Our impact in Colorado

News and perspectives on health care policy in Colorado

Our impact in Colorado

News and perspectives on health care policy in Colorado

Kaiser Permanente has served the residents of Colorado for more than 50 years. We are proud to be the largest nonprofit health plan and integrated health care organization in the state, serving members through medical offices and a network of affiliated hospitals.

Kaiser Permanente of Colorado’s doctors and employees are focused on making the lives of our members and communities healthier — from the populous Denver/Boulder area, north to Fort Collins, south to Colorado Springs and Pueblo, and out west along I-70.

Our history — and our future — are deeply connected to organized labor, and more than 60% of our health care professionals are union members. In particular, our relationships with the Service Employees International Union and the United Food and Commercial Workers International Union have played important roles in our efforts to give more people access to high-quality care and make care more affordable.

We believe it is important to engage in policy debates relating to access, affordability, and quality in health care among lawmakers and regulators.

Key issues in Colorado

COVID-19 response: Kaiser Permanente continues to focus on expanding the availability of COVID-19 vaccines and safely providing testing, treatment, and care for patients. We also focused on urgent policy efforts to preserve care and coverage, while helping to fortify Colorado’s public health infrastructure. 

Market structure — self-funded versus fully insured health plans: Most Americans receive health care coverage through their employer. Employers generally choose between 2 methods of funding when they sponsor a health plan on behalf of their workforce: self-funded or fully insured.

Self-funded plans are an agreement in which the employer (or labor trust) directly takes on the financial risk of paying for their employees’ medical claims as they occur. With fully insured health plans, the employer purchases an insurance or coverage product through an insurer or coverage provider, such as Kaiser Permanente, and the health insurer or coverage provider takes on the risk for the cost of covered care. 

Self-funded   Fully insured
The employer does not pay premiums; instead, it pays fixed costs (administrative fees and stop-loss premiums) and variable costs (employee health care claims). Payments The employer pays monthly premiums to an insurance carrier or coverage provider.
The employer assumes the risk. Assumption of risk The health plan or insurance company assumes the risk.
The Employee Retirement Income Security Act of 1974 generally preempts state regulations and taxation.  Compliance payments The plan must comply with state regulations and taxation. 
The federal government regulates.  Regulatory authority The state and federal governments regulate.

Self-funded plans are generally not subject to state regulations and requirements. As the largest provider of fully insured plans in Colorado, Kaiser Permanente has a much higher proportion of plans subject to state regulatory authority and state taxes and fees compared to other carriers in the state.

Colorado Market and Kaiser Permanente's market share

Only fully insured plans are under state taxing authority. In Colorado, 25% of the market is fully insured, and Kaiser Permanente represents 32.8% of this market segment. 

The Colorado Market breakdown [Market size source: Decision Resources Group as of January 2020; includes Duals; data for Colorado (statewide)]: 30% Self-funded (administrative services only), 25% Fully insured (non-Medicaid, non-Medicare), 24% Medicaid, 8% Medicare Advantage and 13% Medicare supplemental  Kaiser Permanente is 32.8% of the 25% Fully insured members (non-Medicaid, non-Medicare).  Kaiser Permanente of Colorado Health Plan Membership (as of August 31, 2020; excludes dues subsidy and child health): 3.8% Self-funded (administrative services only), 25% Fully insured (non-Medicaid, non-Medicare)71% Fully insured (non-Medicaid, non-Medicare), 6.5% Medicaid, 18.7% Medicare Advantage.

1. Market size source: Decision Resources Group as of January 2020; includes Duals; data for Colorado (statewide)
2. Membership as of August 31, 2020; excludes dues subsidy and child health
3. Administrative services only

Guaranty association reform: Insurance guaranty associations are state-sanctioned organizations of insurers intended to protect policyholders in the unlikely event an insurer becomes insolvent or files for bankruptcy. The recent policy proposals include provisions that would require health insurers to subsidize life insurers for insolvencies in the long-term care market.

Currently, 75% of the long-term care market is owned by life insurance companies and 25% by health insurance companies. This proposal could require health insurance companies, including Kaiser Permanente of Colorado, to pay a disproportionate amount in the case of insolvency.

The life insurance industry as a whole is stable and making healthy profits, despite not initially pricing the long-term care products accurately to reflect future claims experience. With multiple revenue streams to offset less-productive units, there is no need for health systems to subsidize our life insurance counterparts.

Our impact in Colorado

Kaiser Permanente’s status as a nonprofit organization sets us apart from other health plans and allows us to live our mission as a comprehensive health care organization.

We’re committed to our social mission, and in 2020, we proudly invested more than $136 million in community health programs to improve the health of all Coloradans.

Learn more about our community health work in Colorado, including how we invested our resources, the types of projects we invested in, and some of our achievements.

Our care

  • Patient-Centered Medical Home recognition: Twenty-six Kaiser Permanente medical offices in Colorado, representing nearly 375 Colorado Permanente Medical Group primary care doctors, have earned top-level Patient-Centered Medical Home recognition from the National Committee for Quality Assurance for their patient-centered care, integrated teams, coordination, and tracking over time.
  • Quality and service recognition: Kaiser Permanente offers the top-rated private and Medicare health insurance plans in Colorado, according to annual rankings by the NCQA. Our private and Medicare health plans each consistently rank number one in the state, earning the top spot from 2008 through 2020.
  • Top-rated for Medicare Advantage: Kaiser Permanente is a top-rated option for seniors everywhere we operate, according to U.S. News & World Report’s 2021 list of best insurance companies for Medicare Advantage. In Colorado, Kaiser Permanente and its Medicare Advantage health plan stand alone as being rated best in the state.

Our people 

Top Doctors: Each year, 5280 — the city magazine in Denver, Colorado — asks more than 7,500 area doctors which metro-area doctors they’d trust to treat themselves and their families. A number of Kaiser Permanente doctors, representing a wide range of specialties, have appeared on the resulting Top Doctors list over the past decade. Many have appeared on the list multiple years.