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Shaking Things Up: Introducing Your Weekly “Top Eight”

We love the legislature, and we’re passionate about tracking health bills — but even we can admit that our weekly legislative blogs have become a bit verbose. Extended. Detailed.

They’re long.

So we’re trying out a new format this week that we hope to carry through the remaining month of this session and into next year. The blogs might still be long but they’ll allow us a deeper dive into select bills.

Instead of trying to include everything, we’ll profile what we view as the five most notable votes – either in committee or on the floor – from the past week, and preview our picks for the three most important health votes to watch in the coming week. We’ll continue to highlight new bills worth tracking at the end.

We’ll also keep updating our master bill tracking list, which we’ll post for your viewing pleasure at the end of the session. It summarizes every bill we’ve watched this session, along with their outcomes.

Capisce? Here we go.

The honors for the top five votes from the past week go to:

House Bill 1405

  • What the bill proposes: This is the Long Bill, or the full state budget proposal for the upcoming fiscal year of 2016-17.
  • What happened: The final version of the budget passed the “conference committee,” which is the Joint Budget Committee in a different role, 6-0 and is about to secure final approval from the full legislature. Earlier, it passed the House 39-26 and the Senate 30-5. The conference committee ironed out small differences between the chambers’ versions. HB 1405 will soon be headed to Governor Hickenlooper for a signature.
  • Why we chose it: This was an easy one: The budget bill weighs in at about $26 billion, so it’s kind of a big deal. Colorado is a state with a constitutional mandate for a balanced budget each year. The six-member JBC – which includes three Republicans and three Democrats – managed to draft a budget that met this requirement and drew considerable bipartisan agreement, even after a lot of bluster over amendments that, for the most part, did not pass.

 House Bill 1294

  •  What the bill proposes: HB 1294 would require health plans to cover all forms of contraception that are approved by the Food and Drug Administration, which would more than double the contraceptive options that are currently mandated.
  • What happened: The bill failed in the Senate State, Veterans and Military Affairs Committee by a vote of 3-2, with Republicans opposing it and Democrats in support. In a bit of political theater, Senate Democrats substituted two women onto the committee (which is made up of five men) for the bill’s hearing.
  • Why we chose it: After making its way through one chamber, this bill about a contentious issue – mandatory birth control coverage – failed in the other chamber’s “kill committee.” Many proposals have met a similar fate, typical for a legislative session with split party control. HB 1294’s failure attracted attention from The Denver Post and other media outlets. The bill was supported by groups such as the Interfaith Alliance, the League of Women Voters and NARAL Pro-Choice Colorado, while opposition came from organizations including the Colorado Association of Health Plans, Denver Health and Colorado Right to Life.

House Bill 1160

  •  What the bill proposes: HB 1160 would continue state oversight of surgical technicians and assistants, which had been set to end. It would also expand requirements for their licensure, including wider monitoring of drug test results and the addition of criminal background checks for both new technicians and those whose registration has expired.
  • What happened: The bill passed its third and final reading in the House by a vote of 49-16. About half of Republicans supported it along with all Democrats. It goes next to Senate Finance.
  • Why we chose it: After passing two House committees and enduring several delays as it was reworked, this bill has finally passed its first chamber. While the issue wasn’t something legislators paid much attention to at the beginning of the session, that all changed when a surgical tech at Swedish Medical Center was discovered stealing drugs and replacing them with dirty needles – a story that was widely covered by local and national news outlets. The realization that the tech had previously been fired from four hospitals in other states led to calls for greater enforcement of these professionals, and the bill’s sponsors gained an OK from the House to add more than $32,000 for better regulation.

Senate Bill 170 

  • What the bill proposes: As originally written, SB 170 would give the Department of Health Care Policy and Financing (HCPF) the option to use federal funds to buy commercial insurance through Connect for Health Colorado for low-income people, rather than enrolling them in Medicaid. HCPF would need to apply for a federal waiver to allow it to use government subsidies to pay for the private plans.
  • What happened: The bill passed the Senate Health and Human Services Committee on a vote of 4-1, with the Committee’s three Republican members and Democrat Linda Newell in support, but its main provisions were gutted, leaving only the ability to provide information to Medicaid-eligible Coloradans on how to buy insurance through the exchange. The committee had listened to testimony on it back on March 24 but delayed the vote until this week. SB 170’s next stop is Senate Appropriations.
  • Why we chose it: This proposal was similar to the “private option” in Arkansas, which was approved through a federal waiver in fall 2013. It attempts to address some Coloradans’ opposition to being enrolled in a public assistance program and a belief that private insurance plans may offer better, or at least more efficient, coverage. It is sponsored by Senator Jack Tate (R) and Senator Ellen Roberts (R), who is the vice-chair (formerly the chair) of the Exchange Oversight Committee. We’ll see if the bill can pick up more support from Democrats as it moves forward in its new, much shorter form.

House Bill 1374 

  • What the bill proposes: HB 1374 would require freestanding emergency rooms to more clearly notify the public about potentially high costs, and make people aware that they are not at an urgent care clinic.
  • What happened: The bill passed the House Health, Insurance and Environment Committee on a 7-6 party-line vote, with the Democratic majority in favor. It was amended by the sponsor to make its requirements less extensive, which disappointed many Democrats on the committee. The next step is the House floor.
  • Why we chose it: The lack of Republican support has been the big story for this bill. Rep. Lois Landgraf (R) had been deeply involved with the proposal before its introduction, but a failure to compromise resulted in only Democrats as sponsors. It failed to pick up any bipartisan support yesterday, meaning its chances in the Senate are poor. The bill was changed to simply require the notification by posted signage. Originally, it had stated that after an initial patient assessment, freestanding ERs would also have to inform patients that the visit might not be covered in-network by their insurance plan and that they might be better off visiting a primary care doctor instead. Now, this only applies to ERs that are not subject to a federal law called EMTALA. (That’s a story for another day.) The size of the notification signage was increased as a small concession for scaling back the bill.

As for our top three upcoming votes to watch:

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 Bill of Rights (TABOR). A companion bill, HB 1421, lays out where the money would be spent if HB 1420 passes.
  • Who will be voting: The 65 members of the House, following a debate on the floor.
  • Why we chose it: If you’ve followed the debate over the Provider Fee for the past year or more, you know why. This bill was supposed to be voted on today, but has been pushed back to next Monday. While there will be no TABOR refunds next year, proponents say they are unavoidable in future years and that freed-up money could be put toward critical areas such as transportation and education. Senator Larry Crowder drew a lot of attention by agreeing to serve as the bill’s Senate sponsor, and some House Republicans say they will back it too. Whether it can get through the Senate – which depends on what committee it’s assigned to – remains to be seen.

Senate Bill 158

  • What the bill proposes: SB 158 would clarify the tasks that a physician’s assistant (PA) is allowed to perform with oversight from a supervising doctor, such as issuing immunization certificates and writing most prescriptions without a physician’s supervision.
  • Who will be voting: The House Public Health Care and Human Services Committee.
  • Why we chose it: Similar “scope of practice” bills were popular in the 2015 legislative session, but we haven’t seen as many this year. This bill is viewed as an attempt to put PAs on more level ground with nurse practitioners, who’ve gained the authority to do more to help patients. That’s especially appealing to legislators from rural districts or other areas with a shortage of doctors. It has bipartisan sponsorship from Sen. Kevin Lundberg (R) and Rep. Dianne Primavera (D), and that kind of pairing means it has a good chance of appealing to legislators from both sides of the aisle. SB 158 has been amended to make the need for a physician’s permission more explicit.

 Senate Bill 162

  • What the bill proposes: SB 162 would place greater responsibility on Medicaid enrollees to seek out providers who are designated to serve Medicaid patients. It would do so by allowing financial penalties in the form of cost-sharing for enrollees when they see non-approved providers.
  • Who will be voting: The 35 members of the Senate, following a debate on the floor.
  • Why we chose it: This bill has a strong focus on personal responsibility, which can generate extensive debates in our state legislature. It is notable in that it includes three Democrats as sponsors along with five Republicans. The bill passed the Senate Health and Human Services Committee on a 3-2 party-line vote this week, with both Democrats opposed. We’ll be interested to see how much D support it gets on the floor and, if it passes the Senate, what House committee gets to decide its fate.

There’s only one new bill for us to highlight this week, as the session gets closer to its end date, but we anticipate that more late bills are still to come.

House Bill 1435 was introduced on April 6 but escaped a mention in our most recent blog post. On the surface, you might not think it has to do with health care – it’s titled the “Low-wage Employer Corporate Responsibility Act.” But it’s very much related. HB 1435 would create a public benefits enterprise under HCPF to impose fees on low-wage employers with 250 or more employees.

While the exact fee amount is to be determined, it would “reflect the benefit received by such employers from the provision of state-subsidized health care program assistance to low-wage employees in the state and the costs to the state of providing that assistance.” In other words, it would penalize large employers who don’t offer health insurance by making them compensate the state for covering their workers through Medicaid. The enterprise’s seven-member board would include employers, organized labor, health care advocacy groups and a working person on Medicaid. HB 1435 is scheduled for its first hearing in House Health, Insurance and Environment on April 28.

Also worth mentioning: The Colorado Health Insurance Exchange Oversight Committee met this week. Legislators heard updates from leadership of the state marketplace, Connect for Health Colorado, on results of the third open enrollment period and their thinking around its budget and strategic planning options.

Connect for Health reported that it has enrolled about 169,000 Coloradans, with almost half of that coming from people new to the marketplace. There’s still a long way to go, however, and the organization is staring down the loss of a monthly fee on insurance plans at the end of 2016 that provides much of its revenue. As CEO Kevin Patterson discussed five options for the marketplace’s future direction, he made it clear that simply sticking to the status quo would not be an option, as Connect for Health would soon run out of money under that scenario. For more on the meeting, check out this article by Ed Sealover from the Denver Business Journal.