As I travel around Colorado, I hear people share their anxieties about health care. Their stories fuel my passion to fight for better health care for all Coloradans. Affordable, quality health care is a right we must provide all residents, not a privilege for the wealthy few.

It is clear to us here in Colorado that Washington—given its current level of dysfunction—will not solve our health care problems.  It’s up to us to develop and implement solutions here in Colorado. As Colorado’s next Attorney General, I will work hard to improve health care and reduce the financial burdens on Coloradans.

First, I will stand up against the Trump administration’s attack on affordable health care. I will work to protect the Affordable Care Act’s provisions that enable hundreds of thousands of Coloradans to have access to affordable and reliable health care. I will challenge the Trump Administration’s decision to cut off the Act’s cost-sharing reduction payments, which reduce health care costs for low-income Americans, joining the other states who have already done so, and I will fight to keep in place the law’s protection of consumers from fraud, mismanagement, and deception. 

Second, we need to do more than protect the Affordable Care Act because the rising costs of health care, particularly in more remote areas, is an increasing threat to our residents.  As one multi-state study found, Coloradans pay an average of 17% more for health care than citizens in other similar states.  On the Western Slope, the situation is even more dire, with citizens now paying over $100 more per month on health care than the statewide median.  Consequently, too many Coloradans are buried in medical debt or one medical hardship away from financial disaster.

Together, we can do better.

Increasing Competition among Providers and Insurers

One of the critical driving forces behind the rising costs of health care is the absence of competition and transparency in that market.  One study found that communities served by hospitals with monopoly power over the market pay 15% more in hospital costs than those living in competitive environments.  

As Attorney General, I will enforce competition laws, using my experience as an Obama Administration antitrust official to make sure that health care providers and health care insurers compete on cost and quality for the benefit of all Coloradans.  I will do that by reviewing mergers carefully, combating predatory practices in the health care market, and addressing hidden fees.

We need our AG to review and investigate mergers of health care providers with great care.  Over the last several years, mergers in health care have changed the structure of the industry.  In some cases, mergers can provide valuable economies of scale, but in other cases, they increase costs or reduce quality of care by reducing the number of providers competing for patients.   

Under our antitrust laws, we depend on federal and state enforcers to ensure an adequate level of competition to protect consumers.  I worked on the Obama Administration’s initiative to improve our merger review standards, and, as Colorado’s next Attorney General, I will work to vigorously enforce our federal and state antitrust laws.

I will work hard to investigate and address anticompetitive practices in the health care sector. Consider how some insurers have forced providers to sign “most favored nation” agreements that prevent providers from giving better rates to other insurance companies.  When I worked at the Justice Department under President Obama, we investigated this practice and brought an enforcement action to address the anticompetitive harm to patients on account of Blue Cross Blue Shield’s use of such clauses.  (The Department of Justice also worked with the Michigan Attorney General on that case and the subsequent legislation that banned the practice in the state.)  Similarly, the use of exclusive contracting arrangements—where an insurance plan locks up an important hospital—can prevent new providers from entering the market to provide patients with better care at a cheaper price. At the Justice Department, I also worked on an important case that, along with Texas Attorney General’s office, challenged such a practice.

Finally, we need to protect consumers by addressing the hidden fees that are imposed on them.  In some cases, such fees are referred to as “facility fees,” and they are crammed into consumers’ bills without their knowledge or clear disclosure when the patient is receiving care.  One recent study on Colorado’s health care costs concluded that facility fees are one of the key cost drivers in Colorado’s health care market.  Such fees, as one important case concluded, can constitute fraud and be illegal.  

Similarly, emergency rooms sometimes impose exorbitant fees, taking advantage of consumers who are inherently vulnerable and unaware that they can be charged additional “facility fees” of hundreds or even thousands of dollars on top of the cost of treatment for their urgent medical needs.  In some cases, consumers might not be aware that they are being treated in a “pop-up” emergency room (as opposed to an acute care center), and that such fees wouldn’t arise had they visited a conventional urgent care facility.  Indeed, 70% of the people who are treated at free-standing ERs could be treated at urgent care centers and the cost of procedures at such facilities are up to ten times what they cost at urgent care centers.  

To add insult on top of injury, emergency room facility feesrose 89 percent between 2009 and 2015 — rising twice as fast as the price of outpatient health care, and four times as fast as overall health care spending.”  As Attorney General, I will advocate for consumers, work to make such fees transparent (as required by Colorado law), and address any cases where consumers are unfairly charged such fees.

Encouraging Innovation in Health Care

Over time, one of the important strategies for lowering the cost of health care and increasing access will be to encourage innovation in this sector.  For starters, we need to enable tele-medicine solutions by ensuring that all hospitals have access to top-flight reliable broadband. When I visited Craig, Colorado, I learned that the hospital there lacks access to reliable broadband, instead depending on a single fiber line that often gets cut.  That vulnerability undermines progress, and endangers lives.  We need to do better.  And we also need to ensure that all Coloradans have reliable broadband connections so they can benefit from tele-medicine and remote monitoring opportunities, which both increases access to health care and lowers costs.  Here’s my plan for bringing broadband to all Coloradans.

Second, we need to evaluate opportunities to encourage accountable care organizations and other experiments designed to improve health care outcomes—rather than merely paying for health care services, which can incentivize hospitals to provide too many complex and expensive services without regard to their patients’ actual health care needs.  We should also use innovative programs to address the shortage of family medicine doctors, and the lack of good options in many corners of our state.  One promising program worthy of support is the CU School of Medicine’s rural program, which encourages Colorado doctors to practice in rural areas that are frequently underserved.

Colorado is uniquely well-positioned to drive such health care innovation, as we have a thriving health care ecosystem and the potential to be a nation-wide leader.  I have worked, as the Founder of the Silicon Flatirons Center, to develop this ecosystem and would continue to do so as Attorney General (see, for example, this conference and this report).

Third, we need to liberate health care information—while also safeguarding its privacy—so patients can better manage their own care.  The federal Health Information Portability and Accountability Act, or HIPAA, gives patients the right to access their own health care information. But in practice, patients rarely have meaningful access to their electronic health records, which means health care intermediaries are not to help patients better manage their care.  

If patients can get access to their own health care information, this will enable improved health care analytics and open up new lines of innovation that could enable cheaper, more effective, and more accessible health care, and all without providing third parties any access to such information except with the clear consent of the patient.  As Attorney General, I would work to enforce the right of Coloradans to access their information, drive the development and deployment of appropriate standards, and oversee the use of such information by health care intermediaries, thereby facilitating important health care innovation.

Finally, we need to develop innovative policy solutions, like a reinsurance program that would address the high costs of rural health care.  One study suggests that an appropriate reinsurance program would reduce premiums by 20% in the individual insurance market.  The essence of this proposal is that, under the Affordable Care Act, states can take steps that would reduce federal spending (in this case, tax credits that support health insurance) and, through a waiver process, receive federal support on account of such savings.  

Another set of innovative solutions includes considering a “public option” model where Coloradans can buy into Medicaid or a co-op plan that would allow small businesses to band together.  As Attorney General, I would work with the Legislature and the Governor to consider, develop, and implement appropriate solutions (including public-private partnership models) that would bring needed relief to the many Coloradans—particularly in the 14 Colorado counties with only one provider on the health care insurance exchange—who are suffering under the weight of rising health insurance costs.

Challenging Health Care Fraud

A final opportunity to lower health care prices is to address the level of health care fraud in Colorado.  The Attorney General’s office is charged with bringing cases to address health care fraud. And the AG can also work with others in the state to help improve our oversight process.  Unfortunately, Colorado has fared poorly on this front, with only 3 of 28 states in a recent audit performing worse than we did on Medicaid waste.  As the Denver Post put it in a recent editorial:  “Colorado’s $10 billion Medicaid program is throwing away money and not doing a good enough job trying to get it back.”  As Attorney General, I will work hard to turn this record around and prosecute those entities than commit health care fraud and take away money that should be spent helping out those in need.

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With the passage of the Affordable Care Act in 2010, the United States made important strides in creating a just and equitable health care system. But we still have a long way to go, and efforts to set back the law’s protections are taking us further back.  The high cost and lack of access to quality and reliable health care is a serious threat to Coloradans.  By fighting for competition and innovation, and challenging fraud, I will work tirelessly to protect our citizens and provide them with the health care they deserve.