Let's go Crazy, Let's go Nuts: Your Friday Legislative Blog

Thirteen weekdays (and three more CHI blogs) remain in this legislative session. Nearly 650 bills have been introduced, and at last count, fewer than 100 have crossed the finish line and received a signature from Governor Hickenlooper. That means a lot of bills have either died or have yet to be decided.

We’re continuing with our new format, which looks at five notable votes from the past week and previews three to watch in the coming week. We do this so you don’t have to. Sometimes, finding updates on bills is about as intuitive as figuring out how to pronounce the symbol that Prince used for his name in the ‘90s. (RIP Prince.)

Without further ado, your top five recent health policy votes are:

House Bill 1336 

  • What the bill proposes: HB 1336 would direct the Division of Insurance to study the idea of getting rid of the state’s nine geographical ratings areas, which are used to determine the cost of insurance premiums. It is sponsored by three Democrats and two Republicans, all of whom represent western counties.
  • What happened: The bill passed the Senate with bipartisan support on a vote of 25-9. It just needs final approval and a signature from Governor Hickenlooper to become law.
  • Why we chose it: In addition to drawing bipartisan agreement (it earlier passed the House 54-11), HB 1336 has appealed to legislators from different parts of the state, but especially those from mountain and western areas. Residents of Colorado’s Western Slope counties saw their insurance premiums rise an average of 25 percent this year, so it’s easy to understand their frustration. Insurance companies, however, will argue that the Affordable Care Act already limits their ability to raise prices, and that this bill would take one of three remaining permissible factors – location – away. (Insurers could still base premium pricing on an enrollee’s age and smoking status.) We’ll be interested to see what the DOI’s study finds. One likely takeaway: The move to a single rating area, while helpful for lowering costs in the mountain regions, would increase them for residents in other areas.

House Bill 1390 

  • What the bill proposes: HB 1390 would prevent people who report an emergency drug or alcohol overdose from being arrested or prosecuted. In addition, the bill would expand immunity protections for people who overdose and need immediate medical attention. It is sponsored by Rep. Dominick Moreno (D) and Sen. Lucia Guzman (D).
  • What happened: The bill passed the House on a vote of 58-6 with the support of all Democrats and most Republicans. It moves to the Senate, where it will be heard by the Judiciary Committee next week.
  • Why we chose it: HB 1390 is a revised version of an earlier bill (SB 42) that failed. While similar to SB 42, HB 1390 simplifies the proposed changes, and so far it’s seen success. Substance use and overdose deaths have been a hot topic in Colorado recently, especially as they relate to opioid use. (If you missed CHI’s map showing county overdose deaths from 2002 to 2014, you can view it here.) The growing number of drug-related deaths has many people desperate for solutions. This bill is walking a fine line between providing a safety net for people in vulnerable situations and, in the eyes of some, failing to adequately hold people accountable.

 House Bill 1097

  •  What the bill proposes: HB 1097 would create a new carrier category for people who provide non-emergency transportation for Medicaid clients. Other carriers include charter buses, fire crews, luxury limousines and off-road scenic tours, which all require permits to operate. The bill would authorize the Department of Health Care Policy and Financing (HCPF) to transfer Medicaid funds to the Public Utilities Commission to help pay for these drivers’ permits. It is sponsored by Reps. Don Coram (R) and Dominick Moreno (D), and by Sen. Ray Scott (R).
  • What happened: Like HB 1390, this bill passed the House with strong bipartisan support and is on to the Senate. The final House vote was 64-1. Its next stop is the Senate Transportation Committee.
  • Why we chose it: Look, Republicans and Democrats do agree on things! We don’t spend much time looking at transportation issues, but this bill would collect fingerprints and run criminal background checks on those who transport Medicaid enrollees for care. Such people provide an important service. After all, if clients can’t get to an appointment, they definitely can’t receive medical attention. But legislators have been backing most health care regulatory measures in 2016. You can read more about non-emergency transportation options for Colorado Medicaid clients here.

House Bill 1360 

  • What the bill proposes: HB 1360 is about oversight of direct-entry midwives by the Department of Regulatory Agencies (DORA). These midwives enter the field by apprenticing with practicing midwives, which differentiates them from certified nurse-midwives, who train formally through an accredited program. The bill would continue DORA’s oversight of direct-entry midwives and make recommended changes to their allowed scope of practice, such as authorizing them to give stiches and local anesthetics for basic procedures. It would also convene a working group to report on ways to minimize risks in midwifery practice. HB 1360 is sponsored by Reps. Lois Landgraf (R) and Susan Lontine (D), and by Sen. Kevin Lundberg (R).
  • What happened:  he bill passed the Senate Health and Human Services Committee unanimously.
  • Why we chose it: Like the physician assistant bill we profiled last week, this proposal deals with health professionals’ “scope of practice,” or the types of work they are allowed to perform. However, it’s also one of many examples of the legislature seeking to maintain or increase regulation over some health professions. Unlike other regulation-focused bills, this one seems to be more about making life easier for practicing midwives, not reacting to negative media attention. (We’re looking at you, HB 1160 and HB 1320.) HB 1360 has attracted quite a bit of attention, and it required nearly three hours for testimony and discussion yesterday.

 House Bill 1047

  •  What the bill proposes: HB 1047 would allow the governor to enter into an interstate compact to allow licensed doctors in other states to gain expedited licensure in Colorado, as well as other member states. This might sound like a simple proposal, but the bill is a whopping 32 pages long. It is sponsored by Reps. Perry Buck (R) and Faith Winter (D), along with Sens. Linda Newell (D) and Ellen Roberts (R).
  • What happened: After being amended slightly, the bill passed the Senate Health and Human Services Committee by a 4-1 margin. Sen. Lundberg was the only “no” vote.
  • Why we chose it: Legislators love efficiency, and “expedite” is basically a synonym for “efficiency.” But this bill’s movement through the legislature has been far from expeditious. It was introduced on the first day of the session but only made it through one committee hearing in the following 10 weeks. It’s on the move now, and judging from its popularity in the House – which passed it 63-2 – it’s up for a positive reception in the Senate. In a world where many doctors relocate and where anxiety is growing about physician shortages, this bill is an attempt to ease red tape for doctors and improve access for patients.

Many bills are awaiting votes. We’re keeping an eye on proposals like House Bill 1420 (converting the Hospital Provider Fee to an enterprise), which is supposed to get its moment in the sun on Monday, but may not. Similarly, House Bill 1101 (allowing doctors to make decisions for unrepresented patients) and House Bill 1164 (putting the state health department in charge of reviewing student immunization exemptions) have faced delay after delay.

We’re highlighting these three upcoming votes, which we think will actually happen.

 House Bill 1435

  • What the bill proposes: HB 1435 would create a public benefits enterprise under HCPF to impose fees on large, low-wage employers who do not offer health insurance. The fees would be used to offset Medicaid costs paid by the state to cover employees. It’s a pretty long and complicated proposal, so you may want to read the bill for more information. The bill is sponsored by a long list of Democrats, led by Reps. Crisanta Duran and K.C. Becker as well as Sens. John Kefalas and Jessie Ulibarri.
  • Who will be voting: The House Health, Insurance and Environment Committee.
  • Why we chose it: This bill was generating media attention before it was even introduced. (See Examples A and B.) It’s sure to lead to partisan debate in its first committee hearing next week. We’ve seen many bills dealing with the Medicaid program this session, as its costs have swelled along with its enrollee numbers following an expansion of the eligible population. The bill’s all-Democrat sponsor list is pointing a finger at low-wage employers as a major source of the problem. This seems destined to be a “statement bill.”

 Senate Bill 147

  • What the bill proposes: SB 147 would make Colorado the first state to implement an ambitious prevention model to address suicides, known as the “Colorado Suicide Prevention Plan.” It is sponsored by Sens. Linda Newell (D) and Beth Martinez Humenik (R), and by Rep. Brittany Pettersen (D).
  • Who will be voting: The House Health, Insurance and Environment Committee.
  • Why we chose it: For years, our beautiful state – with plenty of sunshine, outdoor opportunities, and communities on America’s “best places to live” lists – has been plagued by a high suicide rate. Sen. Newell, who is term-limited, and others have made addressing the issue a priority, and they believe SB 147 sends an important message. This proposal had originally been titled the “Zero Suicide Plan,” but that language was changed to emphasize prevention (and fewer ties to an existing national model) through an amendment. At first, the program lacked any money to implement the new measures, but it has since picked up $100,000 in funding through the budget process. Only six senators voted against SB 147. Will it be similarly popular in the House?

 House Bill 1374

  •  What the bill proposes: HB 1374 would direct freestanding emergency rooms – those that are not attached to a hospital – to use large signage to notify the public about potentially high costs and clarify the difference between an ED and an urgent care clinic. It is sponsored by Rep. Beth McCann (D) and John Kefalas (D).
  • Who will be voting: The 65 members of the House, following a debate on the floor.
  • Why we chose it: We talked about this bill in more detail last week, but the two upcoming votes on the House floor will reveal whether the proposal – originally a source of bipartisan agreement – has picked up any support from Republicans. Monday’s second reading will showcase representatives’ arguments on both sides, and if it passes then, the third and final reading should tell us if HB 1374 has any chance of making it through the Senate.

The six members of the Joint Budget Committee introduced several bills as a team this week. Two of them caught our eye.

  • Senate Bill 191 would allocate about $2 million from the marijuana tax cash fund to cannabis research at CSU-Pueblo. Among other research, the university would extend an existing study of the effects of retail marijuana on local law enforcement. SB 191 would also give about $80,000 to the Department of Public Safety for an ongoing study of legalized marijuana implementation.
  • Senate Bill 192 would direct HCPF to choose and begin using a “needs assessment tool” for people who receive long-term services and supports. The goal is for the new tool to allow eligibility reassessments to be completed within 30 days of when they are requested.

Don’t let those elevators try to bring you down today – unless it’s on your way out of work. Enjoy the beautiful weekend.