Today we’re looking back at Governor Bill Ritter's term in office. This time specifically at his impact on health care. Our Health Reporter Eric Whitney has this assessment.

WHITNEY: On the campaign trail, and in office, Bill Ritter made it clear he wanted to have a big impact on health care in Colorado. Here he is at a rally on the capitol steps shortly after the election.

RITTER: One day we will cover all Coloradans with some level of health insurance that's affordable and accessible to everybody (Cheer).

WHITNEY: That was a tall order back at the beginning of 2008, but it would get a lot harder that fall when the national economy crashed. Tens of thousands of Coloradans lost their jobs, and the health insurance that often goes along with them.

Rachel Velasquez meets people like that every day. Like the father of a little girl who got sick and needed surgery after he was laid off.

VELASQUEZ: so he had to sell his house in order to provide that surgery for his child.

WHITNEY: Velasquez helps enroll people in public health insurance plans like Medicaid and ChiP Plus for kids. The father who had to sell his house was part of a two-income family. His wife made too much money for the family to qualify for the public plans, but not enough to afford private health insurance.

Governor Ritter came up with a plan to help families like that.
He allowed people with higher incomes to get on Medicaid and ChiP, and paid for it without raising state taxes.
Here he is stumping for the plan last year.

RITTER: we are trying to put in place a thing called a hospital provider fee, and to run that through the legislature. What it is, is every hospital would pay, per bed, per patient, a certain fee, and we would use it for Medicaid. We can draw down a matching amount of money from the federal government, and we can expand care. Maybe a minimum of 100,000, maybe up to 200,000 additional people we can insure. That's not just a small increment, it is something that really helps us tackle this in a bigger way.

WHITNEY: The hospital fee would pass, and this spring enrollment specialists like Rachel Velasquez were able to start getting more working families public health coverage, like a mom whose son had a bad bone fracture.

VELASQUEZ: he was able to get surgery, Mom didn't have to worry about losing her home.

RITTER: The hospital fee wins Governor Ritter lots of praise from advocates for the uninsured.

And, maybe surprisingly, hospitals like it, too. Steven Summer is president of the Colorado Hospital Association. He praises Ritter for winning hospital support for the fee, even though it's going to cost several of the state's biggest for-profit hospitals millions of dollars a year.

SUMMER: I think how he went about it, that is it was a partnership from the beginning. It had to be win for the citizens of Colorado, win for the government and the medicaid program, and it had to be an opportunity for Colorado hospitals to find a way for it to be beneficial for them as well.

WHITNEY: Most Colorado hospitals will end up getting more money back than they pay in in fees.

That’s because putting more people on Medicaid means fewer people showing up at hospitals with no insurance at all, so most hospitals should lose less money.

The fee puts Colorado in a pretty special category – one of just a handful of states that’s making it easier for people to get on public health plans during a recession. At least 15 states are either kicking people off of Medicaid and ChiP, or telling people who qualify they're going to have to wait until the economy improves to enroll.

Governor Ritter's ability to expand safety net programs in a down economy, without raising taxes, impresses a lot of people involved with health care in Colorado. But not Republican State Senator Shawn Mitchell.

MITCHELL: the problem is, we don't have the money. The state and the nation are in a terrible fiscal crunch, and the good intentions involved in expanding the safety net don't create the resources necessary to expand the safety net, and there are harmful effects.

WHITNEY: Mitchell points out that the six-hundred-million-dollars-a-year that Colorado's hospital fee is expected to draw down from the federal government, only adds to the ballooning federal deficit.

And he says, sending hospitals more patients with Medicaid sounds helpful, but Medicaid still doesn't pay enough to cover the full cost of caring for the new patients. That means private insurance companies are billed more to make up the difference, resulting in higher costs for the private sector.

MITCHELL: His impact on the private sector has been primarily to increase regulation and mandates on the private health plans. Mandatory coverage of therapy for autism, mandatory new screenings and treatment regimes, which again, sounds compassionate, but you can't on the one hand complain about the rising cost of health insurance and on the other hand keep ordering insurance companies to do more and cover more.

WHITNEY: Denver Insurance Broker Bill Lindsay agrees at least one regulatory bill the governor signed made insurance more expensive for small businesses. But overall, he describes Ritter's leadership on healthcare as “thoughtful.”

LINDSAY: he has really chosen to engage in places that are a little more complicated, but where the impact would be potentially much greater.

WHITNEY: Lindsay was a Republican appointee to the Blue Ribbon panel on health care that gave Governor Ritter advice at the beginning of his term. He says the hospital fee is already having a positive impact on health care. And he says Ritter has put the state on the right track to lower health care costs over the long term.

LINDSAY: what he decided to do was to really try to study and address the issue of provider shortages, provider reimbursement, and other things that have not been discussed on a national stage, but which have a significant impact on health care cost in Colorado. And that was a very thoughtful and deliberate approach.

WHITNEY: Doctors in Colorado generally echo that praise. This even after they came up losers in the state's Medicaid expansion. Doctors saw a net cut in how much Medicaid pays them under Governor Ritter.

Dr. Michael Pramenko is president of the state's biggest physicians organization, the Colorado Medical Society. He says of course doctors don't like the Medicaid cut, but in the big picture, Ritter has started Colorado moving in the right direction on health care.

PRAMENKO: if we look where we were four years ago, we have moved toward systems changes. We are making progress on changing the systems of healthcare, which should lead us to savings in health care.

WHITNEY: Pramenko and other health care leaders say Ritter's leadership legacy will be on the biggest and toughest health care problem: costs that keep going up at an unsustainable rate. They say Ritter has brought people together from across all parts of the health care system to focus on that goal.

PRAMENKO: we've gotta communicate better, we've gotta operate our systems more efficiently, and we're in the middle of doing some of those things in the state of Colorado right now and he's certainly helped those efforts.

WHITNEY: A more efficient health care system is a major goal of the federal health reform law passed last spring. Governor Ritter has positioned Colorado to synch up with the federal law and benefit from it’s changes.
Gretchen Hammer, head of the Colorado Coalition for the Medically Underserved praises Ritter for that. She’s hopeful his successor will pick up where he left off.

HAMMER: all indications of Gov. Elect Hickenlooper during his campaign and his early transition documents show this committment in efficiency and efficacy of government, so those are I think hopeful signs.

WHITNEY: The new governor is going to need all the savings from efficiency he can find. Federal stimulus money helped states grow public programs to cover people who lost health insurance due to the recession.
But that’s running out.

And the private sector is still waiting for an economic rebound before it starts offering more jobs that include health insurance benefits.