Hot Issues in Health Care 2014: Day One

Highlights and Takeaways from Day One of the 2014 Hot Issues in Health Care conference underway in Colorado Springs:

Opportunities for states to rethink many aspects of the Affordable Care Act dominated the morning’s discussion.

Veteran political adviser Cindy Gillespie, who worked with Govenor Mitt Romney to reform health care in Massachusetts, predicted that many states will begin considering a little-known provision of the Affordable Care Act that would allow them to pick and choose which provisions of the law to implement as long as they maintain the same level of coverage.

The provision is called a 1332 waiver, or a state innovation waiver. Besides rethinking the ACA, it allows states to apply for permission to consolidate other waivers, allowing for changes in Medicaid, Medicare and the Colorado Health Plan Plus (CHP+) public insurance programs.

“This is next big thing,” she said. “There’s never been a waiver written like this before. The potential is enormous for states to step back and design something that fits them. I think over the next few years, this is all anyone is going to be talking about.”

States must start working on a 1332 waiver in 2015 to have it ready by 2017, she said.

The next keynote speaker, Stuart Butler, a well-known economist who has just joined The Brookings Institution in Washington, D.C., after more than 30 years at The Heritage Foundation, built on the theme of state innovation when it comes to health reform.

First, Butler said he doubts there will be significant change to the Affordable Care Act coming out of Washington.

“The big changes are going to come from outside of Washington,” he said.

Watch for a sea change in employer-sponsored insurance, where most Americans get their coverage, he said. Butler predicted the end of employer-sponsored insurance within five years, 10 at the most.

Employers want to get out of the complicated business of providing health insurance to their workers. Instead, watch for the rise of private exchanges, where workers will be able to shop for insurance with money from their employers, he said.

Finally, states will step forward as the primary drivers of change in the health care system, he said.

“This is where federalism is really going to come into its own,” he said. “This is how we in America will try to create a system that achieves some national objectives and goals, but in a way that reflects the differences of what people want in different parts of the country.

“Colorado, trust me, is not like Vermont or Arkansas or New York City. It’s a big diverse country. So when we think about American federalism, it’s designed to deal with those differences.”

A flaw of the Affordable Care Act is that it doesn’t recognize the nation’s variations, and instead tries to make one-size-fits-all changes, he said.

In response to a question, Butler outlined his five elements of a good state-based health system framework, one that states could consider as they work on the waiver:

• Revamped subsidies and tax benefits to focus on people who need help the most.
• An employer-based insurance system that has migrated to a place where you sign up for insurance, not the controller of your health care.
• Strong, competitive private insurance exchanges where people can shop for coverage.
• A seamless system instead of one featuring different insurance types as people change, including as they age.
• And, finally, a system where change is being driven at the state level, not the federal level.

Ideally, a national discussion would yield an agreement on basic goals of health insurance and then states would be freed to arrive at those goals in ways that are best for their residents, he said.

Michele Lueck, president and CEO of the Colorado Health Institute, kicked off the morning with a welcoming talk that focused on the importance of health policy discussions and the unique position of Colorado as a purple state with a closely-divided legislature. Health is personal for the state’s 5.2 million residents, and it’s an economic driver as well, she said.

In the evening, Sen. Irene Aguilar, Rep. Lois Landgraf, Rep. Jonathan Singer, and Sen. Ellen Roberts talked about health reform, working across the aisle, and how important it is to listen to constituents, as part of “A Lawmaker Conversation. ”It was a great session filled with hope for Colorado’s legislature to work together this session to tackle important problems.

Republican Representative Amy Stephens and Democratic Representative Beth McCann co-hosted the reception before dinner.

Hot Issues Sightings:

Annie Wohlgenant, a prominent health policy consultant, and Marcy Morrison, former Colorado insurance commissioner, who founded the Hot Issues in Health Care conference in 2000. This year’s conference is the seventh.

Newly-elected legislators, including Representative-elect Terri Carver, Representative-elect Alec Garnett, Representative-elect Gordon Klingenschmitt, Representative-elect Susan Lontine, Senator-elect Mike Merrifield, Representative-elect Kit Roupe, Representative-elect Jack Tate, Representative-elect Dan Thurlow, and Representative-elect Yeulin Willett.

Veteran lawmakers, including Senator Irene Aguilar, Representative Kathleen Conti, Representative Don Coram, Representative Joann Ginal, Representative Janek Joshi, Representative Lois Landgraf, Representative Pete Lee, Representative Beth McCann, Representative Dianne Primavera, Senator Ellen Roberts, and Representative Jonathan Singer.

Finally, great to see retired Senator Andy McElhany at the conference. Also former Senator Kiki Traylor, as well.