What The Affordable Care Act Means For Coloradans

In 2007, nearly 13 percent of adults in Colorado reported they were unable to visit a doctor when necessary due to cost. Health insurance premiums in Colorado have risen 25 percent for singles between 2003 and 2009. The cost of family policies rose 40 percent in that time, according to the Common Wealth Fund. Of the Colorado residents who do have health insurance, 52 percent are covered through their employment, eight percent purchase individual private policies, and 26 percent of Colorado residents are covered by public programs such as Medicaid and Medicare. This leaves more than 700,000 Colorado residents, 14 percent of the state’s population, uninsured. [1]

Who are the uninsured in Colorado?

Non-elderly adults–those younger than 65 who are ineligible for Medicare–are uninsured at a rate of 19 percent in Colorado. The uninsured rate among children is 10 percent overall, but rises to 23 percent among children in households with incomes less than 139 percent of the Federal Poverty Level. Non-elderly adults in these lower-income households are uninsured at a rate of 44 percent. [2]

Disparities in insurance coverage exist between race and ethnic groups. Non-elderly persons of Hispanic origin are uninsured at a rate of 27 percent, 21 percent of non-elderly Blacks in Colorado lack health insurance, and the uninsured rate among non-elderly Whites is 12 percent. [3]

How does the Affordable Care Act affect Colorado residents?

The Affordable Care Act requires states provide access to an online marketplace where individuals and small businesses may compare, select and purchase private health insurance policies that offer a minimum level of coverage. States have the option of establishing their own exchange, operating an exchange in cooperation with the federal government, or turning all administration of the health care marketplace over to the federal government. Colorado, along with 16 other states and the District of Columbia, has opted to create its own exchange.

Colorado’s health insurance exchange

In June 2011, Colorado Governor John Hickenlooper signed legislation to establish a Colorado health care exchange, officially called Connect for Health Colorado. Colorado’s application to establish its own exchange was approved by the U.S. Department of Health and Human Services in December 2012. The Colorado Health Benefits Exchange Act sets up the exchange as a non-profit entity governed by a board of directors. The exchange operates using a clearinghouse model, meaning all qualified plans offered by insurers licensed to do business in the state will be allowed in the exchange. The Connect for Health Colorado website serves as a portal through which individuals and small businesses may purchase health insurance. The Colorado health benefits exchange begins enrollments October 1 for insurance effective January 1, 2014.

According to the Colorado Department of Regulatory Agencies (DORA), as of May 2013, 17 insurers have submitted 813 health plans for inclusion in the Colorado exchange. The DORA Division of Insurance is tasked with reviewing plans to ensure they meet federal standards under the Affordable Care Act (ACA). All plans must provide a core package of Essential Health Benefits, which includes hospitalization, emergency services, and mental health treatments. Annual wellness check-ups and other preventative screenings must be covered with no co-payments or deductibles.

Policies are categorized into four tiers. Bronze level plans cover 60 percent of medical costs. Silver plans cover 70 percent. Gold covers 80 percent. Platinum plans cover 90 percent of medical costs. Additionally, adults younger than 30 may purchase catastrophic plans with limited coverage.

Under the ACA, residents may not be denied health insurance for pre-existing health conditions, and insurers may not place a lifetime cap on benefits. Households with incomes at or below 400 percent of the Federal Poverty Level may be eligible for tax credits to offset premium costs.

Small Business Health Options Program (SHOP)

Under the ACA, small business employers with fewer than 50 full-time workers, or full-time equivalent workers, will not be required to offer health insurance to their employees. (Check here for a definition and calculator to determine who qualifies as a full-time worker.) However, the ACA encourages many small business employers to provide health insurance by offering small business health care tax credits.

Many small businesses were already offering health insurance packages to their employees before the ACA was passed and signed into law. These plans are accepted, or grandfathered in, under the ACA.

For small business owners who wish to change their coverage plans, or for those who did not offer health insurance before the new law, the ACA establishes the Small Business Health Options Program or SHOP. SHOP allows employers to compare and shop for quality insurance plans side by side for their employees. Colorado small business owners may access SHOP through Colorado’s health insurance exchange.

Certified in-person enrollment organizations

The Colorado government, through Connect for Health Colorado, certifies organizations to provide in-person help with enrollment. Approved organizations include:

External resources for Colorado residents

See the full list of external resources from CBS Denver.


[1] http://kff.org/other/state-indicator/total-population/?state=co
[2] http://kff.org/state-category/health-coverage-uninsured/?state=co
[3] http://kff.org/uninsured/state-indicator/rate-by-raceethnicity/?state=co

Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.


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