In Pursuit of Unicorns and a Bipartisan Budget Deal

It’s hard to keep up with the news. At the Capitol, some notable health bills are moving quickly, while there seems to be a growing stalemate over other bills as parties try to force action on their priority topics. Outside the Gold Dome, talk of repealing the Affordable Care Act continues, Serena Williams is expecting and Starbucks is offering a limited-edition Unicorn Frappuccino. It’s a lot to take in.

State legislative highlights from the past few weeks include both chambers passing a fiscal year 2017-18 budget, progress for several health care bills backed by Lt. Gov. Donna Lynne, and a successful first hearing for Senate Bill 267, one of the biggest bills of the session that would, among other things, reclassify the Hospital Provider Fee.

The Senate took up the Long Bill, or state budget, first this session. After voting on 46 amendments, senators approved the bill 30-5, with four Democrats and one Republican opposed. It then moved to House, where legislators had a whopping 93 amendments to consider. It eventually passed that chamber 38-27, with all Democrats in support and all but one Republican (Bob Rankin, who sits on the Joint Budget Committee) against it.

Of note for health policy, both chambers restored $5.1 million in federal funding for the state insurance marketplace, Connect for Health Colorado; $44,000 to track the new medical aid-in-dying law; and $745,000 for the Healthy Kids Colorado survey. This support ensures that all three are safely in next year’s budget. Other amendments failed, including a proposal to roll back Medicaid expansion in the state, and a request to increase Medicaid enrollees’ copays for prescription drugs and use the extra funds for transportation projects.

The Long Bill sits now in a conference committee, where JBC members hammer out the final version that resolves difference between the House and Senate. Amendments that passed in one chamber but not the other are traditionally rejected at this step. However, the self-imposed deadline to finish the budget has come and gone, and it looks like the whole thing is being held up as the House and Senate squabble over other bills, including what to do about the Hospital Provider Fee.

The budget is only one of hundreds of bills introduced this session. Five bills backed by Lt. Gov. Lynne are in play, and all feature bipartisan sponsors – thanks mostly to Senate Republicans Don Coram and Larry Crowder. The proposals are:

  • House Bill 1235, which would create a short-term “financial relief program” for people who spend more than 15 percent of their household income on health insurance premiums. To qualify, their income would also have to be between 400 percent and 500 percent of the federal poverty line, which is just above the level where federal subsidies for premium assistance end. In its first hearing, the bill was amended to reduce its projected $13.2 million cost to $5.7 million. It picked up the support of five rural Republicans (Reps. Jon Becker, Marc Catlin, Kimmi Lewis, Yeulin Willett and Bob Rankin) on its final vote in the chamber. Yesterday it was introduced in the Senate, and assigned to the State, Veterans and Military Affairs Committee, which traditionally functions as the “kill committee.”
  • HB 1236, which would require the Department of Health Care Policy and Financing (HCPF) to prepare an annual report on the finances of individual hospitals. Sponsors say the bill is an important step for increasing transparency. Rep. Phil Covarrubias (R) joined with Democrats to pass the bill out of committee, but voted against it on the House floor. It’s through its first chamber with the support of all Democrats and Rep. Rankin, and like HB 1235, has just been assigned to the Senate’s State Affairs Committee.
  • HB 1237, which would allow local governments to provide insurance to their employees through plans currently reserved for employees of the state. Sponsors believe this would give local government workers access to more affordable coverage. The bill passed its House committee on a party line vote with Democrats in support, and is poised to pass the full House.
  • HB 1286, which would require insurers that contract to cover state employees to do three things: participate in Connect for Health Colorado, offer plans in two counties in a high-cost geographic area of the state, and participate in both Medicaid and Child Health Plan Plus (CHP+). Like HB 1237, it was approved on a party line vote in its House committee and is about to come up for a final vote on the House floor.
  • HB 1318, which would require insurers to report about pharmaceutical costs and expensive drugs to the state Division of Insurance. Continuing our theme, this bill passed a House committee with only Democratic support and is awaiting a final vote of the full House.

The fate of these bills, if all pass the House, depends heavily on their Senate committee assignments, which may or may not include their Republican sponsors. Neither Crowder nor Coram sits on State Affairs, and the assignment of HB 1235 and HB 1236 to that committee almost certainly means that they won’t advance. In an unusual move, Lynne has testified in support of all five bills, but her encouragement can only take them so far.

And we can’t forget the elephant in the healthy policy room. SB 267, also known as the “Sustainability of Rural Colorado” bill, was introduced with bipartisan support on March 27. The bill would accomplish the long-sought goal of Democrats to remove Hospital Provider Fee revenue from beneath the Taxpayer Bill of Rights (TABOR) cap, thereby avoiding TABOR refunds and sparing cuts to hospitals. But it comes with serious concessions to Republicans concerned about reining in state spending, including an across-the-board budget cut of two percent for all state departments, and a decrease in the TABOR cap of $670 million – essentially negating any wiggle room the state would gain from the provider fee change. The legislation also includes more help for rural areas.

SB 267 passed its first committee, Senate Finance, by a 4-1 margin on April 11 after hearing from supporters from businesses, schools and colleges, and hospitals. Only committee chair Tim Neville (R) opposed it, but the other committee members were cautious in their support. Sen. Lois Court (D) said she had “grave concerns,” and Sen. Andy Kerr (D) pointed out that the bill is much more complicated than last session’s proposed provider fee fix. Sen. Owen Hill (R) stressed that his support for the bill could change as it moved forward, but that legislators must do more for rural Colorado and the bill accomplishes that.

Since then, the bill has been stuck, but it came up this morning in Senate Appropriations with little notice. When it seemed doomed, the sponsor, Sen. Jerry Sonnenberg (R), asked to delay the vote until the committee’s next meeting. With three weeks left in the session, time is of the essence, but SB 267 may have been caught up in the standoff over the budget – and now it seems to be among the major bipartisan bills set to fail.

We’ll be back with updates on items such as the Accountable Care Collaborative (the subject of a pending late bill from members of the JBC), the budget, the provider fee compromise and spotlights on topics like pharmaceutical legislation. We might also share our thoughts on that Unicorn Frapp.

 You only live once, right?