The American Medical Association, in an annual letter to lawmakers, urged states to make medical care more affordable by requiring payment for prescription drugs and other outpatient services.
It’s an approach that has long been part of federal law.
But some states, including Colorado, have gone even further, charging premiums based on how much people can afford.
Colorado’s healthcare overhaul is called the Colorado Health Insurance Plan.
It requires insurers to charge people with pre-existing conditions a monthly premium that is based on their income.
In 2018, about 20 percent of Colorado residents were uninsured, and more than half of them had a pre-injury condition, according to a recent study by the state’s health department.
To qualify for coverage, people must be able to pay $1,000 a month in premiums.
In 2020, they must also pay at least $2,400 in out-of-pocket expenses for medical treatments.
The Affordable Care Act’s subsidies, known as COOPs, are meant to help lower-income individuals pay for coverage.
It gives states flexibility to determine how much to charge and allows insurers to offer lower-cost plans.
Colorado has also expanded the state-run healthcare exchange.
The state has allowed insurers to sell plans across state lines.
But the state is still limiting what types of plans insurers can sell.
Under the COOP, people who qualify must pay a flat premium of $1.50 per month.
That is $1 less than the current premium, which is $4.60.
People who are under age 65 can also get COOP subsidies for up to four people.
The maximum amount they can receive is $3,800.
People can also purchase COOP-approved plans through an exchange.
Insurers that participate in the exchange must provide coverage to about 11.5 million people by 2022.
The ACA has been criticized for not including a co-payment on COOP plans, which critics say hurts low-income people.
The Trump administration has been working to reform the COOL, which will require most employers with at least 50 workers to provide health coverage or face a penalty of up to $1 billion.
Insurers have been reluctant to participate because of concerns that a government-mandated COOL could raise premiums and hurt their bottom lines.
The administration’s proposed changes, which would go into effect in 2020, would make coverage mandatory and also eliminate the penalty.
The White House has proposed that employers pay out a set amount of money per employee to help pay for health coverage.
The federal government has already taken steps to reduce the amount employers can contribute to health insurance premiums.
Under current law, employers who provide coverage through COOP must cover at least 10 employees, but the Obama administration has allowed states to set a higher limit, of 15 or more.
The Trump administration wants to make it more difficult to set the maximum.
The House and Senate are expected to pass the bill this week.
The Associated Press contributed to this report.