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A Diagnosis — But No Prescription — on Health in Governor’s Final State of the State

Gov. John Hickenlooper celebrated the achievements of the Affordable Care Act (ACA) in Colorado and lamented the crisis of high health care costs in his final State of the State Address on Thursday.

But he did not outline an agenda for reining in prices.

His eighth and final annual address to the legislature focused more on job training, fixing highways and building out rural broadband — notably, all topics that could be considered part of the social determinants of health.

In 2017, his office proposed a slate of bills — led by Lt. Gov. Donna Lynne — aimed at high insurance prices in rural Colorado. But all those bills died in a Republican-controlled Senate committee.

There was no hint of a similar health agenda in this year’s address, although Hickenlooper typically does not float specific bills he wants to pass during his State of the State speeches.

The word cloud at the top of the page helps bring out the flavor of this speech. The bigger the word, the more times the governor used it. Broad and sometimes inspirational concepts — such as Colorado, rural, need, love — dominated the speech. Concrete issues before the legislature — education, health, workforce, and even roads — faded to the background.

The governor identified the opioid epidemic at the beginning of the speech as one of the top priorities for the legislature, but he did not return to the subject. Legislators are expected to consider several bills to address the overdose crisis, including one to create a safe injection facility for heroin users.

Hickenlooper celebrated the ACA’s success in extending coverage to 600,000 more Coloradans. He noted that 100,000 Coloradans declared bankruptcy for medical reasons in 2013, but that number dropped by 60 percent after the ACA took effect.

“More than 60,000 families didn’t go through the trauma, the agony of bankruptcy,” he said. “When we’re secure in health care, we’re more likely to take risks, to take a chance, to start a business.”

Our astute readers will recognize that the numbers for coverage expansion and bankruptcies come from the Colorado Health Access Survey, run by the Colorado Health Institute and funded by The Colorado Trust.

Hickenlooper also lamented that some rural Colorado counties have just one insurer on the ACA exchange and some of the highest premium prices in the country. But he didn’t share any state initiatives to bring down prices. Instead, he put the onus on the U.S. Congress.

“We need our friends in Washington to finally move past the tired fight over the Affordable Care Act. It’s not perfect, and we need to strengthen it in lots of ways — but it has helped reduce our uninsured rate by half,” he said.

The lack of specifics in the State of the State Address doesn’t mean the 2018 session will be a quiet one for health.

As of 1 p.m. Thursday, legislators had already introduced 139 bills and resolutions, including bills on opioids, drug prices and access to behavioral health. And Senate Minority Leader Lucia Guzman (D) endorsed a Medicaid public option in her opening day speech Wednesday.

That alone will make the 2018 session exciting enough for health policy.