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Colorado Exchange Watchdog Likes What It Sees

Colorado lawmakers overseeing the set-up of the state’s health insurance exchange are generally pleased with how it’s going, but they are worried some residents will still be “left out in the cold,” without insurance even if the exchange works well.

Colorado is one of 16 states and the District of Columbia that chose to set up its own exchange, via a bipartisan bill the state passed in 2011. Republicans agreed to vote for it only if it included a special legislative oversight committee that would allow a majority to block exchange funding requests.

That hasn’t happened yet, but oversight committee hearings have been testy in the past. Not so last Thursday, the final hearing before the exchange’s opening day October 1. It was remarkable for the praise members from both parties heaped upon exchange leadership.

Creating an exchange “was not something I was convinced was the right thing to do,” said Republican Rep. Bob Gardner, who voted against the exchange bill, “but (I) have become convinced.”

He said he has been impressed with exchange leaders, and observed, at the hearing’s end, that the exchange “is on a road to success.”

Most committee members did express confidence that “Connect for Health Colorado” appears ready to start enrolling Coloradans Oct. 1 and to connect those eligible for subsidies to that new benefit. Committee members also praised public outreach and education efforts.

But Republican Sen. Kevin Lundberg remains deeply skeptical of anything associated with the Affordable Care Act, and he pointed to “train wrecks” he sees coming.

One both he and Democrats on the committee expressed concern about access to premium subsidies for family coverage for employees of small businesses.

According to federal rules, workers can decline employer-sponsored coverage and possibly get federal subsidies to shop on the exchange if their employer’s plan is not “affordable,” meaning it costs more than 9.5 percent of their income. But that rule is based on the cost of individual health plans. If a worker is offered both an affordable individual plan, and a family plan that costs more than 9.5 percent of income, the worker’s family is ineligible for premium subsidies.

“Why are you putting up with this?” asked Lundberg, who called it a “perverse effect on low income people who have a job.”

“Do not put up with this,” Lundberg told exchange leaders. “I’m sure this is a federal rule. If this is a rule you guys came up with, I will scold you.”

“This might be something we want to think about drafting a letter (to the U.S. Department of Health and Human Services) to address,” said Sen. Irene Aguilar, the committee chairwoman who is a Democrat and a backer of the ACA.

The committee agreed to meet again to work on a letter to HHS. Members may also want federal help on the issue of the ACA’s open enrollment period.

In order to discourage people from waiting until they are sick or have an accident to buy health coverage, the ACA forbids sales of health policies, on or off of exchanges, after the annual open enrollment period, except in the case of “life events” like the loss of a job, divorce or birth of a child. Republicans and Democrats alike on the committee expressed concern for people who will miss the enrollment window and must remain uninsured for up to nine months.

This story is part of a reporting partnership that includes Colorado Public Radio, NPR and Kaiser Health News.