The Public Health Policy Playbook
You know you’re a health policy nerd when the back-and-forth action of this spring’s NCAA basketball tournament reminds you of public health legislation in Colorado. Wondering how action on the court translates to action at the state Capitol? I’ll explain.
Republicans and Democrats have taken turns advancing their offensive playbooks by introducing public health bills over the past couple years. But opponents have played solid defense, blocking the easy lay up to the governor’s desk.
This trade-off has persisted for the past couple of years, likely due to split control of the state legislature.
CHI has been tracking various public health bills, including legislation introduced in the current session.
When we talk about public health bills, we are focusing on bills designed to promote health among a population. Many bills in 2018 fit this definition, including legislation addressing the opioid crisis, suicide prevention, and marijuana use and regulation. Here’s a sampling of the public health bills I’ve been tracking in my legislative bracket:
At-Risk Populations
House Bill 1006: Infant Newborn Screening
This bill would make two updates to the Infant Newborn Screening program. It would require all birthing facilities to ensure that hearing screenings are complete within 30 days and allow the Colorado Department of Public Health and Environment (CDPHE) to assess a fee to cover costs of the program that will be put in a cash fund. Status: Amended version referred to House floor for debate.
HB 1046: New Birth Certificate to Reflect Gender Change
HB 1046 was introduced to allow people born in the state of Colorado to receive a new birth certificate if someone identifies with a different gender than what is indicated on their original birth certificate — and to do so without a court order confirming a surgical procedure. Status: Sponsored by Democrats, this bill was killed by the Republican-controlled Senate State, Veterans and Military Affairs Committee.
Senate Bill 74: Designate Prader-Willi Syndrome as a Developmental Disability
SB 74 was introduced to support people who have Prader-Willi Syndrome, a rare genetic disease that affects a person’s ability to feel full after eating, as well as causing other cognitive and physical disabilities. It allows people to receive services and supports that are currently available to those with intellectual or developmental disabilities. Status: Signed by Governor.
SB 13: Expand the Child Nutrition School Lunch Protection Act
Kindergarten through fifth grade students in public schools who are eligible for reduced-price lunches can receive free lunch through the Child Nutrition School Lunch Protection program. This bill expands the program through eighth grade. Status: In Senate Appropriations.
Population Health Bills
SB 53: Primary Offense for No Safety Belt
Current law does not allow a police officer to pull over drivers and cite them for failure to wear a seatbelt, unless the person was pulled over for a different traffic violation. SB 53 would have changed this to allow a police officer to stop and write someone a ticket solely for not wearing a seatbelt — including back seat passengers. Status: Sponsored by Democrats, SB 53 was voted down by the State, Veterans and Military Affairs Committee.
HB 1223: Declare Autism Epidemic in Colorado
HB 1223 directs the Department of Public Health and Environment to create a committee to research and decide if there is an autism epidemic in Colorado. If the committee determines there is an epidemic, funding and programs would be put towards a commensurate response. Status: This bill has not made it to committee yet, but it has a tough battle ahead. Its original sponsor, Steve Lebsock (D), was expelled from the House earlier this year following sexual harassment allegations.
Suicide Prevention Package
Three bills have been introduced during the 2018 session to address high suicide rates in Colorado: SB 114, SB 153 and HB 1177. The two Senate bills, one with bipartisan sponsorship and one backed exclusively by Democrats, failed in the State Affairs Committee, while HB 1177, which has bipartisan sponsorship, narrowly passed House Appropriations on April 17. Check back soon for a blog about these bills.
Opioid Crisis Package
A special legislative committee introduced six bills to respond to the growing number of Coloradans dying from drug use. Five of these bills are still standing — read this blog from CHI’s behavioral health expert Teresa Manocchio for more on the bill package.
Miscellaneous
As usual, plenty of bills aim to regulate the marijuana and tobacco industries in Colorado. Notably, the issue of immunizations — a legislative hot topic as recently as last year — has not surfaced in any 2018 bills.
The Defensive Battle of Public Health Legislation
Looking back to the 2016 and 2017 sessions, new policies related to public health from both the left and the right have had little success getting to the governor’s desk. Among them:
- The Student Exemption for Immunization (SB17-250): Sponsored by Republicans, the bill failed on the Senate floor during second reading — a rare outcome. It would have allowed parents to complete an immunization exemption letter that would make it easier for students to attend schools without getting vaccinated.
- Contraception Coverage Public and Private Insurance (HB16-1294): Sponsored by Democrats, this bill to expand access to contraception failed to get Republican support in committee.
- Nicotine Products Warning Label (HB16-1137): This bill was sponsored by members of both parties but failed to get enough support from either party to move it out of committee. It would have required all nicotine products that are used with electronic cigarettes to have warning labels about addictive nicotine.
But what about the funding?
It’s impossible to separate policy from funding. While the state has provided some stability to public health programs lately, the federal government has created major uncertainty.
Public health budget items that caused heated debate in previous years passed this session with ease. Programs such as the long-acting reversible contraceptive initiative, school-based health centers, the Healthy Kids Colorado Survey and the Colorado Immunization Information System were approved in the 2018 budget.
But as state legislators and health policymakers learned last year, it is hard to ignore the federal government. Public health officials are feeling whiplash from the funding status of the federal Prevention and Public Health Fund (PPHF) over the past five months. An overview:
- December 2017: Congress approved cutting PPHF funding to make up for the cost of the Children’s Health Insurance Program (CHIP) as part of the Tax Cuts and Jobs Act.
- February 2018: But the Bipartisan Budget Act eased these cuts in the short term by restoring funds for fiscal year 2019-2021. After that, long-term reductions would result in the PPHF losing a total of $1.35 billion over the next 10 years.
- March 2018: The 2018 omnibus spending package that funds the federal government through September restored PPHF funding for the rest of the fiscal year. This package also provided money specifically for fighting the opioid epidemic.
Federal funding for the PPHF remains stable for now — which is good news for Colorado, as our state received nearly $9 million in PPHF funds in 2016 to pay for programs such as immunizations and chronic disease prevention.
While Colorado seems steady in its public health funding and major policy initiatives, an evolving cast in the Trump administration may push for some big changes. Among them: A new Centers for Disease Control and Prevention (CDC) director who previously advocated for policies to segregate HIV-positive soldiers; a Health and Human Services (HHS) Secretary who was previously the president of a large drug company that hiked diabetes medication prices; and a new Chief of Staff to the Assistant Secretary of Health who has stated her desire to fund abstinence-only education.
As 2019 budget negotiations begin, all eyes will be on the Trump administration’s proposed budget, which calls for large cuts to the PPHF. Tumultuous times may be coming, but our state legislators have shown a willingness to play man-to-man defense to protect key public health programs.
Find Jalyn Ingalls on Twitter: @CHI_JIngalls
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