We’re losing a unique and promising health care resource in our state. Colorado HealthOP, the state’s consumer-directed, nonprofit health cooperative, will not be offering health insurance policies in 2016. It was shut down by the state’s insurance division due to concerns about its ability to pay claims for a needier-than-expected group of enrollees.
The company was formed under a provision of the Affordable Care Act. By design, co-ops were encouraged to promote competition in monopolistic markets, innovation in payments to providers and develop prevention and wellness programs for the large newly insured population. The co-op program was designed to take advantage of three-year financial protections, including long-term loans and direct payments intended to protect all insurers from losses attributable to pent-up demand in the first years of the ACA. Colorado HealthOP was undone by congressional cuts to these financial supports.
What was Colorado HealthOP all about? The company was founded by the Rocky Mountain Farmers Union, a rural-focused organization whose members had, for years, suffered from a dwindling number of health insurance options. Colorado’s relatively small rural population wasn’t sufficient to support an insurance program alone, so the concept was expanded to cover the entire state. A steering board was formed, including some of Colorado’s most distinguished figures in public health, insurance regulation and health care finance and delivery. The commitment was clear — unlike most insurers, Colorado HealthOP would put rural folks at its forefront, not an afterthought.
People flocked to the new plan. Colorado HealthOP enrolled 14,000 individuals in 2014 and more than 80,000 in 2015. It was the only plan to offer polices in every one of Colorado’s 64 counties. These people became the co-op’s “members.” Many were attracted to lower prices, but it quickly became apparent that there was something bigger going on. Many enrollees had been uninsured for years, and Colorado HealthOP tapped into a consumer groundswell.
For decades, for-profit insurers had done little to earn consumer loyalty. They reaped gains by carefully deciding who to cover and who to avoid due to medical history, and by designing labyrinthine administrative procedures to avoid paying for care. Colorado HealthOP’s members wanted be part of something, to have a voice.
Colorado HealthOP’s workplace had the exuberance — and the stress — of a burgeoning tech startup. People worked hard, convinced they were making a positive change. There were no bloated salaries or stock options. When the big claims started coming in, nervous concern was consciously replaced by joyous re-commitment. This is why we’re here. Our members have needs, and we’re the agency that connects them to services. Colorado HealthOP’s plans contained concrete, financial incentives for prevention and wellness. Customer service staff were trained to stay with members until problems were resolved. Health care “navigators” were employed to assist members to find low-cost treatment options, especially important when so many people chose “high deductible” health plans. Colorado HealthOP supported mental health services like no other carrier. And it was an agent for change — for example, Colorado HealthOP was the first insurer to very publicly offer specific coverage for services to transgendered people. Thereafter, other carriers quietly followed suit.
Lest I give the wrong impression, Colorado HealthOP had its struggles, too. As a new company with explosive growth, the company dealt with immature information systems and operational challenges. Some hospital systems and doctors were reluctant to offer discounts to a small fledgling company. Because of the politicized environment of the ACA, Colorado HealthOP was consistently scrutinized and audited by multiple federal and state entities.
But it was striking how members cared about the organization to which they belonged. When news broke about the latest federal cut and impending closure, members staged a writing campaign. They went to rallies to support what — their insurance company? It’s this legacy that provides continuity and hope. Colorado HealthOP will close, but the co-op members’ passion will endure. There is more to come.
Dan Tuteur is a former chief strategy officer for Colorado HealthOP.
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