100 days. It’s enough time to grow a really good tomato, if you’re lucky.
It’s not nearly enough time to reform a health system.
I’m thinking about both of these things today. My tomato seedlings are sprouting under the heat lamp in my garage. Meanwhile, Gov. Jared Polis has arrived at the 100th day of his administration.
The 100-day mark is arbitrary, but Polis invited voters to look at his accomplishments as of today when he issued a 100-day agenda for cutting health care prices in the closing weeks of his campaign last fall.
Most items on his list remain unfinished, and some have been abandoned entirely.
It’s a classic case of campaign promises versus governing realities.
Even during the heat of the campaign, some items on Polis’ 100-day agenda seemed unrealistic. (If it took only 100 days to “end prescription drug price gouging,” as Polis promised, wouldn’t 49 other governors have done that long ago?)
So, it’s no surprise that the new governor hasn’t been able to check off most items on his list.
That doesn’t mean that his plan has failed. The policy seeds in the governor’s 100-day agenda have the potential to grow into something much bigger, given the proper care and some luck. This was the more realistic outcome all along.
Here is a look at select items on that 100-day agenda and where they stand.
Strengthen the Division of Insurance’s role as consumer watchdog. This is arguably the biggest shift we’ve seen in the early days of the administration. Legislation in progress gives the Division of Insurance (DOI) a much stronger role in regulating the market — both for health insurance and potentially for hospital care. The DOI likely will soon have broad authority to set up a reinsurance program, help craft a public option for insurance coverage, and require insurers to invest in affordable primary care.
Support community organizing opportunities: Polis’ insurance commissioner, Michael Conway, is working closely with Summit County leaders in creating a new health alliance to lower the county’s sky-high cost of coverage. Overall, Conway seems to be taking a pro-consumer approach to running the DOI.
Establish a reinsurance program: This one is almost done. House Bill 1168 has already passed the House with strong bipartisan support, and it is scheduled for its Senate hearing today.
Make hospital visits more affordable, and reform payment methods by setting global budgets: The Polis administration and legislature are addressing hospital prices. Polis has already signed House Bill 1001, which requires hospitals to disclose financial data. Behind the scenes, Polis’ administration is working on something called the Hospital Transformation Program, which uses the Hospital Provider Fee to pay performance incentives to hospitals. The goal is to move hospitals away from fee-for-service payments and into reimbursements for the value of the care they deliver, rather than the quantity.
End prescription drug price gouging: It was never realistic for a small state like Colorado to take on a multinational industry and win in three months. But Polis is backing bills to require greater price transparency from drug companies and to get federal permission to import lower-priced drugs from Canada. It’s a start.
Strengthen enforcement of parity requirements for physical and mental health coverage: Polis implied during the campaign that he would issue an executive order about this, which he has not. But HB 1269 would strengthen parity requirements through legislation, which is more durable over time than an order from the governor. The bill wasn’t introduced until the end of March, but it passed the House on Wednesday by a wide margin with support from both parties.
Expand access to mental health treatment: Several bills in the legislature aim to increase access to mental health care for children — which was a big part of this promise from Polis. He also said he would direct the Colorado Department of Public Health and Environment to study the impact of gun violence, especially suicide, but he has not issued that order.
Not Yet Started
Create a statewide insurance rating region to bring down premiums in rural areas: Polis has not acted on this. He might have been swayed by a 2016 DOI study that warned such an approach could backfire and drive up prices while reducing consumer choices.
End the doctor and provider shortage: Polis said he would direct state agencies to provide seed funding to providers to open rural clinics, expand loan repayment programs for rural behavioral health providers, and cut regulations that might keep out-of-state doctors from moving to Colorado. He has not issued any executive orders on this topic.
Polis has essentially replaced his 100-day health agenda with his Roadmap to Saving Coloradans Money on Health Care, which he unveiled on April 4. It’s a product of the new Office of Saving People Money on Health Care, led by Lt. Gov. Dianne Primavera.
The new roadmap is a sign that Polis and his inner circle understand that reforming health care isn’t as simple as growing a tomato. It outlines his health plans in the short term and long term. Read our blog about it here.
Most significantly, it endorses a public option to allow Coloradans to buy into the Medicaid program, which likely will offer lower-priced coverage than many Coloradans can find currently. (Here is CHI’s explainer.) A public option bill is on the cusp of passing the legislature, which will give Polis’ state agencies the authority to create a system this summer and fall and request the federal waiver that it will need. It’s a potentially major change in Colorado’s insurance market.
In other words, 100 days is just the start.
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