adhere to the health care reform law championed by President Obama. The bill will also set up a regulatory group to oversee the exchange.
The group will be comprised of nine members, four of which coming from the insurance industry. The Governor is tasked with finding these members, a search he has already been doing nearly a month before he signed the bill.
Hickenlooper says that the bill shows that Colorado is unified in its pursuit of better health care. “The health exchange will give Coloradans more control, quality choices, and better protections when buying insurance,” he says.
The exchange will be funded by federal grants awarded to the state by the Department of Health and Human Services in recognition of the initiative taken. Efforts are already underway to establish the infrastructure of the exchange but it is unclear what insurance plans will be available through the exchange when it is launched.
Though the establishment of the exchange is now inevitable, several Republicans in the state have criticized their colleagues whom voted in favor of the bill. Some have gone so far as to launch primary challenges against their party members.
State officials expect that the Colorado exchange will be fully operational ahead of the federally established deadline of 2014.
Colorado doesn’t have enough primary care physicians, and the shortage is expected to worsen in coming years.
“In Colorado, we need 194 primary care docs in underserved communities – now,” said Steve Holloway, director of the Office of Primary Care of the Colorado Department of Health and Environment. “In the next three years, that number will more than double.”
Colorado Public News found medical professionals and administrators statewide are grappling with a big crunch – because there aren’t enough graduating primary care physicians to replace the family doctors about to retire.
The average age of a primary care physician in Colorado is 55. Many of them will be hanging up their stethoscopes in as little as 10 years.
The shortage is expected to worsen in 2014 when the federal health care law is due to add 32 million people to health insurance. Treating their postponed health problems will require more time from primary care doctors.
If they don’t have one now, Coloradans might want to find their own family doctor soon, Holloway suggested.
Currently, the state has 3,271 licensed primary care physicians. Most of them work in affluent areas of Douglas, Arapahoe and El Paso counties.
Poorer – often urban – areas have the most critical need for primary care, including inner city Denver and Adams County.
Enormous swaths of rural Colorado also are facing severe shortages, including the San Luis Valley and non-resort areas of the mountains. There is no primary care physician at all in Jackson County in north-central Colorado.
In the southeastern towns of Rocky Ford and Ordway, patients are largely monitored by nurse practioners, who handle everything from prescribing psychiatric medicine to setting bones.
On Thursdays, Dr. Ozzie Grenardo makes a 300-mile loop from his family practice in Parker, near Denver, to the two southeastern towns to see patients.
“I wish I had frequent flier miles for my car,” Grenardo joked during one weekly road trip, as he was driving from clinic to clinic. Still, says the Colorado Springs native, “I don’t mind my long Thursdays. It’s an escape from the routine.”
Grenardo, 38, says he wanted to go into family medicine since before he started medical school. “I know a little bit about everything , and have amazing relationships with my patients, whereas a specialist knows a lot about a specific field and may only see a patient once for a specific procedure.”
But not all young doctors-in training have the same priorities as Grenardo. The number of American medical students who go into primary care has dropped by half since 1997.
Holloway explains that young medical students often are “idealistic” when they start medical school. “At first, as many as 40 percent of them express a desire to go into family medicine,” Holloway said. “But by the time they graduate, that number plummets to only two percent.
“They change their minds when they find out how much loan debt they’ve rung up.”
With as much as $300,000 in loans, a half million dollar a year surgeon’s salary can be can be far more appealing than the $130,000 to $140,000 earned by a family doctor.
“It’s a mortgage worth of debt,” say Longmont primary care physician Dr. Mike Laitos. He remembers the star status of choosing a specialty over family medicine. “When I was in medical school in the late ’70s, the attitude was, if you’re a really good doctor, you specialize.”
Colorado is in the middle compared to other states in terms of the urgent call for more primary care physicians, with Detroit, Mich. and the Mississippi Delta having the most critical need.
In Colorado, a program operated by the state Department of Public Health and Environment offers incentives to recuit medical students for family practice.
The “Colorado Health Service Corps” pays as much as $150,000 of a graduating medical student’s educational loans in exchange for a promise: The graduate must practice full time for three years in a federally qualified area. Now a year and a half in existence, the program has matched 80 to 100 young doctors with underserved populations. The program has sent young primary care physicians to Pagosa Springs in southwestern Colorado, Eads in the northeast part of the state, to the Westside Family Health Center in Denver, and places in between.
“When we go over the applications, we are looking for professionals who maybe grew up in a small town and want to stay put,” Holloway said. “We pay for three years, but we want a lifetime.”
Enter other medical professionals, including nurse practitioners, who are highly trained in most aspects of providing family health care but lack a medical degree. In Colorado’s Rocky Ford, for example, the city hosts Grenardo as a part-time doctor, but Doug Miller has been a nurse practitioner there for 13 years. He is known around town as “Dr. Doug.” It’s common for him to treat patients ranging from a 3-day old to a man of 96 who is still ranching.
“It’s going to be interesting to see how the medical field will change in this new world of health care,” says Grenardo. “The nurse practitioners truly can do everything I do. We teach each other.”
Grenardo suggests that health care professionals utilize telephone or Skype computer conferences as good substitute when an M.D. can’t physically be where a patient is.
Dr. Laitos, the Longmont family doctor, understands the predicament facing underserved areas like Rocky Ford.
“The depth and breadth of knowledge a doctor receives is valuable, but if that doctor is not willing to move to your town, you will need to see a [nurse practioner],” he said.
At least 30 percent of employers are likely to stop offering health insurance once provisions of the U.S. health care reform law kick in in 2014, according to a study by consultant McKinsey.
McKinsey, which based its projection on a survey of more than 1,300 employers of various sizes and industries and other proprietary research, found that 30 percent of employers will “definitely” or “probably” stop offering coverage in the years after 2014, when new medical insurance exchanges are supposed to be up and running.
“The shift away from employer-provided health insurance will be vastly greater than expected and will make sense for many companies and lower-income workers alike,” according to the study, published in McKinsey Quarterly.
“While the pace and timing are difficult to predict, McKinsey research points to a radical restructuring of employer-sponsored health benefits.”
Among employers with a high awareness of the health reform law, the number likely to drop health coverage for workers rises to more than 50 percent, the report predicted.
The numbers compare to a Congressional Budget Office estimate that only about 7 percent of employees currently covered by employer-sponsored plans will have to switch to subsidized-exchange policies in 2014, McKinsey said.
The consultant also found that at least 30 percent of employers would gain economically from dropping coverage even if they compensated employees for the change through other benefit offerings or higher salaries.
Losing employer-sponsored insurance would not prompt workers to leave their jobs, contrary to what many employers assume, McKinsey also predicted. The study found more than 85 percent of employees would remain at their jobs even if their employer stopped offering insurance, although about 60 percent would expect increased compensation.
It’s no secret, your home value is probably half of what it was five years ago, but you may wonder why your insurance premium is still going up. The cost to rebuild and/ or repair your home, supplies, labor, etc. have not gone down, according to industry experts. These components are what insurance premiums are based upon. In fact, insurance premiums will only take the structure and liability exposure into consideration – which maybe ticking upwards based on a rise in catastrophes predicted.
“The price of homeowners’ insurance is based on the cost to repair or rebuild your home. The price of a home is based on the market value of that home and the land upon which it sits,” Robert Hartwig stated, president of the Insurance Information Institute. He also mentioned that even though the recession has been hard on the construction industry, it still hasn’t caused a major decrease in materials and labor.
In this crazy upside down market we’ve been in, some say it’s even possible for the cost to rebuild your home is actually more than the resell price. Also, people are questioning their high loan balances compared to the insurance amount on their policy. For example, the structure coverage might only be $195,000 but your loan balance is $250,000. This has caused many to be concerned so
we asked many insurance brokers and the general response was, “insurance does not insure the land but your loan includes the land. If the home had a total loss, then the insurance coverage would pay for the dwelling to be repaired…not the loan to be paid off.”
Many are struggling to keep up with their bills and found that the only way to lower their premiums is to either take a chance and raise their deductible or shop it. You may find a conversation is in line…talk to your agent to make sure all discounts are being applied.
Effective June 16, 2011: The Occupational Safety and Health Administration (OSHA) will require residential construction workers who are 6 feet or more above lower levels to be protected by conventional fall protection systems — i.e., guardrails, safety nets, personal fall arrest systems, etc.
Generally, OSHA’s position is that fall protection products are diverse enough to fit virtually every residential construction scenario. However, employers who can demonstrate that conventional fall protection methods are infeasible or create a greater hazard must create a written, site-specific fall protection plan in accordance with regulatory requirements. The document must include the reasons why conventional fall protection systems are infeasible or why their use would create a greater hazard. OSHA does not consider economic infeasibility a basis for exclusion from the requirements.
Failure to comply with the new regulation may result in severe fines and penalties. Each OSHA office has a compliance representative available to answer questions. Talk to your local representative or visit http://www.osha.gov/doc/residential_fall_protection.html for details.
Cigna is now offering Dental plans on their Individual Health Insurance plans. This is great news for not only current policy holders, but anyone wanting new coverage coupled with Dental!
The following was released by the Division of Insurance.
Child-Only Policies – Open Enrollment Update
On April 29, 2011, a new bill was signed into law in Colorado that affects existing child-only policies. SB 128 changes the initial open enrollment period for applicants under the age of 19 who are seeking insurance to August for 2011.
Previously, the open enrollment periods for applicants under the age of 19 were in January and July of 2011. In subsequent years, the open enrollment period for these applicants will go back to January and July.
DEPARTMENT OF REGULATORY AGENCIES
Division of Insurance
3 CCR 702-4
LIFE, ACCIDENT AND HEALTH
Emergency Regulation E-11-03
MANDATORY OPEN ENROLLMENT PERIODS FOR CARRIERS ISSUING CHILD-ONLY PLANS
Section 1 Authority
Section 2 Scope and Purpose
Section 3 Applicability
Section 4 Definitions
Section 5 Rules
Section 6 Severability
Section 7 Enforcement
Section 8 Effective Date
Section 9 History
Section 1 Authority
This regulation is promulgated and adopted by the Commissioner of Insurance under the authority of §§
10-1-109, 10-16-104.4, and 10-16-108.5, C.R.S.
Section 2 Scope and Purpose
The purpose of this regulation is to facilitate the implementation of SB11-128 entitled “Concerning
Requiring a Carrier That Participates in the Individual Health Insurance Market in Colorado to Issue Child-
Only Plans on a Guaranteed Issues Basis, and Making an Appropriation in Connection Therewith.” This
regulation also facilitates the implementation of certain provisions of the Patient Protection and Affordable
Care Act of 2010, Pub. L. No. 111-148, 124 Stat. 119 (2010) and the Health Care and Education
Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010), together referred to as the
“Affordable Care Act” (ACA). It replaces Colorado Insurance Regulation 4-2-33 in its entirety.
The Division hereby finds that the immediate adoption of this emergency regulation is imperatively
necessary to comply with a state or federal law, or federal regulation, or for the preservation of public
health, safety, or welfare. The Division further finds compliance with the notice and hearing requirements
of § 24-4-103, C.R.S., with the exception of those set forth for temporary or emergency rules, would be
contrary to the public interest. The Division hereby provides the following reasons for this emergency
regulation:
A. Colorado Insurance Regulation 4-2-33 provides for semi-annual open enrollment periods for
child-only plans in the months of January and July.
B. SB11-128 was signed into law by the Governor on April 29, 2011. SB11-128 provides that “The
first open enrollment period shall begin on the first of the month closest to ninety days after the
effective date” of the legislation which is August 1, 2011;
C. The provision of SB11-128 pursuant to which the remaining open enrollment period for child-only
plans in 2011 is to begin is August 1, 2011 and supersedes the provision of Colorado Insurance
Regulation 4-2-33 setting the open enrollment period as July 2011.
Emergency Regulation E-11-03 1 of 3 Effective May 3, 2011
D. To avoid confusion by carriers and consumers, and to facilitate compliance with state and federal
law, it is necessary and imperative that the remaining semi-annual child-only open enrollment
period be changed from July 2011 to August 2011, and other changes be made in the regulation
to comport with the requirements of SB11-128.
Section 3 Applicability
This regulation applies to carriers that issue child-only plans on or after May 3, 2011.
Section 4 Definitions
A. “Carrier” shall have the same meaning as defined in § 10-16-102(8), C.R.S.
B. “Child-only plan” shall mean an individual health benefit plan that is issued on or after April 29,
2011 that provides coverage to an individual under the age of nineteen years of age. A “child-only
plan” does not include coverage provided to a dependent under an individual or group health
benefit plan.
C. “Qualifying Event” shall include birth, adoption, marriage, dissolution of marriage, loss of
employer-sponsored insurance, loss of eligibility under the Colorado Medical Assistance Act in
Parts 4, 5, and 6 of Title 25.5 of the Colorado Revised Statutes, loss of eligibility under the
Children’s Basic Health Plan in Article 8 of Title 25.5 of the Colorado Revised Statues, entry of a
valid court or administrative order mandating the child be covered, or involuntary loss of other
existing coverage for any reason other than fraud, misrepresentation or failure to pay premium.
Section 5 Rules
A. Enrollment Only Allowed During Certain Periods
1. Carriers issuing child-only plans on or after April 29, 2011 shall accept an application for
child-only plan coverage only during the open enrollment periods set forth in subsection
B. below unless the application is received within thirty (30) days after a Qualifying Event.
2. Enrollment outside the open enrollment periods shall be prohibited, except upon the
occurrence of a Qualifying Event. The submission of an application for coverage must
occur within thirty (30) days after the occurrence of such Qualifying Event.
B. Twice Yearly Open Enrollment Periods for New Applicants
1. There shall be an open enrollment during the month of August, 2011. For each year
thereafter, beginning January 1, 2012, carriers offering child-only plans shall hold an
open enrollment period each January and July, for the duration of the entire month.
During these open enrollment periods, all children under the age of nineteen shall be
offered coverage on a guaranteed issue basis, without any limitations or riders based on
health status. Carriers shall use such rates as are filed and approved in accordance with
§ 10-16-107(1.5), C.R.S. The open enrollment period shall be followed by a thirty (30)
day waiting period for the child-only plan to take effect.
2. Notice of the open enrollment opportunity, open enrollment dates for new applicants, as
well as the opportunity to enroll due to a Qualifying Event, and instructions on how to
enroll a child in a child-only plan, must be displayed continuously and prominently on the
carrier’s web site throughout the year. Each carrier shall also provide a link to public
programs administered by the Department of Health Care Policy and Financing.
3. Nothing contained in this regulation shall alter an applicant’s ability to obtain a child-only
plan, outside the open enrollment period, upon the occurrence of a Qualifying Event.
Emergency Regulation E-11-03 2 of 3 Effective May 3, 2011
C. As a condition of issuing coverage in the individual health market, a carrier shall have an
approved child-only plan available to be issued pursuant to § 10-16-104.4 and this regulation.
D. A carrier may cancel coverage for a dependent in the individual market if the parent subscriber
cancels his or her individual coverage. The carrier shall allow the dependent to apply for a childonly
plan during the next open enrollment period with no surcharge.
E. A carrier may deny coverage to an applicant for enrollment in a child-only plan if other creditable
coverage as defined in § 10-16-102(13.7), C.R.S., is available. For purposes of this subsection
E., creditable coverage does not include eligibility for a high-risk pool insurance plan, including
but not limited to CoverColorado and Getting US Covered, but creditable coverage does include
current enrollment in a high-risk pool insurance plan.
F. A carrier may impose a surcharge for up to twelve (12) months on an individual who enrolls in a
child-only plan if the individual was previously enrolled in a child-only plan, subsequently dropped
the coverage, and the lapse in coverage is greater than sixty-three (63) days. The surcharge may
be up to an additional fifty percent (50%) of the amount that would be charged for the same child
demonstrating continuous coverage.
G. Annual Report
At the time a carrier submits the information required in § 10-16-111(4)(a), C.R.S., it shall submit
a report, in a manner specified by the Commissioner, providing the following information:
1. The number of applicants for a child-only plan in each of the open enrollment periods for
the previous calendar year;
2. The number of individuals enrolled in a child-only plan as of January 1 and December 31
for the previous calendar year; and
3. The number of applicants denied enrollment in a child-only plan and the specific reasons
for the denials for the previous calendar year.
Section 6 Severability
If any provision of this regulation or the application of it to any person or circumstance is for any reason
held to be invalid, the remainder of this regulation shall not be affected and shall remain in full force and
effect.
Section 7 Enforcement
Noncompliance with this regulation may result, after proper notice and hearing, in the imposition of any of
the sanctions made available in the Colorado statutes pertaining to the business of insurance or other
laws which include the imposition of fines, refund of excess premiums plus interest, restitution, issuance
of cease and desist orders, and/or suspensions or revocation of license or certificate of authority. Among
others, the penalties provided for in § 10-3-1108, C.R.S. may be applied.
Section 8 Effective Date
This regulation shall become effective on May 3, 2011.
Section 9 History
Emergency Regulation E-11-01 effective September 23, 2010.
Regulation 4-2-33 effective January 1, 2011.
Emergency Regulation E-11-03 effective May 3, 2011.
Emergency Regulation E-11-03 3 of 3 Effective May 3, 2011
A House committee gave the go-ahead to a controversial bill that would allow Colorado to join other states in opting out of national health care reform that was passed last year.
House Bill 1273, dubbed the Health Care Opportunity and Patient Empowerment (HOPE) Act, would create an interstate compact that would trump federal law.
“HOPE is our way of telling Washington, D.C. that the changes ‘Obama care’ brought to our state simply do not work,” said Rep. Amy Stephens, R-Monument, the bill’s sponsor.
Stephens, the House Majority Leader, is also the sponsor of Senate Bill 200, which would set up health benefits exchanges in Colorado, which is a central facet of health care reform.
H.B. 1273 next heads to the House Appropriations Committee before it reaches the House floor for debate and a vote.
It’s near certain that the bill, if approved by the full House, will die in the Democrat-controlled state Senate
In Colorado’s helathcare market, United Healthcare has extremely competitive rates. If you have a small group health plan, you should strongly consider rating your coverage with United Healthcare. Eric Smith at Mountain Insurance Brokers, specializes in these kinds of policies and would be glad to assist you. 720.974.1703
