Obamacare, rural services and culture wars lead Capitol health headlines

April 22, 2015
Photo: End Of Life, Death With Dignity Testimony, Carrie Ann Lucas
Carrie Ann Lucas, right, a lawyer with significant disabilities, was among those testifying against the "Death With Dignity" bill on Feb. 7, 2015.

The make-up of the Legislature, with each party controlling one chamber, proved to be one critical factor for virtually any health-related proposal.  

The non-profit, non-partisan Colorado Health Institute found bills that made health care more efficient or expanded access passed. Those tied to social issues did not.

"Things that tend to not be very expensive and allow us to expand care or resource availability in several different areas of health care have been really popular with politicians from both sides of the aisle," said Allie Morgan, a CHI policy analyst.  "Anything that is a partisan issue or a culture war issue or tied to a culture war issue is not really making it through."

The money is tied to a pair of larger, long-term budget trends are also affecting health legislation. One is the impact of the Taxpayer Bill of Rights, known as TABOR.  It requires tax refunds if state revenues grow faster than the rate of inflation and population growth. So even though the state's economy is doing well, and revenues are growing, the state budget is tight.  

The other notable thing is Medicaid. The healthcare insurance program for the poor is taking up a growing slice of the state budget pie.  More than a million Colorado residents, about a fifth of the population, are on Medicaid.  The state agency that administers Medicaid has seen its share of the state budget grow rapidly the last 15 years.  It now consumes more than a quarter of the state budget. 

So with lawmakers wrestling with Medicaid growth and TABOR tax refunds, there's not much money to spend to start new initiatives or expand other health programs. 

Close scrutiny for health exchange

As part of the Affordable Care Act, Colorado chose to start its own exchange, Connect for Health, where state residents can buy private insurance as part of Obamacare. It must be self-sustaining, without public funding, by the end of this year. The exchange signed up  150,000 Coloradans for private insurance last year and expects to surpass that this year. Meantime, the state's overall uninsured rate has dropped significantly.  

But an audit late last year revealed it lacked adequate financial controls. So lawmakers passed a bill calling for a more comprehensive "performance" audit. It directs the State Auditor to examine issues like fees and whether the exchange can be operated on its own without public funding.

State Sen. Kevin Lundberg, R-Berthoud, said he hopes the audit boosts transparency. “I do look forward to the exchange being more straightforward because I’ve been unsatisfied with how that has occurred in the past," he said . "But there’s new management and I trust we can have a better system in place.”

An interim CEO, Gary Drews, took the reigns as interim CEO in August, replacing Patty Fontneau.

After some initial resistance by Democrats, both parties supported the expanded audit. Gov. John Hickenlooper signed that bill into law. But a measure to limit bonuses for executives and employees of the health exchange failed. That proposal passed in the Republican-controlled Senate, but died in a health committee in the House where Democrats have the majority. A bill to repeal the exchange also failed in a House committee.

Five laws with a clean bill of health

Connect for Health Colorado performance audit (SB 19)

It directs the State Auditor to examine issues like fees and whether the state's health insurance exchange can be operated on its own without public funding. Auditors could examine operations, management of projects and  contracts, and the performance of the shared eligibility system, through which Coloradans can enroll for Medicaid or private insurance.

Telehealth services (HB1029)

The law expands services residents can access via a computer or a smartphone. It requires healthcare insurers to reimburse providers for telehealth services, no matter the size of the county. Prior state law required reimbursement only in counties with 150,000 or fewer residents. Proponents say it will lower health costs, by reducing re-admissions and ER visits.

Expanded prescription authority  (SB 197)

The legislation aims to improve access to medical care in rural Colorado. It lowers the number of hours of training required, under a doctor's supervision, of an advanced practice registered nurse (APRN) in order for them to write drug prescriptions. The standard is being changed from 3,600 hours to 1,000 hours. It removes a significant hurdle for nurse practitioners to work in underserved parts of the state.

Expansion of mental health services for minors (HB 1032)

The measure expands access by those who are at least 15 years old to essential mental health services. It expands the definition of who can provide services to include licensed social workers, family and marriage therapists, and addiction and professional counselors. Under current law, those who can provide that care must be licensed to practice psychology or medicine. Advocate argue it'll relieve pressure on the state's mental health providers.

Donation of prescription medication by health care facilities  (HB 1039)

The law expands the ability of institutions to donate unused medications, as wells as medical supplies and devices. Current law restricted donations to those helping disaster victims.  It bans resale of donated materials.

Six bills that died

Bill to repeal Colorado's health benefit exchange (HB 1066)  

Republicans opposed to the Affordable Care Act backed this bill to repeal the act that created Colorado health insurance exchange, Connect for Health Colorado.  Democrats opposed the repeal. The measure died in the in House health committee.

Bonuses for exchange executives and employees  (SB 052)  

The exchange drew criticism after reports that it had paid more than $200,000 in bonuses to executives and employees since 2012, with more than $100,000 in the works for this year. The bill would have required a legislative committee to review exchange bonuses and salary increases. Critics of the proposal said it would generate unneeded red tape.  It failed to make it out of committee.

Physician-assisted death (HB 1135)

The bill would have let terminally-ill patients end their lives with prescription drugs.  It would have required two doctors to verify the patient's condition was terminal and could self-administer the lethal drugs. After 10 hours of emotional discussion, a House committee voted it down on a bipartisan eight to five margin. 

Restriction on abortion providers  (HB 1128)

The bill was fashioned after laws that passed in states with conservative legislatures. It would have enacted a series of restrictions on abortion providers, most significantly forcing their clinics to be staffed by doctors with admitting privileges at a hospital within 30 miles. It would have essentially shuttered rural clinics located more than 30 miles from a hospital. It failed to make it out of committee.

Protection of human life at conception  (HB 1041)

The bill would have banned abortions after the point of conception, except to prevent the death of the mother, if a doctor makes a reasonable effort to save the life of the mother and the fetus. It made no exception of rape or incest, and made a violation a Class 3 felony. It failed to make it out of committee.

Marijuana pregnancy warning (HB 1298)

This bill concerned the posting of warnings at marijuana businesses for pregnant women about the risks of the drug. The warnings would have been the first of their kind in a state with legal recreational marijuana. Proponents said it would have given pregnant women valuable information. Critics argued the bill would have created a double standard, since bars and stores selling alcohol don't have to provide similar warnings. It died in a Senate committee April 23. 

On life support

Teen pregnancy prevention funding  (HB 1194)

The Colorado Family Planning Initiative began seven years ago, backed by $23 million in private donations. The bill, which had bipartisan sponsorship in the House, would allocate $5 million in state funds to keep it going. The effort provides long-acting reversible contraception, like IUDs, to low-income teens, for free or low cost. The Hickenlooper administration says the program has helped reduce teen pregnancies by 40 percent. As introduced in the GOP-controlled Senate, assigned to State, Veterans and Military Affairs Committee on April 2o, it faces an uphill battle against abortion rights opponents.

Offenses against an unborn child (SB 268)

Senate President Bill Cadman introduced this bill after a pregnant Longmont woman was brutally attacked in March. The bill would allow give unborn children legal protections. The Senate Judiciary Committee approved the bill Wednesday. It faces an uphill battle in the House. 

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