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Informing Policy. Advancing Health.

No Magic for Muggles: Legislators Work the Old-Fashioned Way

It’d be nice to have a time-turner right about now.

Legislators are working overtime to get through still undecided bills, and of all the magical things from Harry Potter’s universe, a pendant to increase the number of work hours in a day might sound the most appealing.

But without wands to make bills disappear or invisibility cloaks to hide behind, our 100 lawmakers and an army of legislative staff are spending days and nights at the Capitol to hammer out deals and make decisions. They can bend the rules to some extent during the session’s last three days, but every bill must have some kind of hearing.

We raise a glass of firewhiskey (or perhaps a milder butterbeer) to their efforts.

Now for five bills we watched with interest over the past week.

House Bill 1374 

  • What the bill proposes: Coming into this week, HB 1374 would have required freestanding emergency departments — those that are not attached to a hospital — to notify people via signage about potentially high costs and clarify the difference between an emergency department (ED) and an urgent care clinic. But the bill, which had undergone extensive changes since being introduced, was changed again on the House floor to create a stakeholder group to study issues concerning freestanding EDs. It is sponsored by Rep. Beth McCann (D) and John Kefalas (D).
  • What happened: The bill failed 3-2 in the Senate State, Veterans and Military Affairs Committee. Earlier this week it had squeaked through the House on a 34-31 vote, with all Democrats in favor and all Republicans against.
  • Why we chose it: This proposal, which had seemed so promising earlier in the session, experienced one setback after another and finally went down in flames. Despite numerous changes it could not gain any Republican support. In a last-ditch effort, a “strike-below” amendment — where much of the bill text is deleted and replaced with something different — was added by Democrats to instead create a task force. The 18-member stakeholder group would have tackled topics such as public education about the difference between primary care, urgent care and emergency care; what kinds of signage at EDs would comply with existing federal laws; costs and fees charged by freestanding emergency departments; and regulation of these facilities, which are common in Texas and Colorado but not anywhere else. But Republicans were over the proposal for this year. This won’t be the last we hear about this issue – expect another bill next session.

Senate Bill 162

  • What the bill proposes: SB 162 would allow Medicaid enrollees to visit providers who are not designated to serve Medicaid patients if they are willing to pay out of pocket to do so. It is sponsored by Sen. Jack Tate (R) and Reps. Jovan Melton (D) and Lang Sias (R).
  • What happened: The bill failed 5-4 in the House State, Veterans and Military Affairs Committee. It had passed the Senate by a 23-12 margin, with a handful of Democrats in support.
  • Why we chose it: We’ve written about this one before, but we are gaining a better understanding of the point of the bill. By allowing cost-sharing for Medicaid enrollees to see non-approved providers, it wasn’t an attempt to place greater responsibility on Medicaid clients to see designated providers. Rather, it was presented as a way to increase patient choice and access to care. But Democrats worried that patients would be confused or that doctors would lose some incentive to serve Medicaid patients if the program’s enrollees were allowed to seek care elsewhere. The bill was amended to state that non-Medicaid providers could not charge Medicaid enrollees “more than the usual and customary rate” for any services and that providers would have to notify patients about services that would have been covered by Medicaid. However, neither those changes nor the fact that the bill had a Democrat as a sponsor were enough to sway the five members of the House kill committee.

Senate Bill 202

  • What the bill proposes: SB 202 would grant about $6 million from the marijuana tax cash fund for substance use disorder services, which would be assessed and delivered through Colorado’s existing regional managed service organizations. It is sponsored by the bipartisan Joint Budget Committee.
  • What happened: The bill passed the House Appropriations Committee 8-5. It was supported by all seven Democrats and Republican Rep. Bob Rankin. It had flown through the Senate after being introduced on April 26 and was supported by 27 of 35 senators.
  • Why we chose it: This bill could provide a lot of funding for substance use programs across Colorado, and it’s moving through the legislature with little discussion or debate in the final days of the session. We were somewhat surprised to see the nearly party-line vote in House Appropriations after SB 202 gained solid bipartisan backing in the Senate. But now that it’s on to the House floor, it should have no trouble passing its last couple votes. Colorado is one of many states struggling to provide adequate support to people with substance use disorders. CHI has seen an increase in requests for data on drug overdoses in response to a time-lapse map we created, and last month, The New York Times published an article on heroin use in Pueblo.

 Senate Bill 135

  •  What the bill proposes: SB 135 would allow insurance plans to cover services provided by pharmacists as long as the pharmacists meet certain requirements. For example, a pharmacist must have a current Colorado pharmacy license, must carry adequate liability insurance, and must have either earned a Pharm.D. or have at least five years of work experience as a licensed pharmacist. The bill was amended to require that a reimbursement rate must also be agreed upon between a pharmacist and insurer. It is sponsored by Sen. Irene Aguilar (D) and Rep. Joann Ginal (D).
  • What happened: The bill was passed by the House Health, Insurance and Environment Committee on a 13-0 vote and then was approved unanimously by the full House. It is headed to Governor Hickenlooper for a signature.
  • Why we chose it: The bill underwent several amendments, but overall has stayed relatively intact since being introduced. Like HB 1360 (which concerns direct-entry midwives) and SB 158 (which concerns physician assistants), this bill is an attempt to increase medical professionals’ scope of practice — a goal that has consistently been popular with legislators over the past two years. These proposals are ways to “do more with less,” or at least with what’s in place now. SB 135 is a rare success for Sen. Aguilar this session. The senator, a primary care doctor, has faced Republican opposition to most of her health care proposals, such as those dealing with out-of-network services, immunizations and immunity for reporting drug overdoses.

 House Bill 1322 

  • What the bill proposes: HB 1322 would require insurers to reimburse in-network providers who prescribe multi-month supplies of contraceptive pills and other methods of birth control. It was amended in the House to say that contraception and maternity coverage must be offered “in the same manner as [for] any other sickness, injury, disease or condition” that a plan covers. The bill did allow individual policies to exclude coverage for pregnancy and delivery expenses by claiming a pregnancy as a pre-existing condition, but said they may not deny coverage for any subsequent pregnancies. Rep. Don Coram (R), who sponsored the failed HB 15-1194 to provide free long-acting reversible contraception (LARC) last year, joined Democrats Rep. Brittany Pettersen and Sen. Kerry Donovan as a sponsor.
  • What happened: The bill failed 3-2 in the Senate State, Veterans and Military Affairs Committee. As you can see, the designated kill committee in each chamber got a workout this week.
  • Why we chose it: This bill was introduced one week after HB 1294, which also sought to increase access to contraception, and it met the same fate in Senate State Affairs. While HB 1322’s final hearing didn’t feature the same theatrics — including substituting two female legislators onto the committee and displaying birth control samples and props — its failure created similar frustration among health care providers, women’s advocacy groups and Democrats. The bill had gained the support of eight Republicans on its final vote in the House, leading some to believe that it could succeed where HB 1294 had not, but wider access to contraceptive methods proved to be a firm wedge issue in the legislature. Republicans have pointed out that birth control is already required to be covered under the Affordable Care Act.

The legislative calendar is changing quickly and some bills are going through multiple votes in a single day. Among others that have yet to be scheduled, here are three votes we’ll keep an eye on during the last few days of the session.

House Bill 1142 

  • What the bill proposes: HB 1142 would create a new tax credit, capped at $1,000 per year, for rural preceptors who train students to become primary care providers in high-need areas. The preceptors instruct, train and supervise graduate students. The bill has been changed to stress that the preceptors must be uncompensated to qualify. Legislators also chose to broaden the definition of a “rural area” in Colorado. And while it originally proposed to cap the number of preceptors eligible for the credit at 300, it was amended to reduce that number to 200. The bill is sponsored by Reps. Perry Buck (R) and Joann Ginal (D) and by Sens. Larry Crowder (R) and John Cooke (R).
  • Who will be voting: The 65 members of the House.
  • Why we chose it: HB 1142 was introduced way back on January 21 with a daunting three-committee assignment in the House. It passed its first hearing in House Public Health Care and Human Services in February, then was approved by House Finance in March, and it got the thumbs-up from House Appropriations yesterday. It made it through each committee with overwhelming bipartisan support. Assuming the bill passes the House on its final reading today, it will at last make it over to the Senate. If it has to go through another three committees there, HB 1142 could face losing odds against the clock.

 Senate Bill 169 

  • What the bill proposes: SB 169 would add clarity and flexibility to the list of places that are approved for holds of people experiencing a mental health crisis. It’s an attempt to keep these people out of emergency departments, jails and other criminal settings in the first three days, when they are in need of immediate help. While the bill’s list of acceptable places includes jails and other law enforcement facilities, it states that these are last resorts available only if there is no space available in designated places that are better prepared to handle such emergencies. It is sponsored by Sens. Beth Martinez Humenik (R) and John Cooke (R), and by Reps. Tracy Kraft-Tharp (D) and Lois Landgraf (R).
  • Who will be voting: The 65 members of the House.
  • Why we chose it: The House postponed its first floor vote yesterday but seems poised to pass SB 169 today. Mental health has been an important topic in the legislature this session, representing an area that both Democrats and Republicans can agree on, and the timing of this bill is fortuitous given that May is Mental Health Month. (Make sure to check out CHI Policy Analyst Tamara Keeney’s blogs on different aspects of mental health each week in May, starting with this one.) The issue of treating people experiencing a mental health crisis as criminals, rather than people in need of help, is increasingly at the center of discussions about Colorado’s need for more and better behavioral health resources. The bill also clarifies that emergency departments should not be the automatic answer to mental health crises, stating that “many of our hospitals are not equipped or lack other resources to offer the type of specialty mental health care required for designated facilities.”

 House Bill 1420 

  • What the bill proposes: HB 1420 would repeal the Hospital Provider Fee and replace it with an identical program that is not subject to the limit set by the state’s Taxpayer’s Bill of Rights (TABOR). A companion bill, HB 1450, lays out where the money would be spent if HB 1420 passes. It is also awaiting a Senate assignment and vote. HB 1420 is sponsored by Speaker of the House Dickey Lee Hullinghorst (D) and Sen. Larry Crowder (R).
  • Who will be voting: We’re not sure yet. Cue the suspense.
  • Why we chose it: This is obviously one of the biggest questions looming as the end of the session closes in. Removing the more than $700 million Hospital Provider Fee from beneath the TABOR limit would be a big deal. Democrats say the move would correct a mistake and free up much-needed funds for roads, schools and other state priorities. Republicans say that it would be an attempt to get around limits that were set to encourage fiscal responsibility, and that eliminating TABOR refunds would mean taking money away from people around the state. We’ve been waiting all week to see what Senate President Bill Cadman will do with the bill, but he still hasn’t given it a committee assignment. The fact that Crowder supports the bill means that it would pass if allowed to get to the Senate floor. The longer we wait for Cadman’s decision, the less likely that seems to happen.

And there are still bills being introduced in both chambers, but they’ve slowed to a trickle. That makes sense, considering lawmakers are heading home in less than a week. We have only one new bill of note to report.

  • The debate over powdered alcohol is back. Senate Bill 206 is a proposal to ban the substance in Colorado. The bill would prohibit the “use, possession, sale, purchase, transfer, or manufacture” of any powdered alcohol products, and make violating the ban a Class 2 misdemeanor, which in Colorado carries a possible jail term of three to 12 months, a fine of $250 to $1,000, or both. (This class includes petty offenses.) To enact the ban, SB 206 would also repeal provisions of HB 15-1031, which directed the state to develop rules regarding powdered alcohol if it was approved at the federal level. Leadership of both parties decided they couldn’t possibly wait to address this issue, introducing it as a [very late] bill on Wednesday. The two top-ranking members of the majority party in each chamber are sponsors.

We’ll be back next week with our final legislative blog of the session, which must wrap up before midnight on Wednesday, May 11. Until then, we hope everyone can muster focus and dedication that would make Hermione proud.