CCI 2019 LEGISLATIVE ISSUE FORM HHS. 1.) Issue: INDIVIDUAL HEALTH INSURANCE MARKET EQUALITY AND STABILIZATION ACT

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1 CCI 2019 LEGISLATIVE ISSUE FORM HHS CCI is soliciting potential legislative issues for the 2019 legislative session. Please answer all of the questions below for each of your county s legislative issues. If your county submits multiple issue forms, please prioritize your issues. Submitted issues are discussed during the summer steering committees and district meetings. We encourage you to confer with your county managers or administrators and department heads, as well as other elected officials, to determine what issues are the most pressing in your county and have implications for other counties. All submitted issues forms must have the support of the Board of County Commissioners or the Mayor/City and County Council. In accordance with the Legislative Principles that are part of CCI s Policy Statement, initiated legislation should be realistic and closely related to the conduct of our members responsibilities if we are to retain a high level of credibility. Local elected officials groups, county and otherwise, as well as other interest groups, should be encouraged to find sponsors for and initiate their own proposals, allowing our members and CCI to take a supportive role when the bill is introduced. Please your issue forms to Jeanne DeHaven at jdehaven@ccionline.org. Please feel free to use more than one page when submitting issues and to submit additional documentation or background information related to the issue. Legislative Issue Forms need to be returned by Friday, June 29, 2018 in order to be discussed during the summer legislative review and steering committee meetings. Name: Richard Cimino Title: County Commissioner Phone: County: Grand richcimino@gmail.com 1.) Issue: INDIVIDUAL HEALTH INSURANCE MARKET EQUALITY AND STABILIZATION ACT This Act would create One Geographic Rating combined with Re-insurance for Health Care Insurance on the Individual Marketplace. The issue is that health insurance cost too damn much. This bill would only affect the Individual Marketplace, not small group or large group plans (employer provided plans).

2 2.) Background: The Individual Marketplace is where Colorado Citizens can get Health Care insurance if they have no other options (no employer health insurance, not eligible for Medicare or Medicaid). In Colorado, the Individual Marketplace is called Connect For Health Colorado (C4HCO). It is Colorado s version of the Affordable Care Act, aka Obamacare. Approximately 8% of Colorado s population (440,000) get their health insurance from C4HCO. Approximately half of them qualify for a subsidy (household income 400% or less of the Federal Poverty Level, $48,240 for a household of one, $98,400 for a household of four.) Those who qualify for a subsidy do not have a problem. The subsidies are adjusted so that the out of pocket costs for health insurance are the same for everyone in Colorado, regardless of where they live. Not so for the people who make more than 400% of the Federal Poverty Level. For them (approximately 220,000 people in Colorado) their health insurance premium costs vary based on where they live (There are 9 separate rating areas in Colorado). Boulder is the cheapest area, the West and East region are the most expensive. Health insurance rates can be double in the expensive rating areas, for the same health care plan. This has to change. No other type of insurance (auto, homeowners) has different rating areas. This policy greatly harms rural Colorado, and benefits urban Colorado. It affects the health of our people. Colorado s 9 Geographic Rating Areas are: 1. Boulder 2. Colorado Springs 3. Denver 4. Ft. Collins 5. Grand Junction 6. Greeley 7. Pueblo 8. East 9. West During the 2016 Legislative Session, Representative Bob Rankin introduced a One Geographic Rating area bill, but it failed. No Geographic Rating Area bills were introduced in In 2018, Bob Rankin again introduced a One Geographic Rating Area Bill (HB ), which he Postponed Indefinitely when it was clear the Bill did not quite have majority support, and those in favor of reducing health insurance costs for the individual marketplace decided to put all their efforts behind HB , Individual Health Insurance Market Stabilization Act (AKA The Re-Insurance Bill). HB passed the house. It was killed in the Senate State Affairs Committee in May.

3 3.) Proposed Solution/Legislative Remedy (Please provide the specific statutory citation your board is requesting to modify AND the proposed language you are requesting.) HB19-XXXX INDIVIDUAL HEALTH INSURANCE MARKET EQUALITY AND STABILIZATION ACT This bill would create one geographic rating area for all of Colorado, and implement a Re- Insurance program. Rural Colorado will see their health insurance rates approximately cut in half. Normally, one geographic rating would increase costs for urban areas, but the Reinsurance program would reduce costs for EVERYONE, therefore the urban areas would see some cost reduction as well. 4.) County Commissioner role in this issue: County Commissioners from at least 58 counties will need to contact their Representatives and Senators and explain to them how the Health Insurance Equality and Stabilization Act will work. Also, a smaller team of Commissioners will need to work with CO Insurance Commissioner Mike Conway and meet with Insurance companies to try to negotiate language that we can all get behind. 5.) Proponents/Opponents (Please indicate if your board has had conversations with proponents/opponents to date and their perspective on this proposal): PROPONENTS: Representative Bob Rankin (R) (Yes, supports) Representative Chris Kennedy (D) (Yes, supports) Representative KC Becker (D) (Yes, supports, talked to her in June) Representative Susan Lontine (D) (Supports, voted in favor in 2018) Representative Millie Hamner (D) (Supported both One Geo and Re-Insurance in 2018) Representative James Wilson (R) (Voted for Re-Insurance in 2018 Other Representatives Senator Kerry Donovan (Yes, supports, voted in favor last year) Senator Don Coram (R) (Yes, has voiced support before) Senator Jerry Sonnenberg (R) (Yes, has voiced support before)

4 Senator Irene Aguilar (D) (Very much in support) Other Senators Insurance Commissioner Mike Conway (Helped drafted Re-Insurance Bill in 2018) People from Colorado Health Institute (CHI) (Many voiced support at the 2017 annual conference) Maybe: Anthem Blue Cross, Blue Shield (because they are the only Colorado Health Insurance Company that offers health insurance to all 64 counties, the only one). Maybe we can get CML to support? Other Mayors CAST State Chamber of Commerce OPPONENTS: Health Insurance Industry, Associations Only 5 Insurance companies offer Individual marketplace coverage: Anthem (which we might get to support) Bright Health Insurance CIGNA Friday (yes, that is their name, I have no idea why) Kaiser (they are the only company that refuses to pay commissions to brokers) Republicans, because they tend to not want to have government get any more involved in the health care market. 6.) Have you visited with your legislator(s) about this proposal? What was their reaction? Are members of your delegation likely to sponsor, support, or oppose this proposal? Yes, they are supportive. My delegation will support this proposal.

5 7.) Anticipated Fiscal Impact: Zero. Funding the re-insurance program requires money. The 2018 bill applied a fee to small and large group plans. I think we can work with Mike Conway and the insurance industry to reduce the fee on group plans, maybe eliminate it altogether. The re-insurance program can be much smaller than in 2018 because One Geo will shrink the amount re-insurance will try to save. In fact, the amount of funding required for re-insurance might be so small in 2019 that the State can absorb it, in which case there may be a small fiscal impact. We need to work with stakeholders and find the best solution. 8.) Please list the subject matter experts CCI staff can follow-up with for more information on this proposal: Mike Conway and his staff Representative Chris Kennedy The insurance industry Rich Cimino 9.) Priority Ranking (If multiple issues submitted): Priority 1 of 1