UPDATE: Most Health Programs Survive Senate

Thursday 1:30 p.m. Update: Most Health Programs Survive Senate

Public health advocates are breathing easier this afternoon, now that the Senate has wrapped up its debate on amendments to the Long Bill.

A number of public health programs survived defunding attempts in the Senate, although the chamber did strip about $300,000 from the Colorado Department of Public Health and Environment (CDPHE) for its work in enforcing President Obama’s Clean Power Plan.

A group of Senate Republicans attempted to strip $2.5 million from CDPHE’s program to provide long-acting reversible contraceptives. But four Republicans joined all 17 Democrats to oppose the move, and it failed 14-21 today.

The same group of conservatives attempted to remove $1 million in funding for an immunization registry that the legislature provided last year. They also targeted funding for the Healthy Kids Colorado Survey, arguing that the questions are too explicit and violate parents’ rights to raise their children. But both amendments failed in debate Wednesday afternoon.

CDPHE, however, still finds itself mired in the biggest remaining point of contention over the budget: Obama’s clean air rules. Senate republicans voted to cut about $300,000 from the governor’s requested budget for the Air Pollution Control Division, which enforces federal air quality rules. The Supreme Court has put the Clean Power Plan on hold, and Republicans say it will force coal mines to go out of business.

The Joint Budget Committee will meet next week to iron out differences between the House and Senate versions of the budget. But look for the real decision on the air pollution budget to be made behind the scenes in negotiations with senior Democrats and Republicans and the governor’s office.

This post concludes our rolling budget blog. We will post budget updates next week in our regular legislative blog. Thanks for following along.

Friday 3 p.m. Update: Movin’ On Up, to the South Side (of the Capitol) 

Someone get the JBC some champagne: The Long Bill has officially passed the House.

The budget bill advanced on its final vote this morning by a 39-26 margin. All 34 Democrats voted in favor, joined by five of the House’s 31 Republicans. Four of those five Republicans represent Colorado’s Western Slope,  and one of them is a member of the JBC. The remaining Republicans voted against the budget.

Now it’s the Senate’s turn. The process will be the same: Senators will review the bill next week and propose amendments, which can include undoing any of the changes approved by the House.

Once the Long Bill is voted out of the Senate, it goes back to the JBC, which acts as a “conference committee” to reconcile any differences between the two chambers. That committee tends to leave amendments that were approved by both the House and Senate, but otherwise takes them out. That’s why the final budget usually looks very similar to what is first introduced by the JBC.

This is our 12th and final blog post on Budget Week in the House. Thanks for following along with us. We’ll report on what happens in the Senate next week. We’ll also recap recent votes on non-budget bills, which have continued to move through both chambers in the shadow of the Long Bill.

Less than 30 work days remain in the session. Can we get some of that champagne, too?

Friday 11 a.m. Update: Want to Change the Budget? Good Luck.

The House considered 37 amendments to the Long Bill yesterday. It was nine hours of argument, persuasion, indignation and a little humor. The amendments came from both Democrats and Republicans who wanted to make changes to the JBC’s funding decisions, or at least make a statement.

Six amendments passed on a voice vote — legislators simply yell “aye” or “no” in unison — but two of those later failed when the House took a recorded vote.

Next week, senators can either leave the remaining four amendments in place or strip them from the budget bill and start all over with their proposed changes.

We were particularly interested in nine of the amendments discussed yesterday. All nine failed, but we might see them again in the Senate.

• Amendments One and Two, from Rep. Bob Rankin (R), would have reduced funding for CDPHE’s Air Pollution Control Division, which has been the subject of much debate this week. (See our recent post about CDPHE for more background.)
• Amendment 14, from Rep. Lois Landgraf (R), would have defunded CDPHE’s anti-marijuana “trusted adult” ad campaign and shifted the funds to programs for dropout prevention and marijuana-impaired driving prevention.
• Amendment 15, from Reps. Patrick Neville (R) and Kim Ransom (R), would have defunded the Healthy Kids Colorado Survey and shifted the funds to a dropout prevention program. Backers of the amendment read sample questions from the survey, which they say is inappropriate, likely inaccurate, and should require parental consent.
• Amendment 21, also from Reps. Neville and Ransom, would have banned funding for anything related to fetal tissue sales – a clear reference to Planned Parenthood. When House leaders determined that the amendment was not allowed as written, Neville showed his disapproval by asking that the entire Long Bill, which is nearly 600 pages, be read out loud on the floor. After a while, he withdrew the request.
• Amendment 28, from Rep. Neville, would have cut $1.2 million for electronic health record systems for local public health agencies and shifted the money to road construction.
• Amendment 29, from Reps. Neville, Ransom, and Kevin Van Winkle (R), would have cut funding for immunizations in CDPHE and shifted the money to road construction.
• Amendment 30, from Rep. Landgraf, would have taken $100,000 from the Colorado Commission on Affordable Health Care, or more than half of its funding, and shifted the money to transportation. (If you haven’t noticed, roads were a popular choice for additional money.)
• Amendment 31, by Reps. Ransom and Neville, would have defunded the state’s family planning program, which provides long-acting reversible contraception (LARC).

Other health-related amendments dealt with money for monitoring marijuana pesticides, funding for primary care doctors, contracts from the Program of All-inclusive Care for the Elderly (PACE) and the number of mental health professionals in state correctional facilities.

We’ll talk about the House’s final vote on the Long Bill later today and preview next week. Stay tuned.

Thursday 4 p.m. Update: Shift in Smokables Brings Changes for Health Programs

The Long Bill includes lots of funding from marijuana and tobacco. We’ve already mentioned a few of them, but that’s only scratching the surface.

What you should know in a nutshell: Tobacco revenue is decreasing while marijuana revenue is increasing, so going forward, some programs that have been funded by the former will get their money from the latter. While funding from the 1998 Tobacco Settlement Agreement is still expected to provide nearly $88 million in 2016-17, it is decreasing each year. In 2009, the agreement brought in more than $105 million.

Among the many things that the state’s growing marijuana taxes will fund next year: assistance for the homeless, cancer research, substance use treatment, research on the effects of legal marijuana, and even a new Institute for Cannabis Research in Pueblo. Two companion bills introduced with the Long Bill, HB 1408 and HB 1418, address how tobacco and marijuana tax money are allocated. And a failed House amendment debated earlier this afternoon proposed taking $900,000 in marijuana funds — used for monitor plants for pesticides — to fund a school dropout prevention program. Even with the growing funds from pot sales, there’s never enough to go around.

Thursday 1:30 p.m. Update: CDPHE: The Octopus of the Budget

The Department of Public Health and Environment (CDPHE) is a little fish in a big pond. With about $550 million, it makes up just two percent of the total state budget and even less of the General Fund. In health policy, however, this small-but-mighty department often finds itself at the center of contentious debates ranging from environmental regulations to kids’ immunizations.

CDPHE is really more of an octopus than a fish. Like a creature with many arms, the department juggles responsibilities as diverse as air and water quality, food inspections, family planning, emergency preparedness, and even tracking births, deaths, marriages and divorces. It’s all a cephalopod can do to keep up.

Money for CDPHE is holding steady next year, with the department expecting about a three percent increase in total funds despite a two percent drop in its General Fund allocation.

We’ve already touched on funding for long-acting reversible contraception (LARC). $2.5 million remains in the budget for LARC through a program that made national headlines when the legislature refused to fund it last year. 

A louder debate this week had to do with funding for CDPHE’s Air Quality Control Division. It didn’t receive any money from the JBC in the Long Bill. Sen. Pat Steadman (D), a JBC member, explained the issue this way: Republicans opposed to President Obama’s Clean Power Plan wanted budget cuts for this division. Then “Democrats on the JBC refused to vote for the cuts, the Republicans refused to vote for the base funding of the agency, and as a result [the funding] got left on the cutting room floor.” Democrats quickly remedied it in House Appropriations, adding money for the division back into the Long Bill. But when the House started discussing budget amendments today, the first one — from Rep. Bob Rankin (R), a member of the JBC — was a proposal to reduce air quality funding again. The amendment failed, and now it will be up to Senate Republicans to push the issue.

Preventing and treating substance use disorders is near the top of CDPHE’s priority list. It will receive more than $7 million from the Marijuana Tax Cash Fund for substance use prevention efforts in 45 Colorado cities.

Its budget also includes funds for research on the health impacts of marijuana use and the Colorado Commission on Affordable Health Care, which owes a report to the legislature this November. The commission asked for $400,000 but is getting $178,000 through the Long Bill. In addition, CDPHE will receive an added $1.8 million to improve the state’s emergency medical services through grants for ambulances, trauma equipment and recruitment efforts.

Looks for several Long Bill amendments this afternoon to target various parts of the department’s funding.

All in all, CDPHE has its tentacles full.

Wednesday 4 p.m. Update: Let's Explore DORA

The Department of Regulatory Agencies often gets overlooked in discussions of state government health care agencies. But it serves two important functions. DORA’s Division of Insurance oversees private health care coverage, and the Division of Professions and Occupations handles licensing and discipline for a variety of jobs, including health care workers.

The Long Bill would give steady funding to the Division of Insurance — $8 million and 85.2 full-time employees. That's hardly changed compared to the current budget.

The Division of Professions and Occupations also gets stable funding through the Long Bill — $17.9 million and 203.8 employees. However, a separate bill, HB 1160, would add $100,000 to the division’s budget for stricter regulation of surgical technicians. This bill has been in the news because a surgical tech at a Denver hospital exposed patients to disease when he stole medications and left dirty needles in their place. The bill will have to compete outside the Long Bill process for a very limited pot of money set aside for spending bills.

Wednesday 12:30 p.m. Update: Keeping Score on the Hospital Provider Fee

Several questions come to mind when we think about the Hospital Provider Fee:

1. What’s going on with the dueling bills?
2. Wait, what is the Hospital Provider Fee again?
3. Is there anything good on TV tonight?

Let’s take those question in reverse order:

3. No. So you might as well pay attention to the Hospital Provider Fee.

2. This is a fee the legislature created in 2009. Hospitals pay it to the state, and it draws down a federal match that pays for Medicaid expansion and administration. Hospitals make money on the deal because the fee revenue also pays for higher payments to hospitals. It’s a lot of money — around $1.5 billion. The trouble for the legislature is that half that amount counts toward the TABOR limit, which makes it more likely the legislature will have to pay for tax refunds instead of giving more to education, highways and other items.

1. There are two plans on the table to reduce the Hospital Provider Fee’s impact on the TABOR limit. One is the Long Bill. It reduces the size of the fee by $146 million (half from the state and half from the federal match), which will keep the state budget comfortably below the TABOR limit throughout the 2016-17 budget year. The second is HB 1420, by Speaker of the House Dickey Lee Hullinghorst and Sen. Larry Crowder (R). It would repeal the provider fee and replace it with an identical program that is not subject to the TABOR limit. Crowder is the only Senate Republican to publicly back this idea. He is worried that lower payments to hospitals from the Long Bill plan would hurt rural hospitals. But with Senate President Bill Cadman (R) firmly opposed, the most likely outcome is that this bill will die next week in a committee of Cadman’s choosing.

The consequences of each plan:

• The Long Bill plan: There would be no TABOR refund from the 2016-17 budget, but refunds could return in future years. Hospitals would see significantly lower “booster payments” for treating Medicaid patients.
• HB 1420: The Hospital Provider Fee would remain at the same level as today, with no cuts to hospital payments. It would remove the fee from the TABOR limit, which would eliminate TABOR refunds this year and probably for many years to come.

Keep an eye on HB 1420 this week to see if it gets any Republican votes in the House. (It didn’t in its first committee hearing yesterday.) GOP votes could help the bill overcome its big hurdle next week in the Senate.

Wednesday 10 a.m. Update: How This Works

It’s Long Bill day in the House. Today is the day set aside for representatives to debate the budget and try to make changes. A final House vote is scheduled for Thursday.

But amending the budget is not easy, and the bill that ultimately passes is probably going to be nearly identical to the one that was introduced Monday.

The JBC’s budget is balanced. That means legislators who want to add money for a favorite program have to find somewhere else to make a cut. So if you’re a representative who wants better funding for a public health program, you’ll have to cut something else, such as the prison budget. That won’t make you any friends in the Cañon City delegation.

Any changes the House makes this week can be undone by the Senate next week. And the Senate’s changes can be scrapped in a conference committee two weeks from now. So all the debate you will hear over the next two weeks isn’t likely to do much more than reshuffle one or two percent of the $10.5 billion general fund.

Tuesday 4 p.m. Update: Birth Control and the Budget

 The debate over funding for Colorado’s successful long-acting reversible contraceptive (LARC) program made national news in 2015, when the Republican Senate turned down $5 million in state money to keep the previously grant-funded program going.

This year, the JBC put $2.5 million into the budget for LARC and family planning. Rep. Bob Rankin (R) joined all three Democrats on the JBC to approve the funding back in February. There hasn’t been much of a fight since then. The JBC’s two Senate Republicans opposed the move, but they are standing behind the overall budget. And Senate Republican leadership hasn’t made any demands in public to remove the funding from the budget.

But LARC advocates, who have been laying low, are getting ready for a possible fight. The only way to get LARC out of the budget would be to amend the bill on the House or Senate floor. That amendment would be a long-shot in the House this week, but would stand a better chance in the Senate next week. Whether the legislature would then be willing to hold up the entire budget over a LARC funding fight is unclear. Stay tuned.

Meanwhile, many birth control debates continue at the Capitol this week in addition to the budget discussion.

Tuesday 1 p.m. Update: The Kids are All Right in the Dept. of Human Services

Next up in our series is the Department of Human Services (CDHS). It’s responsible for the state’s non-medical public assistance programs, such as child welfare services, alcohol and drug treatment initiatives, food assistance and programs for the elderly. It also operates two mental health institutes.

CDHS will see a small increase in its general fund allocation for next year, but a small decrease – about 1.5 percent – in overall funding. Two hundred and forty jobs in the vocational rehabilitation division are being transferred to the Department of Labor and Employment as a result of a 2015 bill (Senate Bill 15-239). Funding for the state’s Independent Living Centers, which serve people with intellectual and developmental disabilities, is being transferred along with it.

Helping kids is a big focus for CDHS in the Long Bill. The department’s budget includes an increase of more than $6 million for county child welfare case workers and aides. This is the second phase of hiring more child welfare professionals after a 2014 audit found a statewide shortage. CDHS will also see another $6 million for prevention and intervention services for the Division of Child Welfare, as well as an added $1.7 million for early childhood mental health services.

Other budget highlights include:

• An increase of almost $19 million for the Old Age Pension Fund that is needed to catch up with pension payments, which have outpaced the money set aside for them.
• About $6.7 million to cover growing costs for nursing homes for veterans.
• $500,000 for a program to improve access to psychiatric care on the Western Slope.

Big takeaways for CDHS: The decreases in funding and jobs here are deceptive since they represent a transfer of some services between departments, not their elimination. The state is prioritizing kids’ well-being and mental health services for all ages. And in a surprise to no one, supporting Colorado’s older population is expensive.

Tuesday 10 a.m. Update: Providers Fare Well in Health Care Policy and Financing Budget

Let’s start our look at health department budgets with the big kahuna, the Department of Health Care Policy and Financing (HCPF).

HCPF — fondly known as hic-puff — is one of the two largest departments in state government because it pays for Medicaid. HCPF will weigh in at more than $9 billion next year.

It will see a slight reduction in its bottom line from the current budget. It will get an additional $235 million to cover growing enrollment in Medicaid and other programs. But the JBC approved cuts for the hospital provider fee and reimbursement to health care providers.

Here’s what you need to know about HCPF:

Enrollment Growth Is Slowing: Medicaid enrollment is expected to grow 8.2 percent over the next fiscal year. That’s fast by historical standards, but a far cry from the 29.1 percent growth we’ll see this fiscal year because of the Affordable Care Act’s expansion of eligibility. Enrollment is projected to taper off even more next year, to 1.4 percent. This shows that HCPF is enrolling most of the state’s eligible population.

Hospital Provider Fee Back on the Table: This fee on hospitals attracts a federal match and brings nearly $1.5 billion into state coffers. That pays for expanded Medicaid coverage, as well as higher payments to hospitals that treat Medicaid and indigent patients. But the provider fee increased the likelihood that the legislature would have to pay for a TABOR refund. In response, the JBC reduced the amount of the fee by $147 million, a sum that includes the fees paid by the hospitals and the federal match. Speaker of the House Dickey Lee Hullinghorst (D) introduced a separate Hospital Provider Fee bill (HB 1420) that would convert the provider fee into an enterprise fund. The House will consider her bill during the budget debate. Check back later for an update about this fast-moving and complicated issue.

Reimbursement Rates a Mixed Bag: Hickenlooper in November proposed two pay cuts for Medicaid providers. First, he proposed a one percent cut to anyone who provides state services, including Medicaid (with an exemption for primary care doctors). Second, his budget did not include an extension of the “primary care bump” — an added payment that doctors have received for treating Medicaid patients since the passage of the Affordable Care Act. The JBC held steady on funding for providers overall, but it will stop funding the primary care bump, saving the state $145 million. However, a separate bill (HB 1408) will create a new primary care bump worth $20 million for some Medicaid providers. Altogether, that’s a mixed bag for Medicaid advocates who want to preserve incentives for doctors to see Medicaid clients.

Payment Reform Extended: A Medicaid payment reform pilot project will be extended. This pilot currently funds the Prime initiative by Rocky Mountain Health Plans, which integrates payments for behavioral and physical health and shifts away from the fee-for-service model. The nearly $600,000 in funding comes from a companion bill to the Long Bill, HB 1407.

Monday 4 p.m. Update: This is Why It's Called the Long Bill

The state government is filled with acronyms and code names that only insiders understand. To speak budget-ese, you have to know about 228 transfers, the Gallagher amendment, General Fund Exempt spending, and hundreds of other terms.

That’s why the unofficial name of the budget is so refreshing: the Long Bill. It’s named the Long Bill simply because it’s long. This year’s bill, HB 1405, is 581 pages.

Unfortunately, the name is just about the only simple thing about it.

Tomorrow, we’ll start looking in detail at the state departments that deal with health policy.

The state government is filled with acronyms and code names that only insiders understand. To speak budget-ese, you have to know about 228 transfers, the Gallagher amendment, General Fund Exempt spending, and hundreds of other terms.

That’s why the unofficial name of the budget is so refreshing. It’s named the Long Bill simply because it’s long. This year’s bill, HB 1405, is 581 pages.

Unfortunately, the name is just about the only simple thing about it.

Tomorrow, we’ll start looking in detail at the state departments that deal with health policy.

Original Post: Busting Through the Budget: A Long Bill Live Blog

It could have been a lot worse.

That’s the message you’re going to hear this week from the six legislators on the Joint Budget Committee (JBC) as they attempt to pass the state budget through the full legislature. The bill, House Bill 1405, was introduced today.

The JBC spent the past five months writing the state government’s spending plan, which covers July 2016 through June 2017. It started off on a depressing note last November, when Governor John Hickenlooper proposed cuts to K-12 education and colleges, as well as pay cuts for doctors and others the state pays to provide services. At the same time, many legislators, especially Democrats, chafed at the possibility of refunding nearly $300 million under the Taxpayer’s Bill of Rights (TABOR), which requires tax refunds when state revenue grows faster than inflation and population growth.

As recently as last week, things were still looking grim. Economists issued a forecast that features a slowdown because of the oil and gas bust and weak foreign economies that are hurting Colorado exporters. The state can expect less tax revenue as a result.

But the JBC managed to pull a rabbit out of its hat. The budget introduced today features:

• A modest increase of $156 million for K-12 schools.

• Stable pay for those who provide services in state programs such as Medicaid.

• No TABOR refunds.

Highways will get increased funding, too, but not as much as current law requires. The JBC will run a separate bill to allow the smaller increase. Changing the funding for highways allowed the JBC to balance the budget.

“We have a lot to be proud of as a committee. This could have turned out wildly differently,” said JBC Chair Rep. Millie Hamner (D).

For anyone concerned about health policy, the 2016-17 budget is highly important and highly complicated. Check this blog post throughout the week for details on what it all means. 

Although the JBC has been working on the budget since November, this week is the first time most legislators will get to vote on it. The first votes are scheduled for 7:30 Tuesday morning in the House Appropriations Committee. The full House will debate amendments and vote on the bill later this week. The Senate takes its turn next week.

“It’s just short of miraculous that we’ve got to this point, but folks, we’re not done,” said Sen. Pat Steadman (D), a veteran member of the JBC.

Check back soon for updates and details.

Legislative Director Allie Morgan contributed to this blog.