Repealing & Replacing the ACA

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Washington, DC, February 21, 2017 | comments

Repealing & Replacing the ACA

In 1994, as a member of the Colorado State House, I introduced House Bill 94-1210, a pioneering health insurance reform measure. This was long before most people even thought of health insurance as a major issue. HB94-1210 provided what is called “guaranteed issue”, meaning that insurance carriers had to cover those with preexisting conditions and could not rate anyone differently based on their health status. The bill spread the cost of doing this through a technique known as “adjusted community rating,” and the legislation prohibited pricing discrimination based on gender.

HB94-1210, was aimed at the small employer health insurance market and the individual market. Larger employers were not included because were regulated at the federal level and exempt from state insurance regulations under the “Employee Retirement Income Security Act of 1974.” Larger groups were not seen as having the same problems that smaller health insurance groups and individual markets had. Small employers and those who purchase health insurance on their own were experiencing severe difficulties with pre-existing conditions and discrimination based on gender.

Unfortunately, I was not able to fend off an amendment that exempted the individual health insurance market from the landmark consumer protections provided for in my legislation, but I was at least able to advance these protections for the small employers and the legislation was the first major attempt to reform the health care insurance system in Colorado. Ultimately HB-94-1210 was signed into law by then Governor Roy Romer.

Now, ‘fast forward’ to 2010, the year when the Affordable Care Act (ACA), was passed by Congress and signed into law by President Barack Obama.  It provided all of the consumer protections that were adopted in Colorado, and many other states, for the small group market and included reforms to the troubled individual health insurance market.  While many of these provisions were significant improvements, the ACA’s principal tool for expanding health care has been the expansion of the Medicaid program to cover able-bodied working individuals, without dependent children, and by increasing the income eligibility up to 138% of the federal poverty level.

The ACA has expanded coverage through the Medicaid program, at an enormous cost to the taxpayers, but has otherwise failed to deliver on its promises to lower costs and to expand private insurance coverage. This is particularly true in the health insurance exchanges, where individuals are able to navigate these government-sponsored websites to see what options are available for them and the subsidies they are eligible for based on income. 

For those purchasing insurance through Colorado’s insurance exchange in 2017, they will find that rates have increased an average of 20% over 2016. Nationally, the price of insurance coverage has increased by 25%. Additionally, the number of insurers willing to provide coverage to individuals is rapidly dwindling in our state. In western Colorado, there are 14 counties where only 1 insurance carrier services their area. Clearly this model is unsustainable.

What I plan to do to address the inevitable failure of the ACA in Congress is to:

  • Reform the Medicaid program.
    • Key here is giving states more flexibility to design their own systems. This will not only improve outcomes but contain cost. 
    • Limit the Medicaid expansion to those now enrolled and allow them to stay on it so long as they continue to meet current eligibility requirements.
  • Eliminate the employer mandate.
    • This mandate only applies to businesses of 50 or more employees while most of the problems associated with access to employer-based health insurance are found in smaller businesses which have avoided the mandate by not adding jobs. 
    • Allow small business to band together to purchase their health insurance so that they can get the same discounts large businesses.
  • Eliminate the individual mandate
    • In too many cases, it’s cheaper to pay the penalty and buy insurance only when it’s needed, thereby ‘gaming’ the system and pushing up rates for everyone else. 
    • Replace this with a tighter requirement to maintain continuous coverage in order to retain eligibility for all the consumer protections (i.e. preexisting conditions) contained in the ACA.
  • Provide incentives for the purchase of health insurance.
    • Give individuals the same tax deductibility that businesses have when they buy health insurance.
    • Use the tax code, to assist low income individuals, through the use refundable tax credits paid directly for the insurance plan of their choice.
    • Increasing the contribution limits for health saving accounts.
  • Maintain the consumer protections contained in the ACA.
    • Requiring insurance carriers to cover preexisting conditions; 
    • Prohibiting lifetime caps;
    • No price discrimination on the basis of gender; and
    • Allow dependents to stay on their parents’ policies until age 26. 

Finally and perhaps most importantly, I will not vote for to repeal any part of the ACA without a concurrent replacement. 

U.S. Representative Mike Coffman (CO-06) announced earliert this month that during the district work period of Feb. 20-24, he will undertake the first phase of his planned “listening tour” regarding the repeal and replacement of the Affordable Care Act (ACA). Coffman will use this series of meetings to gain the perspective of as many constituents, patients and healthcare professionals as possible.

In the month of March, Coffman will commence the second phase of this listening effort when he plans to hold several telephone town halls to hear directly from constituents regarding their concerns about the ACA. 

For his third-phase, Coffman will hold a 'traditional' town-hall event in the district that will be scheduled in the month April. 

Information on how to participate in these telephone town halls and information on district events will be made available at

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