A Rollicking Seventh Birthday

What an extraordinary day it is for health policy — in Colorado and Washington, D.C.

It’s the seventh anniversary of the signing of the Affordable Care Act (ACA). It’s also the day that House Republicans had planned to repeal major parts of the law. The timing isn’t an accident.

Closer to home, Colorado’s budget writers have finished drafting a spending plan that includes a massive cut to hospitals, even amid reports of bipartisan negotiations to change the Hospital Provider Fee in a way that could save hundreds of millions of dollars for hospitals and the state budget.

And the first bill in a batch backed by Lt. Gov. Donna Lynne was up for a hearing in the state House this afternoon. House Bill 1236 would require hospitals to share information on revenues and costs with the state government for a report to be made public every year.

Whew.

Let’s take these items in reverse order.

Lynne is showing her influence in her first legislative session as lieutenant governor. She is backing several bills aimed at promoting transparency in health spending and competition and affordability in insurance.

Lynne took the somewhat unusual step of testifying for HB 1236 Thursday afternoon, expressing her support and the backing of Gov. John Hickenlooper. The bill would require hospitals to turn over their financial statements and Medicare cost reports to the state Department of Health Care Policy and Financing. Much of this information is publicly available now, but the data are hard to find and difficult to use.

Lynne said hospital costs make up 32 percent of the state’s Medicaid spending — $2.7 billion a year.

“These are public dollars, and the public should know how they are being used,” she said.

The Colorado Hospital Association opposes the bill, saying it could impose an added burden on HCPF, the department that also runs the Hospital Provider Fee, a program that provides crucial funding to many hospitals. The House Health, Insurance and Environment Committee advanced the bill on a 7-4 vote Thursday afternoon, with Republican Phil Covarrubias joining the six Democrats on the committee voting yes.

Speaking of the Hospital Provider Fee, big changes could be in the works. Democrats and Republicans have stalemated for three years over whether the fee should be put beyond the reach of the Taxpayer’s Bill of Rights (TABOR). The fee is so large that exempting it from TABOR would end TABOR refunds for the foreseeable future.

The Joint Budget Committee put the finishing touches on the 2017-18 budget Wednesday. The panel decided to cut a large chunk of the money hospitals receive from the provider fee, which would free up roughly $250 million in the state budget that will not have to be spent on TABOR refunds.

Democrats and a handful of Republicans support removing the fee from TABOR considerations. The past two years, Senate leadership has scuttled the effort. However, the Colorado Independent reported this week that Senate President Kevin Grantham (R) is supporting an effort that could reclassify the fee in return for a broader budget deal.

We’ll see whether such a grand bargain can come together, especially given the timing. The Senate will pause next week to vote on the state budget, and a deal on the provider fee could spur major changes in spending.

And finally, the big news today is what didn’t happen. The U.S. House was scheduled to vote on the American Health Care Act, an ACA replacement backed by President Donald Trump and Speaker of the House Paul Ryan. But conservatives and Republican moderates remain opposed to the bill, even after intense negotiations that went late into Wednesday night and continued all day today.

As of this afternoon, House leaders were planning to hold a vote Friday. That means Obamacare supporters will be able to blow out those birthday candles after all. It’s hard to see how political calculations among the wings of the Republican Party will change in the next day.

But if we’ve learned anything since the November election, it’s that unexpected outcomes can happen. Stay tuned to CHI as we track how federal developments will affect Colorado.

Joe is Manager of Public Policy Outreach at CHI.