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Healthcare and health insurance costs could skyrocket under the second coming of a Trump administration still seemingly bent on eliminating or at least undercutting Obamacare, consumer advocates warn, while the profits of large, corporate health systems are likely to grow.
But regardless of how hard Trump goes after Obamacare, the never-ending battle to bring down the high costs of health care will rage on in Colorado, especially in rural areas of the state that are most impacted by a lack of competition, mounting hospital fees and runaway health insurance rates dating back years.
In a national and statewide election shaped by reproductive rights and waning access to reproductive healthcare – Donald Trump on Tuesday snapped “stop talking about that” when asked how he voted on an unsuccessful Florida abortion-rights question – other forms of health care also leaped to the forefront of the presidential campaign in its final days.
Republican Speaker of the House Mike Johnson, speaking just a week ago at a campaign event in Pennsylvania, promised “no Obamacare” and “massive” changes to the popular law, also known as the Affordable Care Act (ACA) when Trump is reelected. More than 45 million Americans depend on the ACA for health coverage, either through Medicaid or private plans.
With the state insurance exchange – Connect for Health Colorado – accepting enrollment as of Nov. 1, health insurance and healthcare costs were likely top of mind as voters headed to polls across Colorado on Tuesday or filled out their mail-in ballots starting in October. Kamala Harris won Colorado by more than 11 percentage points on Tuesday, and Amendment 79 – enshrining reproductive rights in the Colorado Constitution – won by even bigger margins.
In Colorado’s hotly contested 3rd Congressional District race between Democrat Adam Frisch and Republican Jeff Hurd, who won Tuesday, the high cost of rural healthcare has dogged candidates for years. Current Republican U.S. Rep. Lauren Boebert, who beat Frisch by just 546 votes in 2022, dodged the ACA issue for years in the district that includes most of southern and western Colorado and suffers some of the highest healthcare costs in the state.
Boebert, who also won Tuesday, moved out of the district to run in friendlier GOP territory on the state’s Eastern Plains, and the issue of sky-high rural healthcare prices looms large in her new district and her old one as costs keep going up. Late last year when Trump promised to “never give up” in his quest to undo former President Barack Obama’s namesake policy achievement, Frisch called any such discussion without a replacement plan “idiotic”.
Trump, in his only debate with Democratic presidential candidate and current Vice President Kamala Harris in September, admitted to only having “concepts of a plan” to replace the ACA.
“We’re prepared to protect the ACA no matter what,” Colorado Consumer Health Initiative spokesperson Priya Telang said in a phone interview Monday when asked about Republicans continuing to target the law that protects against denial for preexisting conditions and allows adult children to get coverage through their parents until the age of 26.
“So many people got coverage because of [the ACA],” Telang said of ongoing GOP attacks on Obamacare. “I find it really interesting in general just because it’s kind of a popular concept. So it’s a little striking to me that they would want to strike something down that has given so many people coverage when they weren’t able to access that before.”
Kevin Patterson, CEO of Connect for Health Colorado, wrote in an email blast this week that, “We’ve successfully navigated periods of uncertainty like this several times in the past, including eight years ago [when Trump was elected the first time], and we didn’t do it alone. You, our customers, stakeholders, and partners, make it possible to move forward together. The Affordable Care Act is still the law of the land. Senate Bill 11-200, the state law that created Connect for Health Colorado, is still the law of the state. There are several other important state laws that ensure quality, affordable, and comprehensive health coverage for Coloradans.”
Patterson all addressed access to health insurance for immigrants: “We know this may be a particularly difficult time for immigrant families to navigate. We remain committed to protecting customers’ privacy. For OmniSalud customers enrolling though Colorado Connect, we will not and have never asked for their immigration status. Colorado Connect does not share customers’ personal information with federal partners for any purpose, and the information included in the application cannot be used for immigration enforcement.”
Asked about specific plans to help lower healthcare costs in rural areas of the state, Colorado U.S. Sen. Michael Bennet, a Democrat who will be in the Senate minority next year after Republicans took control Tuesday, sent the following statement via a spokesperson:
“All Coloradans should have access to high-quality, affordable health care. Two years ago, the Biden/Harris Administration beat back special interests in Washington and Congress passed the Inflation Reduction Act,” Bennet’s office wrote. “That historic legislation included responsible policies to lower health care costs for every American, including allowing Medicare to negotiate drug prices for the first time, capping the costs of prescriptions for seniors, and helping 100,000 Coloradans afford health insurance. There is still more we need to do, and as co-chair of the Rural Health Caucus, I’ll keep working in a bipartisan manner to ensure Coloradans who live and work in rural communities can get the health care they need.”
The Inflation Reduction Act (IRA) was Biden’s signature achievement on climate change, which Trump says he will aggressively attack with an “efficiency commission” headed by Elon Musk to claw back climate spending. It also included healthcare and tax provisions.
Rising hospital facility fees
Colorado Consumer Health Initiative’s Telang said the nonprofit is hyper-focused on exposing and hopefully lowering runaway hospital facility fees charged for outpatient services by major hospital systems for all sorts of procedures (the fees used to just cover facilities with emergency departments).
In the 2023 Colorado legislative session, CCHI backed a bill to create a Hospital Facility Fee Steering Committee that in October released a Hospital Facility Fee Report revealing the total amount of facility fees reported in the Colorado All Payers Claims Database (APCD) was $13.4 billion over the six-year study period, from 2017 to 2022.
“The report outlines which hospital systems are the worst perpetrators of facility charges, and so those larger health systems like CommonSpirit [Health] and UC Health, they’re the ones who are charging the fees the most,” Telang said. “If you are seeking care at a hospital outpatient department that is affiliated with a larger system, it’s more than likely that your cost of care will be doubled just because of the site that you’re receiving care at.”
The state law that created the committee and conducted the study also aims to standardize notification to patients of the fees being charged and disallows the fees being charged for preventative care. Independent healthcare providers generally do not charge the fees.
“These charges are so opaque in Colorado and there’s no real standard for the amount that’s being charged per person, per payer, per whatever,” Telang said. “So that’s why we honestly ended up proposing the bill because [the facility fees are] just proliferating so much in the last several years since hospital consolidation has become more of an issue.”
At the federal level, bipartisan legislation seeking site-neutral facility-fee payments has been proposed, including the Site-based Invoicing and Transparency Enhancement Act (SITE Act). U.S. Sens. Bill Cassidy (R-LA) and Maggie Hassan (D-NH) on Friday released a legislative framework to address how site-neutral payment reform.
“I don’t particularly know the nuances of that, but I know that the payments are supposed to be site neutral, which should essentially make it so that patients pay the same price per site,” Telang said.
Bennet’s office, in an email, said the senator is aware of and looking into the SITE Act to further reduce the cost of hospital facility fees. Colorado’s other Democratic U.S. Senator, John Hickenlooper, also said he’s aware of the bill and the issue of hospital facility fees while simultaneously pursuing other forms of legislation to target rural health care costs.
“We’re aware of the SITE Act and our team’s looking into it,” a spokesperson for the office of Sen. Hickenlooper wrote in an email. “We’re also looking at other rural health care issues like Medicare Advantage issues, the expiration of the continuous enrollment of Medicaid benefits from COVID, and access to telehealth to lower the barrier to care for folks in rural areas. The senator recently visited the Southwest Memorial Hospital in Cortez to discuss these challenges in rural health care and how to help bring down costs while increasing access to care.”
Now, with both the Senate and the White House changing hands next year and the House still up in the air, it’s unclear what will happen to Democratic efforts to bring down the runaway costs of rural healthcare, from insurance to facility fees to prescription drug prices. But it is clear that access to public safety nets and reproductive healthcare in general is certain to suffer.
Editor’s note: A revised version of this story first appeared on the Colorado Times Recorder website.
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