Since 2009, health insurance premiums in Colorado have drastically increased, impacting employees, employers and individuals insured in the individual and small group markets. Colorado has done little to combat rising insurance premiums, and at times has exacerbated the underlying problems. During the 2018 election cycle, our Colorado legislators promised to reduce health-care costs. Unfortunately, as we close the 2019 legislative session, it appears these campaign slogans have failed to translate into actual legislation focused on combating skyrocketing health insurance premiums.

Instead, we are getting House Bill 1004 which, far from reducing costs, is a major step closer to forcing a public option on our state. Despite claims to the contrary, a public option will not cure the real cause of rising health-care insurance premiums – the overall cost of care delivery. In Colorado – especially in rural counties – declining competition among providers causes health-care costs to rise, which drives up expenses for both consumers and insurance companies. Unless a public option reimburses providers less for care than private insurers, the public option will fail to drive down premiums. However, if that is the case, then such a model would drive private plans out of Colorado as they would be unable to compete. This would eventually result in a government single-payer system; not a market where private and public insurers compete against each other to offer better pricing and services to customers.

Similarly, the public option would reduce access of care by reimbursing clinics less for the care they deliver to patients. Disappointingly, during the 2019 legislative session our representatives’ only answer to rising health-care costs is to squeeze clinics’ earnings; in addition to HB 1004, the legislature is pushing for reinsurance legislation through House Bill 1168, which would further reduce reimbursements. Squeezing clinics’ earnings will force providers to choose between cutting services or exiting Colorado entirely. Thus, HB 1004 will lead to artificially increased demand for health-care services coupled with reduced supply, the inevitable outcome of which would be either sharply increased costs or lengthy wait lists. 

Instead, Colorado would be wise to re-evaluate its administrative constraints on the delivery of care, with an eye toward reducing shortages, inefficiencies and ultimately skyrocketing costs. For example, consider the laws and regulations controlling how physician assistants (“PAs”) and nurse practitioners (“NPs”) practice medicine. Colorado’s current rules stipulate that physicians, due to their education, training and experience, must supervise PAs and NPs. These mid-level providers are licensed to provide a limited scope of medical services compared to physicians, but the shortage of primary care doctors has generated an increasing demand from patients who enjoy the convenience of having a mid-level treat uncomplicated medical issues. This demand is demonstrated by the explosion of in-pharmacy clinics staffed by mid-levels. Yet, antiquated rules governing the supervisory relationship between physicians and mid-levels creates inefficiencies, impedes quality and drives up expenses. These burdensome, antiquated requirements make little sense today as most physicians no longer own their own practices but instead are employed by large health-care systems. Employee physicians no longer want to bear the liability which supervisory responsibility requires.

Instead, the relationship between a physician and mid-level should be one of collaboration, not supervision. Collaboration allows each clinical team member an opportunity to provide input to create a custom protocol that best fits the team structure, practice environment, skill set, experience level, patient mix and geographic area.

Modernizing our legal framework would encourage clinical teams to tailor treatment plans for each patient, empower mid-levels to perform more proactive patient outreach to coordinate preventive care, screenings, follow-up tests and other quality-generating efforts, and allow physicians to focus their expertise on high-level, complex cases. Moreover, eliminating mid-level supervision by a specific physician will decrease barriers for mid-levels to offer care to medically underserved Coloradoans in communities lacking physicians. Doing away with rigid supervision requirements would allow providers to utilize their full skill set, alleviate shortages and improve efficiencies – ultimately, allowing mid-levels to provide lower-cost health-care that doesn’t sacrifice quality.

This is the type of solution our elected officials ought to be pursuing, rather than the ineffective and counterproductive legislation we have been offered instead.

Toren Mushovic is a health-care attorney and chief operating and compliance officer of IMMUNOe Health & Research Centers in Centennial.