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Informing Policy. Advancing Health.

Committee Approves Medicaid Expansion Bill

The bill setting the stage for Medicaid expansion passed its first hurdle Thursday evening. The Senate Health and Human Services Committee voted 5-2 in favor of SB 200, the bill sponsored by Sen. Irene Aguilar, D-Denver, that would allow Colorado to participate in the Medicaid expansion outlined in the Affordable Care Act.

The vote was along party lines with one exception. Democrats John Kefalas, Jeanne Nicholson and Linda Newell, along with Aguilar voted for it. Republican Larry Crowder of Alamosa joined them. The two no votes were Republicans Kevin Lundberg and Ellen Roberts.

Of note, there was no testimony opposing the expansion.

The bill now heads to the Senate Appropriations Committee, made up of four Democrats - Mary Hodge, Pat Steadman, Rollie Heath and Jessie Ulibarri – and three Republicans – Ted Harvey, Kent Lambert and Scott Renfroe.

The bill’s fiscal note discusses the expected financial impact on Colorado in detail.

Reporter Eric Whitney of Colorado Public Radio filed this report. Read Denver Business Journal reporter Ed Sealover’s story here.  Diane Carman of Health Policy Solutions also reported on the hearing. 

The Colorado Health Institute provided real-time information and fact-checking Thursday during the first committee hearing. That information follows, with the time stamps of our blog posts.

5:03 p.m.: We're signing off. Thanks for reading!


4:00 p.m.:

Russ Johnson, CEO of San Luis Valley Regional Medical Center in Alamosa, is giving helpful testimony about the role of Medicaid patients at hospitals.

Johnson has been featured on ABC News nationally recently, talking about the potential of sequestration and Medicare cuts on local hospitals. He said the cuts would mean tough choices.

“For those folks that don’t have a balance sheet that’s healthy, and they’re already on the edge, it’s a very significant jeopardy,” Johnson told ABC News. “I would expect not just with sequestration but with what’s happening in our country – maybe out of necessity to reduce costs – we’re going to see some hospitals that have been struggling finally not be able to continue.”

Johnson serves on the board of the American Hospital Association.


3:30 p.m.:

Sen. Aguilar cites a Colorado Health Institute report from December 2011 titled “A Half Million Newly Insured: Is Colorado Ready?” when talking about whether the state has a medical workforce that’s large enough to handle an influx of new Medicaid clients.

The report on the Colorado Health Institute website notes that our analysis revealed that Colorado would need between 71 and 117 physicians and between 12 and 24 nurse practitioners and physician assistants to handle the newly insured population.

Our findings surprised some experts, who had expected Colorado would need a great many more new medical practitioners.

It’s important to note that Colorado does have areas, especially in rural Colorado and inner-city urban areas, where doctors and other practitioners are already in short supply. The Colorado Department of Public Health and Environment has information on these areas.

The question of how best to ensure that all Coloradans have access to medical care continues to be an important one.


3:20 p.m.:

Sen. John Kefalis, D-Fort Collins, wonders about percentage of bankruptcies connected with medical costs. The Colorado Health Institute reported on studies answering that question last year when writing about the affordability of health insurance.

Health care expenses were the most common cause of bankruptcy in the United States in 2007, accounting for 62 percent of bankruptcies, up from 8 percent in 1981.

The data came from a national study published in The American Journal of Medicine.


3:10 p.m.:

There’s a question about whether savings have been documented in the state’s experimental Accountable Care Collaborative in Medicaid, which began last year.

Sen. Aguilar points with pride to the cutting-edge reforms in Colorado’s Medicaid program. “I think we’re investing our money into a system that’s driving the kind of health care reform that we need,” she said.

Sen. Ellen Roberts, Republican from southwest Colorado, is not as convinced. She called the efforts “well-intentioned but untested, unproven.”

“Is this the right time to be adding new people to the rolls when we have yet to demonstrate the kind of cost savings that we hope for?” she asked.

The Colorado Health Institute has previously analyzed the initial ACC financial report.

The early results are promising, but they don’t necessarily show great savings yet. The Department of Health Care Policy and Financing (HCPF) revealed in November that estimated gross savings in the first year were between $9 million and $30 million. But administrative costs were about $18 million. So there could be modest savings. But there could also be a loss of up to $9 million.

HCPF revealed these performance results:

  • Hospital readmissions 8.6 percent lower than non-CC enrollees.
  • A lower rate of increase in emergency room visits
  • The use of high-cost imaging decreased by three percentage points.

    Also, there were lower rates of preventable hospitalizations for enrollees with diabetes and asthma.


    3:00 p.m.:

    Senator Ellen Roberts (District 6) cited this article from Modern Healthcare about a proposed $275 billion cut in federal health care spending over ten years. This is part of a larger spending blueprint offered by Sen. Patty Murray, the Democratic chair of the Senate Budget Committee.

    According to the magazine summary of the budget proposal, few details are provided about the proposed health care cuts, but it seems that the discussion is mostly about Medicare.

    Here is an excerpt from the Modern Healthcare article:  

    Murray's budget would eliminate the Medicare physician payment system that is slated to cut pay rates at the end of the year. However, it did not specify what would replace the sustainable growth-rate formula. The spending plan also would end the so-called sequester, the $1.2 trillion program of 10-year cuts that took effect March 1 to reduce federal deficits. That includes a 2% cut in Medicare provider payments that HHS will impose on services provided after April 1. Eliminating the sequester cuts would save 750,000 jobs this year, Murray said, echoing concerns raised by some provider advocates.

    Murray contrasted her approach with the one Rep. Paul Ryan (R-Wis.), chairman of the House Budget Committee, put forward earlier this week. Ryan's plan assumes significant savings from allowing Medicare beneficiaries to choose premium subsidies for private health plans over the traditional program. ‘We reject calls to dismantle or privatize Medicare by voucherizing it,’ Murray said.”

    You can find the entire article here.


    2:40 p.m.:

    The debate begins.

    Sen. Irene Aguilar, sponsor of the Medicaid expansion bill, and Sen. Kevin Lundberg, R-District 15, discussing whether more involvement by government is the best way to fix a “broken” health care system.

    “If I’m at all accurate in my observation of how things work, as the federal government takes more and more responsibility for paying for medical care that it doesn’t have the money to pay for, which they don’t, the obvious public policy solution will not be more money but less money for health care. I submit that what we’re inviting is not better care for everyone, but rationing of medical care,” Lundberg said.

    Aguilar responded: “We already ration health care in the United States. It’s rationed by who can afford it.”


    The attention of Colorado’s health care community will turn toward the state Capitol tomorrow, when legislators are expected to begin debating whether Colorado should expand its Medicaid program. Governor Hickenlooper supports the expansion, which would increase eligibility by adopting higher income levels. Now, state lawmakers will weigh in on the closely-watched question.

    The Colorado Health Institute will be there, sending regular tweets on the proceedings. We’re also going to be standing by to provide data and context during the discussion. Our role is to provide state leaders with evidence-based, non-partisan health care information. We will be doing that in real time tomorrow.

    Check our website regularly and follow us on Twitter to follow the action.