ENGLEWOOD — Every Colorado resident would be required to have health insurance, but the state wouldn't force employers to provide it under a plan unveiled by a blue ribbon commission Thursday.

The proposal incorporates parts of four other approaches and most closely reflects the goals of the members of the Blue Ribbon Commission on Health Care Reform and some of the lawmakers who formed it.

About a half-million Coloradans who now can't afford health insurance would get it virtually for free, and another 250,000 who now choose not to have insurance would have to pay a few thousand dollars a year for it.

"I'm not crazy about any mandate," commission member Arnold Salazar said. "But when I saw what a difference an individual mandate would make in bringing down costs and maintaining quality, I'm now in favor of it."

The upper-middle class and the wealthy would pay somewhat more than they do now to subsidize the less well off, but Colorado's private insurance market would stay basically intact.

Insurers would have to offer a standard plan that includes free preventive care and couldn't refuse coverage to people who have chronic diseases or are at high risk of illness.

The proposal recognizes that hundreds of thousands of Coloradans couldn't or wouldn't pay for such a plan, because it would gobble up too much of their take-home pay.

The state, with help from the feds, would pay the premiums for people earning less than about $25,000 a year, or for families of three with annual incomes under $43,000.

Partial subsidies on a sliding scale would go to singles who earn up to $41,000 or families of three with earnings up to $68,000.

Employers could continue to provide coverage as a way to attract and keep workers. If workers qualify for a government subsidy because of their low income, they would have to use that money to buy their employer's plan. But if the employer's plan is more expensive than the standard plan offered by the state, the worker could opt for the cheaper one.

The proposal is far from its final form and would be just one of five plans the commission will present to the legislature at the end of the year.

State lawmakers then will tweak the plans and decide on their favorite. If the final plan requires a tax increase, and it likely will, the issue will go before the voters, probably in November 2008.

State Rep. Anne McGihon, D-Denver, who introduced the bill creating the commission, said mandating that individuals have insurance might be necessary if the state is to take on a greater regulatory role.

But she noted that nothing is set in stone.

"Everybody in the state wants comprehensive health care reform, but they all have different ideas," she said. "This gives us the opportunity to talk about what it would cost and what it might look like.

"It's time to give the general public a good look at what's been proposed and let them offer their opinions of the various plans."

Legislators and Gov. Bill Ritter appointed the commission that is charged with finding a way to get more Coloradans insured and do something about skyrocketing costs.

The commission picked four proposals from 32 presented by a variety of coalitions around the state.

One is a single-payer plan that, on its face, is the only choice that would save money overall. Total health care spending in Colorado would fall from $30 billion a year to about $28 billion.

But the single-payer plan would have to overcome major resistance because it is so different from how health care is delivered today.

Employers would get out of the health care business, in return for paying a 6 percent payroll tax. Individuals would be covered for free, and with virtually no co-pays, but would see their state income tax rate grow from 4.6 percent to 12.7 percent. That would mean an extra $4,000 in taxes for someone earning about $58,000 a year.

Supporters of single-payer say it all comes out in the wash — that same person would save $4,000 in premiums and out-of-pocket costs for the family.

But people who already get health insurance at work would end up paying a few thousand dollars more in taxes than they get back in government health care. And the wealthy would pay a lot more.

Commission members like some of the ideas in plans developed by a union representing health care professionals and the people who find health plans for companies and individuals. But the low annual benefit — $25,000 or $50,000 maximum — raised concerns that the caps would be exceeded by anyone with, say, cancer treatments or more than a brief hospital stay.

Commission staff member Sarah Schulte said the fifth proposal would save money by putting all Coloradans on electronic health records, streamlining claim forms and creating standard plan ID cards.

She said every Coloradan, including those currently uninsured, would have their own doctor.

The plan would emphasize alternatives to hospital stays, including home and hospice care. It would also eliminate co-pays for prevention services such as cancer screens.

scanlon@RockyMountainNews.com or 303-442-8729

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