2019 will be remembered as the year Colorado’s legislature finally addressed high health care prices.
Democrats began the year in a commanding position, with an active new governor and majorities in the House and Senate — a shift from 2018, when Republicans had a one-seat edge in the Senate. They found willing partners among Republicans, mostly from rural districts, who shared the goal of reducing consumer costs in health care.
Together, they put Colorado on the path to be among the first states to try a Medicaid-based public option for health insurance. They created a reinsurance program that aims to lower premium prices by up to 30 percent. And they cracked down on surprise medical billing, an issue that has festered for years at the Capitol without resolution.
Gov. Jared Polis emphasized his focus on lowering health costs by creating a state office dedicated to that goal. Polis also secured a win on his top campaign promise — funding for full-day kindergarten in every Colorado school district. Early childhood education is a key determinant of lifelong health.
Click on the cover to the right to download our full report. In addition to the information on this page, it features expanded explanations of our five themes and short descriptions of more than 50 health-related bills.
But not every health-related bill succeeded.
Colorado ranks near the bottom nationally on two measures of public health: rates of childhood vaccinations and teen vaping. Bills to increase the vaccination rate and raise nicotine taxes both failed. Legislators also failed to create a family and medical leave program, one of Democrats’ top priorities the past several years.
The 2019 session also will be remembered for its toxic political atmosphere. Polis and Democrats pushed through bills to impose tighter health and environmental rules on oil and gas production, and to allow courts to temporarily separate gun owners from their firearms if they are deemed at risk of harming themselves or others.
Those two bills were highly controversial and opened the door to political maneuvering. Democrats hastily scheduled hearings, and Republicans backed recall campaigns and used procedural delay tactics that routinely kept legislators in session well past midnight. As a result, there was a crunch of bills in the final weeks of the session.
Despite the disruptive politics, the 2019 session was heavy on substantial health policy. These policies can be grouped into five themes:
- Sizable Steps Toward Saving People Money
- Hospitals: Bruised but Not Broken
- Oil and Gas Takes a Back Seat to Health
- A Run for the Money in Behavioral Health
- A Roller Coaster for Community Health
SLOW START, FAST FINISH
In 2019, a class of fledgling Democratic legislators initially struggled to take flight, although their party controlled the House (41 Democrats; 24 Republicans), Senate (19 Democrats; 16 Republicans) and the governor’s mansion.
Their agenda included bills that had passed the Democrat-controlled House in previous sessions. But many of those same bills took much longer to introduce, debate, and pass in 2019. At the mid-point of the 2019 session, 397 bills had been introduced; at that time the year before, legislators had introduced 488 bills. Lobbyists and legislators spent more time on the details because bills were more likely to become law than in recent years, when many Democratic bills were certain to die in the GOP-controlled Senate.
And that, of course, led to a sprint to the finish line.
With two weeks left in the session, stacks of major bills were still on the table. Mental health and SUD parity, reinsurance, public option, and vaccine requirements were just a few of the health policy measures whose fate was still undecided as representatives and senators prepared to go home. Of the 31 major health policy bills CHI identified, only two had been decided before the last week of the session.
Despite their majorities in both houses, Democrats had to compromise on some key bills. A bill to create a reinsurance program struggled to find funding, and substance use disorder (SUD) bills saw major amendments late in the session that cut their budgets. Other bills were left behind. Priorities that didn’t make the cut this year included a new paid family and parental leave program, though there will be a feasibility study; more stringent vaccine requirements; local rent control options; broad pharmaceutical transparency requirements; and a repeal of the death penalty.
Sen. Jeff Bridges (D-Greenwood Village) summed up legislators' actions in a tweet: “Most bills were introduced in their Cadillac form, but we amended them to a Chevy — still gets the job done, but costs less and is more in line with what Coloradans want.”
Democrats will learn from this session’s slow start and fast finish. Look for the party to front-load more bills next year.
Democrats’ election victories in 2018 meant that contentious policy changes involving issues such as gun control and the Taxpayer’s Bill of Rights (TABOR) were on the table, and that Republicans would be determined to stay relevant and influence the session. Democrats expected the opposition to try to derail items on their agenda. But the extent to which the Republican minority was able to stifle bills in both chambers seemed to catch Democrats off guard.
The majority party put a slate of controversial policy changes front and center that exacerbated the bad blood. The list included Extreme Risk Protection Orders (the “red flag” bill), ballot measures to reform TABOR, new requirements for sex education, adding Colorado to the National Popular Vote compact, and automatically registering people to vote when they sign up for Medicaid and other social services.
Republicans chafed at what they called overreach and vowed to fight back; Democrats argued that they ran on these issues and accused their colleagues across the aisle of obstructionism.
The back and forth involved multiple late-night debates over politically thorny issues, a Republican walkout on a Friday, a controversial decision by Senate President Leroy Garcia (D-Pueblo) to keep working during the “bomb cyclone” weather event, and numerous requests by Republicans to have bills read at length — including one 2,000-page measure, which could have taken up to 60 hours. Democrats called the motions, which have historically been uncommon, a delay tactic and responded by using multiple computers to simultaneously speed read the bill. That led to a lawsuit that was ultimately decided in Republicans’ favor.
Republicans also threatened recall efforts, including one directed at Polis. Recalls targeting Democrats who supported bills such as the red flag law, new oil and gas restrictions, and the National Popular Vote movement look increasingly likely in some districts. The effort against Rep. Tom Sullivan (D-Centennial) in House District 37 is the furthest along, and a strong recall push in Weld County’s House District 50, held by Democrat Rochelle Galindo, ground to a halt after Galindo resigned her seat in May amid allegations of sexual misconduct.
With four days left to go, Westword ran an article titled: “It’s Crunch Time for Colorado Lawmakers, and Things Are Getting Weird.” The story details lawmakers attacking each other on Twitter, posting photos of their colleagues sleeping at their desks, and watching movies on their cell phones.
Despite the finger-pointing, lost time, and a few high-profile defeats, Democrats were unequivocal after the session that it had been a major success for their party and their constituents, touting wins for the environment, public safety, working families, health care consumers, and civil rights.
GOVERNOR POLIS' PRIORITIES
Gov. Jared Polis swept into office with an ambitious agenda for the legislature. He got much of what he wanted, including full-day kindergarten and an overhaul of oil and gas laws to favor health and environmental protection.
In health policy, Polis signed into law bills that addressed his top five priorities: hospital financial transparency, reinsurance, a Medicaid public option, importation of prescription drugs from Canada, and a crackdown on surprise out-of-network billing.
But his late push to raise taxes on nicotine fell flat. It would have put heavy taxes on e-cigarettes, which currently are taxed at a much lower rate than tobacco. According to the latest data from the Colorado Department of Public Health and Environment (CDPHE), more than a quarter (26 percent) of high school students engage in the behavior — more than any other state.
Polis is still in the first months of his administration, but the 2019 session gave some clues about how he will govern in the coming years. Here are five things to watch:
A singular aim on costs
Many health reform advocates embrace the Triple Aim — the intertwined goals of improving health care, promoting better population health, and reducing costs. Polis has made clear that his focus is on costs. He calls his health reform initiative the Office of Saving People Money on Health Care, and the health agenda for his first term is called the Roadmap to Saving Coloradans Money on Health Care.
An active and powerful cabinet
Polis’ executive agencies gained power over the course of the session. Legislators entrusted the Division of Insurance (DOI) and the Department of Health Care Policy and Financing (HCPF) to design and operate major new programs like the public option, reinsurance, and drug imports from Canada. The Colorado Oil and Gas Conservation Commission (COGCC) will play a more active role as an industry regulator that keeps a close eye on public health concerns. Rulemaking hearings and stakeholder groups will keep the health policy world busy for the rest of the year.
Painting the state green
One of Polis’ biggest breaks with his predecessor, John Hickenlooper, comes in environmental policy. Hickenlooper, a former petroleum geologist, sought peace with the oil and gas industry and promoted environmental regulation that businesses could support. Polis, in contrast, wants to phase out fossil fuels. This won’t be popular in communities that depend on mining and drilling for jobs and economic health.
Mixed messages on vaccines
Polis set a goal of improving Colorado’s low vaccination rate in his health policy roadmap. But he refused to support a bill to tighten the state’s lax requirements for vaccine exemptions, saying that stricter rules could increase public skepticism about vaccines. Colorado makes it easier to get an exemption for childhood immunizations than most other states. As long as such exemptions are easily available, it will be difficult to get Colorado out of the basement when it comes to protecting its children against vaccine-preventable diseases.
Finally, Polis takes a much different approach to day-to-day governing and legislating than Hickenlooper, who had a hands-off style. Polis, a former member of Congress, engages deeply in the details of bills as they make their way through the legislature. His involvement was on display during the push to fund full-day kindergarten. The Colorado Sun reported that Polis made personal appeals to members of the budget committee and coordinated witnesses to speak in favor of the proposal at public hearings. This can help legislators — especially fellow Democrats — clearly understand how to get his support, but some complained about heavy involvement from the governor’s office. It also means Polis owns the success or failure of bills much more than Hickenlooper did.
SETTING UP FOR 2020
The 2019 session ended May 3, but in some aspects, it’s just beginning.
Legislators gave authority to state agencies to craft the details on high-profile bills, and they asked voters to reconsider a key part of TABOR. Here are some ways the session will leave a legacy.
The real work happens this summer and fall.
The legislature passed a public insurance option, but what will it look like? We won’t know until HCPF and DOI design the program. State agencies also will write the rules for reinsurance and Canadian prescription drugs. Research, rulemaking, and implementation are part of a long and complex process; passing a bill is just the beginning.
Major bills need the Trump administration’s approval.
Proposals to create a public option, reinsurance, and prescription drug importation program each need federal waivers to take effect. That means approval from the Trump administration. The federal government has already approved reinsurance programs in other states, but Colorado is one of the first to try a public option and drug importation. The fate of these programs will remain in doubt until Trump’s appointees sign off on them.
TABOR is on the ballot this November.
TABOR has checked the legislature’s power for nearly three decades. It requires voter approval of tax increases and mandates that some state revenues during boom years be refunded to taxpayers. With the passage of HB 1257 and HB 1258, voters will decide this year whether to do away with the second part and let the legislature keep and spend all the tax revenue it receives. Colorado voters historically have been hesitant to trust the state government with more tax revenue. This ballot question will test whether attitudes are changing.
How will legislators approach the 2020 legislative session?
The 2019 session saw an outbreak of bad legislative manners. Democrats hastily scheduled hearings to catch opponents off guard, and Republicans supported recall campaigns and sued Democrats over the way they ran floor debates. The question for 2020 is whether either side has an incentive to change its behavior. Or will these tactics become the new normal?
The 2020 election:
Speaking of 2020, there’s an election on the horizon. President Trump, U.S. Sen. Cory Gardner, and three-quarters of Colorado’s legislature will be on the ballot. Colorado Democrats will choose their candidates for president and U.S. Senate in a June 2020 primary. Democratic legislators could be on opposing teams until then, depending on which candidates they support. Bipartisan relations won’t get any easier in the 2020 session, either. Legislators are often more hesitant to support controversial legislation in election years when tensions are high and opponents spend heavily on advertising to call out controversial votes, so Polis could have less support for going after big policy goals.