Consumer Assistance Program Drives Policy Advocacy
Colorado has made tremendous gains in insurance coverage in recent years, but consumers often run into barriers and challenges using their insurance once they have it. This can include issues with out of pocket costs, claims denials, surprise out-of-network billing, and more. For older adults, post-enrollment issues are especially common. Because of high utilization of health care services, adults over 50 often face issues with access and affordability, and subsequently are at risk of financial insecurity.
The intersection of health care access and financial security is central to the work of the Colorado Consumer Health Initiative (CCHI). We are a statewide, non-partisan, non-profit membership organization that works towards equitable access to high-quality, affordable health care for all Coloradans. In 2018, in response to pervasive issues in post-enrollment navigation, CCHI launched its Consumer Assistance Program (CAP). The program empowers Coloradans to navigate their health insurance challenges and improve their financial security by providing direct education and assistance with coverage, access, and billing issues. To date, we have worked with 497 consumers across almost 30 counties to save nearly $1.2 million in medical bills. Clients have a variety of insurance statuses, including private insurance, Medicare, Medicaid or CHP+, and uninsured. The majority of the issues that we work on with clients have to do with medical bills in collections, balance billing, and claims denials. We also assist with enrollment issues, service denials, hospital financial assistance and charity care issues, coverage terminations or coverage denials, charge disputes, and affordability issues – including premiums, out-of-pocket costs and other expenses.
Using a community-driven approach, our Consumer Assistance Program enables CCHI to advocate for public policies that strategically address the pre- and post-enrollment issues in health care that we are informed of through our direct connections with consumers. As a result, the knowledge gained by working with individuals through our Consumer Assistance Program informs our strategic engagement and public policy efforts to drive responsible, proactive policy-making aimed at solving issues consumers are facing first-hand.
In doing so, our model allows for the strategic elevation of the stories of Coloradans in health care policy discussions. This includes empowering and assisting Consumer Assistance Program participants in writing opinion pieces and blogs, testifying at the capitol, speaking out on social media, and sharing their stories with reporters. As a result, consumers directly advocate for legislation to address the health care barriers they’ve encountered, and gain experience that enables them to share their knowledge of this process with their communities.
This approach centers the consumer as the expert and leverages their lived experience to inform powerful policy-making that will have a tangible impact on access, affordability, and equity in health care. Although this past legislative session included myriad bills that addressed health care equity, access, and affordability, some of the key bills linked to our Consumer Assistance Program included legislation protecting consumers from surprise out-of-network balance billing (HB19-1174), addressing drug price transparency and affordability, especially in relation to insulin (HB19-1216, SB19-005, HB19-1296), hospital financial transparency (HB19-1001), exempting primary residences and wages from liens and garnishment for medical debt (HB19-1145, HB19-1089, HB19-1189), increasing affordability in health insurance through a state health coverage plan and a reinsurance program (HB19-1004, HB19-1168), strengthening protections for consumers around free-standing emergency rooms (HB19-1010), and advancing mental health parity (HB19-1269). Consumers from our CAP program were directly involved in advocating at the capitol, writing letters to the editor, submitting written testimony, and testifying in person on some of these bills. Many were passed and signed into law, and you can see our full legislative scorecard here to learn more. We are thrilled that consumers had a central voice in advocating for quality, affordable, accessible health care in Colorado this session, as leveraging consumer stories is integral in all of our public policy work.
We also work to influence insurance regulations that protect consumers and work towards more transparency, quality, and accountability for insurance plans in the state. Consumer stories from our Consumer Assistance Program are central in guiding this work to regulate the health insurance industry. In influencing regulation at the Division of Insurance, we can prevent pre- and post-enrollment issues from being so pervasive. This past year, regulatory advocacy directly related to our Consumer Assistance Program included protecting consumers from deceptive marketing of short-term plans (Regulation 4-2-59). Responsible regulation makes sure that Coloradans are informed, get access to quality coverage, and are able to use their insurance without fear for their financial security while getting the care they need.
Legislative and regulatory advocacy to strengthen our health care system in Colorado would not be possible without the community connection CCHI has to consumers through our Consumer Assistance Program. Furthermore, our program enables us to see the impacts of our advocacy work and continue to hold industry and government accountable to equitably providing the best quality, most affordable health care possible to all Coloradans.
We are so proud of the work we have done to protect consumers and further access to quality, affordable health care in Colorado this year. In November 2018, CCHI received the “Get Wise” Consumer Protection Award from the Colorado Department of Regulatory Agencies (DORA). The award recognizes the direct assistance CCHI is providing to consumers navigating health care services, hospital financial assistance, billing, and coverage issues and the advocacy work it does to pair this direct service with systemic policy change. We are grateful for this recognition of the hard work we are doing to champion the voices and rights of consumers across Colorado in our health care system, and look forward to continued strategic collaboration with consumers, community partners, coalition organizations, and public officials. This coming year, we hope to strengthen the work of our program by adding additional staff capacity and an earned revenue stream that will enable us to sustainably provide access to our services for as many Coloradans as possible.
Support our work today with a donation! To read testimonials from the Consumer Assistance program, click here. For more information on the Consumer Assistance Program and to get in touch with CCHI, visit our website here or call 303-839-1261.