1. ColoradoCare Covers Everyone Saves Billions Designed in Colorado for Coloradans www.ColoradoCareYes.co 1 Senator Jeanne Nicholson nicholsonjeanne@gmail.com

2. What is wrong with our current health care payment system? Introduction 2

3. Number Uninsured/Underinsured 3 350,000 Coloradans are without insurance in 2015 Colorado Health Institute 2015 Survey

4. We are paying higher health insurance premiums than we need to 4

5. 2016 Colorado Projected* Health Care Spending Total Colorado Health Care Spending $50.5 Billion Administrative Costs $15.6 Billion (31%) * 5 *Projected under ACA, using current payment system

6. US Wastes $750B Institute of Medicine 2012 $2.8 Trillion is Spent Annually Inefficient Care & Errors Excessive Prices 6

7. Health Care Waste 7 $ 750 Billion Wasted Annually More than the entire Federal K-12 Education Budget U.S. Department of Education

8. Excessive Administrative Costs Source: Bureau of Labor Statistics; NCHS; Himmelstein/Woolhandler analysis of CPS Growth 3000% 2500% 2000% 1500% 1000% 500% 0 19701980199020002010 8 Administrators Physicians

9. US Health Care Paradox If banking worked liked health care ATM transactions would take days. If home building were like health care, carpenters, electricians, and plumbers would work from different blueprints. If shopping were like health care, prices would not be posted and could vary widely within the same store depending on who was paying. 9 The Institute of Medicine, 2010

10. Source: Kaiser Family Foundation (http://www.kff.org) analysis. *Produced by: Larry Levitt, MPP, Anne Jankiewicz, and David Rousseau, MPH Health Coverage with Affordable Care Act 10

11. Health Coverage with ColoradoCare Get a Smart Card and Choose a Provider Are you a Colorado Resident? 11

12. Insurance with High Deductibles has Increased 3% of Insured in 2003 11% of Insured in 2014 12

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16. Boulder Information 16 Colorado Health Institute 2015 Survey jdh.hamkins.org In Boulder there were 5.2%, 20,424 people underinsured in 2015  Boulder County would Save $6.5 M annually  City of Boulder would Save $6.4 M annually

17. Hinsdale County Information 17 www.rootsweb.ancestry.com Hinsdale County would Save $176.657 annually listosaur.com

18. Gunnison County Information 18 http://www.gunnisoncounty.org/ Gunnison County would Save $9.5 Million annually //www.imfromdenver.com

19. Gilpin County Information 19 www.waymarking.com Gilpin County would Save $1.3 Million annually www.landsofcolorado.com

20. Clear Creek County 20 johncarmichaels.typepad.com Clear Creek County would Save $1.1 Million annually www.halslamppost.com

21. US Health Care Paradox “Health Care in America presents a fundamental paradox. The past 50 years have seen an explosion in biomedical knowledge, dramatic innovation in therapies and surgical procedures and management of conditions that previously were fatal yet American health care is falling short on basic dimensions of quality, outcome, cost, and equity.” 21 The Institute of Medicine, 2010

22. ColoradoCare:  Covers every Coloradan  Decreases costs by $4.5B  Increases coverage  System designed in Colorado by Coloradans The Solution 22

23. ColoradoCare Key Feature 23 Full Choice of Primary Care Provider Not from a narrow network

24. What about our Health Care Providers?  Providers would remain in private practices to ensure choice and quality care.  Providers would be well paid to assure good providers remain in Colorado in sufficient numbers to avoid long waiting times 24

25. Comprehensive Benefits, a Platinum Plus Plan  Primary and specialty care  Hospitalization  Prescription drugs  Medical equipment  Mental health & substance use services  Emergency & urgent care  Preventive & wellness service  Chronic disease management  Rehabilitative services & devices  Pediatric care including oral, vision, & hearing services  Laboratory services  Maternity & newborn care  Palliative & end-of- life care  Some adult oral health benefits 25

26. Benefit Terms  No Deductibles  No Co-pays on Preventive Care  Modest Co-payments for other services (with hardship waivers available to insure access to proper care)  Children are covered regardless of age (even over age 26) as long as they are Colorado residents  Beneficiaries temporarily living or traveling in another state are covered for routine and urgent care. 26

27. What It Costs Employers will pay 6.67% of payroll Employees pay 3.33% of their income 27 In place of current health care premiums and deductible costs

28. On $50,000 Income $278 Your employer pays $278 monthly $139 You pay $139 monthly On $100,000 Income * $556 Your employer pays $556 monthly $278 You pay $278 monthly 28 For Example: *Capped at $350,000 filing individually, $450,000 filing jointly

29. Non-payroll and Self Employed Income 29 10% Pay less than10% of Personal income* *This is a state tax which is a deductible expense on federal and state taxes with an effective impact of 5.577% to 8.537% depending on your tax bracket.

30. Retired Coloradans Medicare continues with ColoradoCare as a Supplement  Individual income filers - Social Security Income and retirement income is exempt up to $33,000  Joint income tax filer- Social Security Income and retirement income is exempt up to $60,000  Other income (non-retirement) subject to a premium tax of ≤10% 30

31. For Example 31 Couple with $100K annual Social Security & Retirement Income  Will pay about $3,080 ColoradoCare annual premium versus  Current Medigap Plan with Rx $4,800

32. More Details 32  The Premium tax can only increase by a state wide vote  ColoradoCare will be exempt from TABOR  Cost for the injury portion of car insurance will be reduced  ColoradoCare will cover the medical portion of Workers Compensation, reducing this cost for businesses by an estimated 59%

33. ColoradoCare Governance 33  Interim 3 year appointed 15-member Board of Trustees  21-member non-partisan elected Board of Trustees will oversee ColoradoCare (3 from each of seven districts)  Coloradans are the shareholders

34. 34 Cooperatives: A proven Business Model

35. The Truth, the Whole Truth, and Nothing But the Truth 35 Opponents will say:  "The truth“- Colorado Care will raise taxes $25 B  But they won't say "The whole truth":  Colorado spends > $ 50 billion on health care  Colorado Care will reduce combined premium and out-of-pocket expenses by $4.5B  You won’t have to buy insurance or pay deductibles  Every resident in our state will have excellent coverage!

36. The Truth, the Whole Truth, and Nothing But the Truth 36 "The Truth"  Opponents will say Colorado Care will cause significant job loss in the health insurance industry (administrative jobs!)  But they won't say there will be job churn but overall there will be a net increase in Colorado jobs and an improvement in Colorado's economy

37. The Truth, the Whole Truth, and Nothing But the Truth 37 And nothing but the truth:  Opponents will say you will not receive good care but Colorado Care will provide Platinum Plus care, better than we have now  But they won’t say that health care decisions will be made between you and your provider – no middle man involved!

38.  Be a Colorado resident-owned system  Cover every Colorado resident  Ensure comprehensive, high quality, platinum plus, accessible and affordable life time health care  Collect premiums from Coloradans based on income  Cost significantly less than our current system ColoradoCare would: 38 Summary

39. Next Steps ColoradoCare Ballot Initiative #20  Collect 98,492 valid signatures by Oct 2015  Educate Coloradans about Initiative #20  Pass Initiative #20 in November 2016 39

40. Next Steps Once the initiative is passed, our legislature would enact legislation in 2017 for ColoradoCare to:  Obtain an Affordable Care Act 1332 Waiver to implement An affordable state-based plan that provides a health care payment system for all Colorado residents  Implement ColoradoCare Initiative #20 by January 2019 40

41. Next Steps Implementation of ColoradoCare involves:  Repurposing the Health Benefits Exchange  Managing Colorado Medicaid  Managing the medical portion of Workman’s Compensation  Collecting federal Patient Protection and Affordable Care Act monies 41

42. How you can support ColoradoCare: 42  Learn more by going to our website: ColoradoCareYes.co  Register to vote if you are not registered  Sign a petition  Circulate a petition  Educate your family and friends about ColoradoCareYES  Contribute to ColoradoCareYES AND  Vote for ColoradoCareYES in November of 2016

43. 43 Thank you for coming

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