More affordable, more accessible health care is one step closer to becoming a reality for more Coloradans. As physicians, we are thrilled, and urge Colorado’s elected officials to bring House Bill 1370 across the final finish line so patients can get the relief they need from costly health care.
Countless Coloradans struggle daily to afford their medical care and HB1370 is a crucial component to getting them the care they need. This important legislation, which passed the House Health and Insurance Committee on April 27th, and the House Appropriations Committee on April 29th, addresses one of the main barriers to health care for many Coloradans – high cost. It contains the following important protections for patients and their families:
- Health insurance plans will be required to set firm dollar copay amounts, as opposed to less predictable percentage-based copay payments.
- Medications cannot be dropped from formulary mid-way through the coverage year
- Insurance companies cannot raise out-of-pocket payments for medications during the coverage year
- Health care providers will have opportunities to help patients get the medicine they need when they need it – not just when it is approved by insurance.
- Rebates from prescription medications that currently go directly to insurance companies must be passed along to Colorado families, a step towards protecting patients’ financial security along with their health.
More than one in 10 Coloradans struggle to pay for health care. One in five Coloradans skip routine health visits because they are worried about costs. One in five Coloradans say they get stuck with bills that contain costs their insurance companies should have covered, but did not. By helping patients know exactly what services will cost, HB1370 empowers patients to plan for their care, from prevention to treatment and recovery.
As physicians, we know how critical regular check-ups can be to help keep serious health issues at bay. Early detection of medical conditions can prevent them from worsening, leading to better patient outcomes, reducing the likelihood of costly treatments and hospitalizations, and saving individuals and the healthcare system money.
However, early detection of diseases often requires further lab, imaging, and specialist workup. Physicians know how important these diagnostic tests are. Yet patients are often concerned about the costs they could incur from these necessary next steps. Some patients may delay or even skip them altogether, allowing treatable conditions to worsen. Imagine a system where a patient could be made aware ahead of time how much of an out-of-pocket cost there would be for a given image, procedure, or specialist visit.
Treating illness before it becomes a crisis often involves prescribing medications, which can also be a significant financial and emotional burden. As physicians, it is heartbreaking to see patients forgo life-saving prescriptions because of cost or insurance red tape. It is not uncommon for patients to start a helpful medication while in the hospital only to stop it after they get home because it is too expensive. For other patients, we may recommend an evidence-based medication, but their insurance company forces them to try a different, and less effective, medication first. Patients should not have to spend hours on the phone with insurance companies arguing to get the prescriptions their physicians have advised them to take. Imagine a system where physicians and patients determine what medications are best, not insurance corporations.
For too many Coloradans, these are all-too-familiar experiences. There are patients with chest pain who skip treatment because they fear their heart medications and imaging will end up costing them tens of thousands of dollars out of pocket. There are patients with cancer who fear their insurance company will not cover the type of chemotherapy they need. Patients with diabetes, emphysema, arthritis, and countless otherwise manageable chronic conditions skip care that could significantly improve their health and their lives.
No Coloradan should tolerate or accept any outcome where financial ruin is the cost for families that simply want to prevent a loved one from getting sick or dying. Thankfully, we have an opportunity to help ensure Coloradans transparency and stability of medical costs.
The Colorado Legislature should act without delay to pass HB1370, and put the health and peace of mind of Colorado families first, not the profits of insurance corporations and their CEOs. Coloradans deserve nothing less.
The ideas expressed here are the sole views of the authors. Dr. Kyle Leggott is a family physician practicing in Aurora and Lone Tree. Dr. Allison Costello is a family physician practicing in Denver and Aurora.