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Chicken Little and the Health Care Exchange - Health Care Editorial

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Dear Health Care Leader,

For the last six months, all eyes have been on Connect for Health Colorado (C4HCO). The state’s health insurance exchange has had all of its technological challenges, outrage over premiums in mountain towns and its enrollments scrutinized since the site launched on Oct. 1. The examination has been relentless and perhaps not always fair. To a degree, the pundits, partisan lawmakers, skeptics and critics have behaved in a manner that isn’t so different from the story of Chicken Little. In case you’re unfamiliar, it’s the story of a chicken who, in the woods one day, decides the sky is falling after an acorn drops on his head. As a result of his hysteria, he whips all the other birds into a panic, believing disaster is imminent and the world is going to end.

I think we saw a bit of that frenzy here in Colorado when C4HCO’s website experienced glitches that prevented customers from opening accounts during the first week. Doubts continued to fester as enrollment reports were released. During the first month of operation, C4HCO only enrolled 3,100 Coloradans in private coverage. The numbers appeared dismal, but as I wrote in my weekly letter last November, the real test of the exchange was going to be in the months to come, not the first three and a half weeks.

We now have a much better picture of C4HCO’s achievements. It’s not a complete picture. We won’t know the final enrollment tally until later this month, but we do know the preliminary numbers indicate more than 118,000 Coloradans enrolled in subsidized private coverage through the exchange and more than 158,000 enrolled in Medicaid under the expansion. Added together, more than 277,000 Coloradans obtained health coverage as a result of the Affordable Care Act (ACA).

It’s too soon to say how many of these Coloradans were previously insured, or how many will ultimately pay the
premiums to keep their coverage in effect. Let’s assume all of the enrollments are newly insured. Based on state
projections that Colorado has approximately 770,000 uninsured residents, this means nearly 500,000 Coloradans
will still be without coverage. This means the role of hospitals as key safety-net providers of health care will be as
important as ever. As a hospital community we must return to the message and our strategic imperative of
coverage as the means to the end. The “end” is access to affordable care; the “end” is reducing the number of
uninsured and uncompensated care. Putting partisan politics aside, our commitment must be to maximize
enrollment since the financial health of hospitals depends on it.

CHA’s expectations for the exchange have always been balanced and realistic. In the end, C4HCO came up short of
its target of 136,000 enrollments, but it did exceed its worst-case scenario. We have a distance to travel before
declaring success, but Colorado has made a good start. And, while far from perfect, hospitals have every reason to
want C4HCO and Medicaid expansion to succeed.

There are a couple of endings to the story of Chicken Little. Depending on which version you read, he either
narrowly escapes harm or an unscrupulous fox lures Chicken Little and his friends back to his den. If we tie this story
back to C4HCO’s first enrollment period, I say we choose the happy ending. The skies may not be clear, but we
know they aren’t falling.