Dr. Ned Calonge, president and CEO of The Colorado Trust, has been a dominant figure in Colorado’s health care landscape for more than two decades. Among the roles he’s held are the positions of chief medical officer of the Colorado Department of Public Health and Environment and president of the Colorado Medical Board. In an interview with Advocacy Denver’s policy outreach specialist Catherine Strode, Calonge discusses the impact of the Affordable Care Act in Colorado and sustainable health trends across the state.

What impact do you think the Affordable Care Act is having in Colorado?

The ACA has had the impact it wanted to have in terms of coverage. The uninsurance rate in Colorado is the lowest level it’s been since I’ve been in Colorado. We’re under 8 percent. These numbers are staggering compared to where we were even three years ago. It’s difficult to get care without coverage, but just because you have coverage doesn’t mean you have care. We’re still working through the process how coverage through the exchange and coverage through Medicaid expansion translates to access to care across the state and in populations who now have insurance.

What grade would you give the ACA at this point?

I think probably a B-minus is the best I could give. The problem is, there are parts of what’s been implemented that need tweaking for it to work the way we actually intended it to work. There are parts of it that the right side of the aisle has managed to defund so not all pieces have been implemented. Whenever you hear we’ve delayed something, almost all of those (delays) directly impact the budget advantages of the ACA to health care expenditures overall. When they put off the business requirements for insurance, the tax on the Cadillac plans, projections for when the ACA will start saving money for the country get pushed out a few years. All of these were in the original calculations to make sure that health care costs will come down. There’s nothing in the bill that really requires reducing costs. It’s only demonstration projects. Colorado has an advantage in that we’ve got a lot of those demonstration projects here, most of them running through Medicaid. If we can get them all up and interacting well, we will start to see transition of the health care system on the public payment side.

Has the ACA initiated sustainable trends in services?

I think there’s still a transition envisioned by the ACA that we haven’t necessarily seen come to fruition. This issue of Accountable Care Organizations, where the payer or the provider think about taking care of a population of enrollees and managing their care and their costs, across the spectrum of care. The hospitals tend to still work with the model of filling the beds. A hospital bed is a revenue center. Their model hasn’t changed. The providers, if they do a good job of keeping people out of the hospital, don’t necessarily get any reward. We need to have a system where the Accountable Care Organizations see the hospital bed as a cost center, not a revenue center, and they are working with the provider community to use that expensive hospital resource wisely.

What do you see happening in long-term care trends?

Long-term care is a moving target. There are structures that are changing. What is a for-profit in-home senior care service going to look like? Is it going to expand? Or will it actually drive up the cost of care? I have never seen a for-profit conversion lower costs yet. That’s my analysis. I think other folks see it another way. One of the ways they see it is that age wave we’re approaching means there’s going to be a need for a lot more services. There will be a lot more need, which will generate more resources, which will generate more access to profit and capital. I don’t have a good sense for how we are going to make the transition from what I would say is not enough services to having the resources for age in place, assisted living and other long-term care, nursing home care. That transition, for me, is the cloudiest crystal ball there is.

What trends in health care do you see as sustainable?

I think it will be very unlikely we’ll go back on many of the insurance expansions. There are lots of popular parts of the expansion, like coverage for preexisting conditions, children covered up to age 26. Most of those are parts of the system that continue to increase costs. That makes the expansion even more important, so we can spread those costs over a lower-risk, larger population. We’ll have to continue to figure a way to have choices available to young people to be insured. The Medicaid expansion for those people who can’t literally afford to have health care, in order to make sure they have a source of payment when they do need health care. I think those parts of the system are going to be sustained. They may not look like what they look like now. But I think it would be very difficult for either side of the aisle to ratchet back on Medicaid expansion and affordable insurance premiums for the working class.

Catherine Strode, MPA, is Advocacy Denver’s policy and outreach specialist.