Health care affordability and accessibility are issues that have been at the top of Colorado patients’, families’ and lawmakers’ minds for decades. In recent years, more specifically the importance of health equity has emerged — the idea all people deserve access to the same quality of health care.

Colorado has taken a step, however, to make health care access and treatment less equitable in our state by significantly decreasing the Medicaid reimbursement rate for anesthesia care. The rate recommended by the governor’s proposed budget this year cuts the reimbursement rate for this critical care by a staggering 37.5%.

Every year the Medicaid Provider Rate Review Advisory Committee (MPRRAC) presents the state’s Joint Budget Committee (JBC) with an overview of the reimbursement rates and with suggested strategies for responding to the findings of the review. The 2023 review for anesthesia rates, conducted after consultation with just one provider, resulted in the recommendation to benchmark the Medicaid reimbursement rate for anesthesia care to Medicare — a cut of nearly 40%.

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This significant cut affects both anesthesiologists and nurse anesthetists alike, but its strongest impacts will be felt by Colorado patients. This massive rate reduction could increase already significant inequities in health care faced by those most likely to need anesthesia care under the Medicaid program including low-income Coloradans, pregnant women, children, people of color, people with disabilities the elderly and those living in rural regions of the state.

Medicaid programs cover one in four Coloradans, and 66% of these patients are people of color. Though the majority of Medicaid patients live in urban centers, more than 20 rural counties rely on Medicaid to serve more than 35% of their population. Three rural counties rely on Medicaid programs to serve more than 50% of their population. Decreasing the Medicaid reimbursement rate for critical anesthesia care disproportionately jeopardizes the health and medical outcomes for Medicaid patients, further increasing already significant health equity gaps.

Though this cut will result in lower standards of care and potentially worse health outcomes for patients on Medicaid, it won’t meaningfully reduce health care costs.

This policy was developed by bureaucrats, not providers or caregivers, and is based on flawed data out of line with other carriers and medical reimbursement rates. No other payment system in Colorado benchmarks anesthesia rates to Medicare. Commercial insurers do not, Colorado workers’ compensation does not, and Colorado Medicaid, prior to this recent proposal, has not.

The Medicare reimbursement rate for anesthesia care is due to a fundamental flaw in the original design of the system that did not account for the true cost of anesthesia services. To this date, the error has not been corrected. According to a 2020 report, Medicare pays significantly less for anesthesia services compared to the commercial market than it does for other physician services. In fact, Medicare payment rates are roughly one-third of the rates in the commercial market while Medicare payments for services performed by other physicians are about 75% of the commercial rates. Anesthesia practices have a limited ability to offset payment rate reductions, and the payment rate reduction impacts anesthesiologists, nurse anesthetists and anesthesiologist assistants across the board.

There are countless policies and practices entrenched in our health care system that disenfranchise and exclude certain populations, resulting in different tiers of care based on your income, race, region of the state or other factors. This tiered system also results in significantly disparate health care outcomes. It’s impossible to overstate the importance of adequate anesthesia care for patients. Access to proper anesthesia care plays a critical role in reducing surgical complications, patient pain levels, recovery times and overall costs, as well as increasing mobility and positive patient outcomes overall.

In addition, in a recent report the Colorado Department of Health Care Policy and Financing found there were opportunities to address health disparities in two major areas including increasing access to care in lower-cost, outpatient surgery centers and working to improve pregnancy outcomes and reduce maternal morbidity and mortality. What is not accounted for, however, is the critical role access to optimal anesthesia care plays in finding success in both areas.

We should all be working to ensure everyone in Colorado can access the same high-quality care we would want for ourselves or our loved ones. Though we understand the state has a budget shortage, it should not be balanced on the backs of Medicaid patients who already face serious barriers to health care.

State Rep. Leslie Herod represents House District 8 in Denver and serves on the Appropriations and Judiciary Committees. State Rep. Mary Young represents House District 50 in Weld County and serves as vice-chair of the Health and Human Services Committee and on the Education Committee.