Colorado Governor On Republican Health Care Bill: This Is Not An Improvement

NPR's Robert Siegel talks to Colorado Gov. John Hickenlooper about health care reform. Colorado expanded Medicaid under the Affordable Care Act and would either have to take on that funding burden or change eligibility requirements under the American Health Care Act.

ROBERT SIEGEL, HOST:

The signature achievement of President Barack Obama and the Democratic Party is in limbo. The House of Representatives passed a bill last week to repeal and replace most of the provisions of the Affordable Care Act. Senate Republicans say they will now draft a health care law of their own. And we're going to be hearing right now from a governor whose state has much riding in the balance. John Hickenlooper is the Democratic governor of Colorado. His state expanded Medicaid eligibility under the Affordable Care Act, or Obamacare. Welcome.

JOHN HICKENLOOPER: Thank you.

SIEGEL: You have urged the Senate to reject the House bill for what it would do to Medicaid enrollees and people with pre-existing conditions. On the other hand, Colorado's health co-op failed. Several counties in western Colorado have only one insurer selling health insurance. Premiums are going up. Would continuing the Affordable Care Act as is be that much better than what the Republicans have proposed?

HICKENLOOPER: Well, certainly, there were problems with Obamacare. And, you know, many of us, for years, have been saying we wanted to improve it. But this is certainly not, by any measure, an improvement for almost anyone. We don't see how it's going to lower premiums. It's going to shift costs massively to the state. For Colorado, it'll be at least - probably more than $1.5 billion. And it's not going to improve outcomes. I mean, the losers - poor people, older citizens, people with pre-existing conditions - are going to have a much harder time with things. And really, a big part of it - it's a massive tax cut - right? - for the richest people in America, who, at least in Colorado, aren't clamoring for this tax cut. They're not demanding the tax cut. Why is it such a rush to go through and - I mean, it's not even scored by the Congressional Budget Office yet.

SIEGEL: Let's say that what passed the House actually becomes law, which people don't expect. They expect it to be much changed once the Senate does it. But if it did, what would you do as governor? Would you raise state taxes to cover the Medicaid enrollees, who'd be dropped? Or would you cut other services? How do you - how would you respond to this law?

HICKENLOOPER: Well, it's hard to say because we don't know what kind of waivers we would have. Obviously, we'd have to make major adjustments in how we cover people, who gets covered, what that coverage looks like. Probably, in all likelihood, we would not be able to cover as many people as covered now, although we've kind of drawn a line in the sand and said that we are going to do everything we possibly can to make sure that we don't rollback coverage. I think that we'd be much better off getting a bunch of governors - Republicans and Democrats. You know, look at the Senate committee that's working on this. It's all Republicans. I'd like to see the people that actually implement this on a bipartisan level, say, all right, maybe we have to modify what Medicaid does cover, and we can't keep spending more money. Let's look at that but not go backwards and cut the number of people that are covered.

SIEGEL: I've seen a number for Colorado - that premiums in the individual market were expected to go up by about 20 percent in your state. And I think the number's 14 counties where there is there's no competition among insurers. Can you explain, why is there no competition? What is it about the system that's been created that doesn't bring in multiple insurers to, perhaps, drive the price down through competition?

HICKENLOOPER: Well, these are rural counties. Almost everyone but one are very rural counties. It's interesting. They're the ones that voted most strongly for the president. But they now have the most to lose. When you actually look at a map of Colorado and the United States, you see the greater - greatest concentrations of Medicaid recipients on a percentage basis are in most parts of rural America. So the reasons that they don't have multiple insurance companies offering coverage is there are so few hospitals, so few clinics that are available - and this is not new. This is something - they've been paying disproportionately higher insurance premiums for decades.

SIEGEL: Health care in America is a multidimensional problem. I mean, our costs as a nation are very high compared to those of other countries. In part, that also means that health care is a profitable sector of the economy, and lots of people work in health care. And it would appear that however the care that people expect is paid for - whether it's out of taxes or premiums - it's more than people want to pay given what they expect. What's a sustainable, long-term solution to that very complicated problem?

HICKENLOOPER: Well, I think we have to get everybody together, and everybody's got to give a little. I mean, you're right. Our - as a percentage of our GDP, it's almost - it'll be, this year, 18 percent of our GDP. Most other industrialized countries, it's 11 or 10 or even 9 percent, and they live longer. They have better outcomes than we do. You look at it - we have right now, our hospitals, our doctors, the pharmaceutical industry and the insurance industry, and they have unfettered freedom to - I mean, no one's really reining them in terms of, let's be transparent. How do we measure the real outcomes and rank one against another? They all fight this intensely, but I think that's the direction we've got to go, is more towards transparency.

SIEGEL: Transparency meaning also regulation, more powerful bodies that can tell companies what they should be doing?

HICKENLOOPER: I don't think that's - I mean, obviously, at some point, we need additional regulation, if you're talking about transparency, just to make sure it's done properly and that we protect people's privacy. But by transparency, I mean, if you're going to one clinic versus another or a hospital to get a, you know, some sutures for - you cut your arm playing baseball - or your child did (laughter). But anyway, the - you end up - you want to be able to measure what those different procedures - if you get a tonsillectomy, one place versus another. Who doesn't have high readmission rates for infection? You know, who's doing the job at a high quality? And then, what are they paying? Right now, ask anyone. Nobody knows what the real cost of any procedure is. It's hard to imagine getting our arms around inflationary tendencies without getting that.

SIEGEL: Last year in the Democratic Party, young voters, certainly, really took a liking to what Senator Bernie Sanders had to say about health care, which was single-payer, Medicare for all. Is there any possibility of such a program in your view?

HICKENLOOPER: Well, I think we're going to lean - move that way. In other words, expanding Medicaid, which we've already done in most states - not all - that is a step in that direction. I'm not sure how far - whether we'll actually get all the way there in the near term. But long term, I think we are going to get towards - slowly but consistently move towards - universal coverage. I'm not sure we're going to get to just single-payer, but I think we'll get to universal coverage sooner than later.

SIEGEL: Governor John Hickenlooper, Democrat of Colorado, thanks so much for talking with us today.

HICKENLOOPER: It's been my pleasure. Thanks so much.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.