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Transparency and Information for Colorado Patients

Partner Institute: 
Department of Behavioral Science and Health Education, Rollins School of Public Health, Emory University
Survey no: 
Elena Conis
Health Policy Issues: 
Quality Improvement, Access, Remuneration / Payment
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no yes no no no


A series of bills signed into law in Colorado last spring focused on improving consumer access to health care information. The complete set of bills was introduced to enact state-level reforms to improve access to care in advance of federal reform. A subset of these bills, which is the focus of this report, focused on making health care information more transparent, requiring health plan information be made accessible to all Coloradans, and the simplification of insurance forms.

Purpose of health policy or idea

In February 2009, Governor Bill Ritter and state lawmakers introduced an executive order and ten bills drafted to address three broad health care concerns, as outlined in a press release issued by the Governor's office: "cost-savings, efficiency and accountability; access to public and private systems; and women's health care."

Four of the bills and the executive order focused on improving health care systems, namely by facilitating enrollment in health plans and by creating standardized, legible, and easily understood health plan information for both patients and health care professionals. The Governor's executive order promotes electronic data sharing--specifically, citizenship information--across state agencies in order to facilitate the enrollment of low-income Coloradans in Medicaid, Children's Basic Health Plan, Child Health Plan Plus (CHP+), and other state supported public assistance programs.

The four bills took a slightly different approach to improving access to care; these largely targeted materials produced by insurers and insurer practices. House Bill 10-1166 eliminates "confusing language and jargon" from insurance policies, making such policies easier for consumers to read and understand. Specifically, the bill requires written materials to meet a minimum font size and be written at a tenth-grade reading level or below. House Bill 10-1242 requires insurers to provide consumers with a single, standardized application form, saving consumers time and confusion, and enabling them to easily make cost comparisons across the insurance market. House Bill 10-1004, closely related to the previous bill, requires insurers to provide consumers with standardized policy forms, with clearly written explanations of benefits. Finally, House Bill 10-1332 standardizes insurance billing codes across all insurers, a move that was conceived as a time and cost-saving measure for health care providers. All four house bills were signed into law between April and May of this year and will begin to go into effect in 2011.   

The remainder of the bills in the package proposed to ban gender discrepancies in the health insurance market; improve mammography benefits; adjust loan prepayment programs for health professionals; increase Medicaid efficiency; and investigate the creation of an all-payer database.

Main points

Main objectives

The main objectives of the overall package of bills is to promote cost savings by increasing efficiency in state health care systems and improve consumer access to care by making health care information (and select services) more accessible.

Type of incentives

By simplifying the application process for consumers looking to enroll in a health plan-whether public or private-the new laws provide consumers with (an albeit weak) incentive to apply for and obtain health coverage.

Groups affected

Consumers, Insurers, Providers

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Characteristics of this policy

Degree of Innovation traditional rather traditional innovative
Degree of Controversy consensual rather consensual highly controversial
Structural or Systemic Impact marginal marginal fundamental
Public Visibility very low high very high
Transferability strongly system-dependent rather system-neutral system-neutral

This particular set of laws was fairly uncontroversial and were easily passed by the Democrat-ruled legislature.Their impact will be readily felt by consumers who shop for plans or examine their benefits or policies - that is, nearly every consumer in a health plan in coming years.

Political and economic background

Since taking office in 2007, Governor Ritter, a democrat, has repeatedly emphasized that his office would take steps to drive down health care costs and improve the quality of care in Colorado - without waiting for the passage of health reform legislation in Washington. When federal health reform was passed earlier this year, Ritter argued that his state-level reforms had uniquely positioned Colorado to take advantage of national reforms.  

"Colorado has never waited for Washington on healthcare reform, and we aren't about to start waiting now," Ritter said in a statement last April. "Because of our efforts the past few years, Colorado is better positioned than most states to make the most of national reform. National reform allows us to accelerate and build on our work to provide higher quality care at lower costs to more Coloradans."

In April, the same month that Ritter began signing this package of bills into law, he also signed an executive order creating the Interagency Health Reform Implementing Board and appointed health policy analyst Lorez Meinhold director of state implementation of federal reforms. The move angered republican lawmakers, who argued that any changes related to federal reform should go through the legislative process. That same month, 11,000 citizens sent their signatures to Republican Attorney General John Suthers in support of his participation in a national lawsuit challenging the constitutionality of federal health reform.

Ritter's support for federal health reform and his push for related state level reforms have thus pitted him in an ideological battle with state Republicans. But while lawmakers and citizens have expressed skepticism toward federal health reform, there was no organized or vocal opposition to the transparency measures Ritter signed into law. Indeed, the popular focus on federal health reform may have caused this set of local reforms - none of which were inherently controversial - to evade scrutiny or attack.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no yes no no no

Origins of health policy idea

Governor Bill Ritter has made health care a top priority - and, according to his office, a top area of accomplishment-under his tenure. In 2009, he signed the Colorado Healthcare Affordability Act into law; the Act implemented a hospital provider fee to expand Medicaid and Children Health Plan Plus eligibility in an effort to provide coverage to an additional 100,000 state residents. That same year, Governor Ritter and state lawmakers introduced the executive order and bills described above as part of his office's broad objectives of reducing costs and improving access to care.

The bills promoting transparency and legibility in the insurance market are designed to increase competition, according to HB-1242 sponsor Dennis Apuan; ultimately, the bill sponsors hope these measures will play a role in driving down costs and improving consumer access to coverage.

The Governor's Executive Order, in particular, came in response to findings from several national studies that the citizenship documentation requirements enacted with the 2005 federal Deficit Reduction Act (DRA) made it more difficult for families and children to enroll in public assistance programs. As a result, the studies found, the total number of uninsured across the nation has increased in the past five years. Applicants must, for example, produce birth certificates, which can be both costly and administratively difficult for individuals to obtain. Because 78% of children and 43% of adults eligible for public assistance were born in Colorado, enabling state agencies to share information is expected to facilitate the verification of identity and citizenship status for a large fraction of applicants to state programs. By streamlining this process, the order aims to increase health coverage among low-income groups and thereby reduce uncompensated care.   

The governor's executive order is a direct response to a provision of the DRA which permits "cross-matching" across state agencies to verify identity and citizenship. The laws targeting the language of insurance documents and policies are also not unique; many states have similar laws, although Colorado's is now one of the top four or five most consumer-friendly in the nation.

Initiators of idea/main actors

  • Government

Approach of idea

The approach of the idea is described as:
renewed: See "Origins of Health Policy Idea," above.

Stakeholder positions

The bills have been supported by proponents of both health reform and consumer advocates. In recent years, the Colorado Department of Insurance had reported a high volume of complaints from consumers who were unable to understand various insurance policies; Rep. Kefalas's bill (HB 10-1166) was proposed as a solution to the number of consumer complaints. (The bill applies to health, dental, and auto insurance policies.) Insurers will need to cover the cost of rewriting application forms and policies to conform to the new set of laws, but little objection was raised on this front.

Actors and positions

Description of actors and their positions
Gov. Bill Rittervery supportivevery supportive strongly opposed
Rep. John Kefalasvery supportivevery supportive strongly opposed
Rep. Dennis Apuanvery supportivevery supportive strongly opposed
Rep. Jim Riesbergvery supportivevery supportive strongly opposed
Sen. Betty Boydvery supportivevery supportive strongly opposed

Influences in policy making and legislation

As described above, Ritter has been strongly influential in making health reforms a top priority of his tenure as governor and has benefitted in this effort from the support of ruling Democrats in the legislature.

Legislative outcome


Actors and influence

Description of actors and their influence

Gov. Bill Rittervery strongvery strong none
Rep. John Kefalasvery strongstrong none
Rep. Dennis Apuanvery strongstrong none
Rep. Jim Riesbergvery strongstrong none
Sen. Betty Boydvery strongstrong none
Rep. John Kefalas, Rep. Dennis Apuan, Rep. Jim Riesberg, Sen. Betty BoydGov. Bill Ritter

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The new laws will begin to go into effect in less than a year. HB 10-1166, HB-1004, and HB-1242, affecting the reading level and font size of insurance policies and the standardization of policy forms and health plan applications, respectively, will go into effect in January 2012. By the end of November 2012, a specially appointed task force organized by the Department of Health Care Policy and Financing will have issued initial recommendations on the standardization of insurance industry billing codes.

Expected outcome

The bills did not receive much publicity or press coverage last spring, and will likely be implemented as written. Their passage was overshadowed by legislation also signed by Ritter in May ensuring coverage of contraception and pregnancy; establishing a council to make recommendations on expanded access to healthy foods; and promoting rehabilitation programs for prisoners.

The laws will likely reduce consumer complaints regarding illegible, difficult-to-understand policies and forms to the state's Department of Insurance. But their impact on coverage rates and health plan premiums will likely be difficult to discern, particularly as they will be implemented amidst a host of reforms.

Impact of this policy

Quality of Health Care Services marginal rather marginal fundamental
Level of Equity system less equitable four system more equitable
Cost Efficiency very low neutral very high

Because the presently described laws could increase enrollment in public plans, they may have the effect of making the health care system more equitable - but again, these changes will be difficult to separate from changes occuring as a result of the overall reforms instituted by Ritter's administration in recent years. 

Additionally, alhough consumers and health plan enrollees will undoubtedly benefit from this set of laws, their overall impact on the quality of health care and health plans may be small.


Sources of Information

Office of Governor Bill Ritter. Press Releases, February 2009 - May 2010.

Nancarrow, David. Governor Ritter Signs Health care Bills. KKTV, April 20, 2010.

Sealover, Ed. "Ritter signs several health measures, including contraception-coverage rule." Denver Business Journal, May 26, 2010.

Author/s and/or contributors to this survey

Elena Conis

Suggested citation for this online article

Elena Conis. "Transparency and Information for Colorado Patients". Health Policy Monitor, October 2010. Available at