OPINION: There’s a simple solution to the health care calamity

The healthcare calamity unleashed by Republicans in Congress and Trump will ensure that hundreds of thousands of Coloradans lose coverage, and our healthcare system will be devastated.

The so-called "Big Beautiful Bill," supported by U.S. Reps. Gabe Evans, Jeff Hurd, Jeff Crank, and Lauren Boebert, is already having ugly consequences for Coloradans. Individual market insurance rates are spiking an average of 28% (38% in rural areas) as Republicans strangle the Affordable Care Act and slash Medicaid.

Because of the deliberate decision to terminate the enhanced ACA tax credits that have led to record enrollment, Coloradans are in for an excruciating shock when they renew their insurance this November. An estimated 36,000 Coloradans will lose access to financial assistance altogether and will see their premiums skyrocket; those who remain eligible for some tax credits will see their premiums spike an average of 170% statewide, with some rural areas seeing spikes over 300%.

This ugly bill adds paperwork and will kick refugees, asylees, and others off of coverage. Combined with the huge increase in premiums, 100,000 or more Coloradans are expected to lose private insurance coverage.

More Colorado families have been able to afford coverage in recent years because more financial assistance has been available. That is all getting yanked away. Just one change, the termination of enhanced premium tax credits, amounts to a roughly $230 million a year tax hike on Coloradans.

While Colorado worked to minimize the harm with legislation this special session by securing funding for state affordability programs for insurance, there is no way Colorado can make up the difference if these tax credits expire.

All of this is disastrous for the individual market, but insurance carriers shouldn't be using this to take advantage of their members. Just recently, Rocky Mountain Health Plans, a for-profit subsidiary of United Healthcare, and Anthem, also for-profit in Colorado, announced they were planning to withdraw their individual market plans from the Denver metro area, and Anthem is planning to withdraw plans from additional areas, affecting 96,000 Coloradans and likely leading to more coverage losses. Rocky and Anthem represent the largest proposed rate increases for next year, at 36% and 34% on average, respectively.

The Colorado Consumer Health Initiative digs into the rate requests every year to identify areas where health insurers' proposed rates may not be justified. For both Rocky and Anthem, it's hard to see a clear rationale for pulling their plans back. There doesn't seem to be evidence in their filings that these areas of the state are harming their bottom line.

Rocky has seen more fluctuations in claims and how much they've been paying out for healthcare, but seemed to be doing decently in the Denver area. Anthem, on the other hand, has often made so much that they had to actually issue refunds because they set their premiums too high and have not spent enough of their premium dollars on health care. Under the ACA, they must spend at least 80% of premiums on healthcare.

The market turmoil creates a convenient smokescreen for carriers to make changes, but we have to question what is really motivating these changes. Anthem indicated to the Colorado Sun that it "might backtrack pending the outcome of the state's regulatory review of its proposed rates."

Is this a similar tactic to what CommonSpirit subjected Anthem to not too long ago, when the hospital corporation threatened to leave Anthem's network to try to get significantly higher reimbursement rates across the state? Anthem cried foul then — largely rightfully so. Based on Anthem's own statement, we have to wonder if this is merely an attempt to get our Division of Insurance to approve a higher rate increase and ignore the objections the DOI or consumer advocates like us have made in the rate review process?

While Republicans at the federal level have plunged our market into chaos, insurers must still be held accountable for their pricing, market behavior, and how they treat Coloradans at the state level.

There is a simple solution to avoid the massive premium spikes and protect Coloradans from losing coverage: Congress must act quickly to extend the enhanced ACA tax credits. This will stabilize the market, lead to smaller rate increases, and protect Coloradans from massive spikes in their health insurance.

This is squarely in Trump and Congressional Republicans' hands. They can fix this, or they can be responsible for catastrophic harm to millions of Americans and roughly 300,000 Coloradans.

Adam Fox is the Deputy Director of the Colorado Consumer Health Initiative. This column was first published in Colorado Newsline.