Abortion, Behavioral Health, and Cost Control: The ABCs of the Legislative Session

Spring is officially here. The sun is shining into the evening, March Madness basketball games are well underway, and the Colorado legislative session is past its halfway point. Today marks Day 74 of the 120-day working period.

Legislators are about to turn their attention to the annual state budget bill, sending a message about Colorado’s priorities. Before the budget debate begins in the Senate next week, CHI’s legislative team is reflecting on the topics and stories that have headlined this year’s session so far. Many of the year’s most anticipated bills are related to health, and many have been introduced in the past few weeks.

Mental Health and Substance Use

The calls for more resources and creative solutions for behavioral health needs reached a crescendo early in the COVID-19 pandemic, and they have stayed loud ever since. Notable bills in this area include House Bill 1003, which would stand up a state-run mental health screening program available to some public schools serving students in 6th through 12th grades. The bill has been scaled back through amendments to slash its $17 million General Fund price tag, reducing the number of schools that would qualify for screenings. Legislators also removed funding to support the existing I Matter program, which provides up to six free therapy sessions per year for Colorado youth. HB 1003 has passed the House and is on to Senate.

HB 1071 allows certain licensed psychologists to prescribe and administer psychotropic medications in collaboration with a physician or advanced practice registered nurse, with the goal of further expanding access to mental health treatment. Governor Jared Polis has signed the bill into law.

Among the session’s most controversial bills: HB 1202, which would allow local governments to authorize overdose prevention centers. In addition to offering access to harm reduction services, these centers would provide a sterile, monitored setting for people to use previously obtained controlled substances, such as fentanyl. Like HB 1003, the bill passed the House after extensive debate and heads next to the Senate. Its future in that chamber, where Democrats’ margin of control is slimmer, is uncertain, and the governor may also have reservations.

Reproductive Health Care

Even before the U.S. Supreme Court overturned Roe v. Wade in June 2022, Colorado Democrats were vowing to strengthen the state’s protections for access to reproductive health services, including abortion. A bill package introduced on March 9 would do just that. The three bills, all starting in the Senate, are:

  • Senate Bill 188, which would codify protections for health care providers delivering reproductive health care or gender-affirming health care services in Colorado. This includes strengthening insurance protections and adding these providers to the list of professionals protected from doxing, or having their identifying personal information posted online.
  • SB 189, which would expand insurance coverage requirements for services from breast and cervical cancer screenings to abortion and create a grant program to cover contraceptive costs for minors. It would also make changes to Medicaid benefits.
  • SB 190, a measure that would crack down on false advertising for abortions or emergency contraceptives and make providing medication abortion reversal, which the bill refers to as “a dangerous and deceptive practice,” an unprofessional conduct violation for regulated health providers in Colorado.

Insurance carriers have raised concerns about SB 189 over the feasibility of further benefit expansions. The package passed the Senate this week and is headed to the House.

Addressing Gun Violence

The Club Q shooting in Colorado Springs in November added momentum and urgency to the push for more gun control in Colorado, which is increasingly seen as a public health issue. Democrats introduced a package of bills on February 25 that includes creating a three-day waiting period for all gun purchases (HB 1219), removing barriers to suing firearm manufacturers (SB 168), increasing the age to purchase a gun to 21 (SB 169), and expanding the list of who can ask a court to temporarily remove someone’s guns through a “red flag” or Extreme Risk Protection Order process (SB 170). All four bills are moving through the legislature and are now in their second chamber.

On March 3, two Democrats introduced a bill to ban assault weapons (HB 1230). This measure is the most controversial, so it was not grouped with the others in the bill package. Other states that have enacted similar policies have faced an uphill battle with lawsuits, adding to concerns and skepticism from some. Among HB 1230’s sponsors is Senator Rhonda Fields, who lost her son to gun violence almost 20 years ago. It is awaiting a date for its first hearing.

Health Care Cost Control

It wouldn’t be a legislative session without more proposals for curbing health care costs. Proponents argue these measures would not only help consumers’ wallets, but improve their access to care.

A bill package introduced on March 2 seeks to broaden state authority for cost control. HB 1224 would make changes to the Colorado Option, the state’s new standardized health benefit offered by private insurers. The shifts would include allowing the Commissioner of Insurance to set limits on carriers’ administrative costs and profits for Colorado Option plans. HB 1225 also focuses on an existing program, the Prescription Drug Affordability Board. Changes range from implementation improvements to an increase in the number of drugs for which an upper payment limit can be set each year; the number is currently capped at 12 drugs. HB 1226 continues a focus on transparency from past sessions. It would require hospitals to disclose more information on revenues and expenditures and allow the Department of Health Care Policy and Financing to impose fines for noncompliance. The bill would also require more plain-language descriptions of hospital services for patients.

Hospitals are on their heels with two other bills, though one is being scaled back substantially. As introduced, HB 1215 would prohibit hospital-affiliated providers from charging facility fees for off-site or telehealth services. Hospital representatives said the change would hurt their bottom line and ultimately their patients, including those enrolled in Medicaid, and lobbyists now indicate the bill will be significantly amended to require a study of facility fees rather than make the policy change. HB 1243 aims to strengthen hospital community benefit requirements. Currently, there is little enforcement of hospital spending on community improvements; the bill would require more reporting and stakeholder feedback opportunities. Specifics on minimum spending requirements in the bill are still evolving.

An honorable mention: HB 1209 calls for model legislation and a quick-turnaround study, led by the Colorado School of Public Health, of a statewide publicly financed single-payer health care system. Could the state soon see another ballot measure proposing this kind of system, after Amendment 69 lost by an approximately 4-1 margin in 2016? That feels like a long shot, but Colorado’s political dynamics have shifted since then.

CHI will continue to monitor legislative developments until the session concludes on May 6. After that, keep an eye out for our annual recap report, Legislation in Review.