Legislature mulls new review panel for managed care

Health-care reform isn’t an issue in this year’s presidential election as it was four years ago, but that hasn’t limited the number of bills going through the state’s General Assembly. Maintaining an average established over the past few years, approximately 60 bills have been introduced dealing with health care.
Even though the number of bills has remained fairly consistent, the attitude toward managed care has changed over the past three of four years, said Bill Hopkins, the Greeley-based government relations director for State Farm Insurance Co. in Colorado, Utah and Wyoming.
He said the medical community’s original stance of “We don’t like managed care, let’s make sure it doesn’t grow” has changed to one seeking to define how managed care works.
But “that can be taken to the point of interference,” he said. He sites House Bills 1257 and 1216 as potential examples. Introduced by Rep. Mary Ellen Epps, R-Colorado Springs, HB 1257 would establish an independent review panel of three physicians to whom disputes raised by patients, doctors or managed-care organizations could be referred.
“That really adds a level of oversight that’s inappropriate,” Hopkins said. “Because of pressure from the public and public officials, each managed-care organization does have such a panel in place. The goal should be to make them work well. Then the problem is solved without an added level of oversight and government. Let’s make sure the system works well for the customer instead of designing a system that says it doesn’t.”
In Hopkins opinion, HB 1216 may do more than provide a level of oversight; it may interfere with how contracts between managed-care organizations and doctors are written.
“There’s a possibility that it’s an interference with the right to contract,” Hopkins said. Managed-care organizations are looking to manage costs and have the right to set procedures, he said, “and I don’t like to see that threatened.”Lower taxes on insurersClif Sams, volunteer law and legislative chairman for the Colorado Association of Life Underwriters, hopes House Bill 1261 by Littleton Republican Paul Schauer has a healthy future. HB 1261 could lower premium tax rates insurance companies with a home office in Colorado are required to pay.
Sams thinks the lower tax rates would encourage more insurance companies to relocate to Colorado, thus generating jobs throughout the state.
“I’m hoping more and more insurance companies relocate to Colorado and get out of the East,” Sams said.
Currently, insurance companies with a regional or home office in Colorado pay a 1 percent tax on premiums written in the state. Insurance companies that don’t meet the in-state requirements pay a 2.25 percent tax. HB 1261 aims to lower that out-of-state tax to an even 2 percent over the next five years.
The problem has been that other states have levied similar taxes against Colorado-based companies. These “retaliatory taxes have become a burden for domestic life companies,” Hopkins said. As Colorado lowers its tax rate, it is expected that other states will in turn lower their rates. As it is now, the tax system “isn’t a good thing for anybody,” Hopkins said.Cure for fraudRep. David Owen, R-Greeley, and Sen. James Rizzuto, D-Denver, are working on a cure for insurance fraud. If passed, their House Bill 1149 would provide clearer definitions of insurance fraud while also providing immunity to possible legal action for any party that reports possible fraud — be it an individual, a doctor or an insurance company, Hopkins said.
Based on a national model created by the Coalition Against Insurance Fraud, the bill could cut into Colorado’s $1.2 billion-per-year insurance-fraud problem, Hopkins said. The original model called for creation of a fraud bureau, Hopkins said, but that provision was removed from HB 1149 to fit Colorado’s fiscal limitations.Operating on coopsSenate Bill 25 has been introduced to the House after passing through the Senate unscathed.
Introduced by Sen. Mike Coffman, R-Aurora, and Rep. Tim Foster, R-Grand Junction, SB-25 aims to end the limitations designating health-care coverage cooperatives as nonprofit organizations.
Coffman hopes such deregulation would encourage better service and lower prices by increasing the amount of competition. As things stand now, he sees incentives for small business to join health-care co-ops, but he sees no incentive for anyone to go through the “brain damage” of forming a co-op.
“By making it for-profit, there may be reason to go through that brain damage,” he said.