Win, Lose or Draw: Who Fared Best in the Legislative Session

At the beginning of the legislative session 120 days ago, it looked like Colorado hospitals had been dealt a bad hand. Legislators were gunning at the freestanding emergency rooms several hospital groups have been opening around the Front Range, the lieutenant governor wanted to open hospitals’ finances to public inspection, and worst of all, they were facing a $260 million funding cut through plans to shrink the Hospital Provider Fee.

But as Kenny Rogers taught us, every hand’s a winner, and every hand’s a loser. With the 2017 legislative session just hours from its ending, hospitals top our list of winners.

Here’s our take on how different groups fared in health policy during this year’s session.

Winners

• Colorado hospitals. They averted a massive funding cut thanks to Senate Bill 267, arguably 2017’s most complex, comprehensive and controversial proposal. It takes the Hospital Provider Fee out from under the Taxpayer’s Bill of Rights (TABOR), a move that eliminates the annual threat of cuts to a program that many hospitals have come to depend upon. Hospitals also secured the defeat of House Bill 1236, an attempt by the governor’s office to open their finances to greater public scrutiny. And they saw one bill to crack down on freestanding emergency rooms die early in the session, while a rumored second bill was never introduced.
• Public health. Advocates for immunizations, family planning and health surveys all won funding battles this year, fending off serious challenges from conservatives who wanted to reduce or end the state government’s role in those initiatives.
• Moderate Republicans. When former Sen. Ellen Roberts (R) retired last year, we wondered who would play the role of moderate in a solidly conservative caucus. Turns out plenty of Republicans were willing to step into the role. Sen. Don Coram, Sen. Larry Crowder, Sen. Beth Martinez Humenik, Rep. Phil Covarrubias, Rep. Bob Rankin and Rep. Marc Catlin are a few, but certainly not all. Collectively, this crew did more to venture across the aisle on high-profile votes than any others , regardless of party.

Losers

• Western Slope insurance customers. Individual market insurance prices in western Colorado are among the highest in the nation, and only one or two companies offer policies in most western counties. Bills attempting to boost competition (HBs 1237 and 1286) and extend subsidies to middle class people who make too much to qualify for Affordable Care Act tax credits (HB 1235) both failed in the Senate State Affairs Committee. It’s the second straight year that the efforts of Western Slope legislators to find relief for their constituents have come to naught.
• TABOR traditionalists. SB 267 takes the Hospital Provider Fee out from under the TABOR revenue cap. The large program had been pushing the state above the TABOR cap and mandating tax refunds. Removing this program from TABOR is likely to eliminate those refunds for the next several years. That explains why 10 Senate Republicans and 16 House Republicans voted against the plan — even though the bill includes several items that have been on the conservative wish list for years, including a business personal property tax cut, increased Medicaid copayments and an across-the-board 2 percent budget cut for state agencies.
• The power of leadership. SB 267 was backed by senior leaders of both parties in both chambers. But until a last-minute breakthrough, it was on the rocks. And another bill for transportation funding died in a Republican-controlled Senate committee, despite its sponsorship by Senate President Kevin Grantham. Maybe the leader’s gavel just isn’t what it used to be.

Breaking Even

• Insurance companies. They faced a sustained assault of bills to crack down on some business practices that have irked patients and health care providers. They fought off some and saw others pass, as detailed in a May 9 blog by my colleague Ian Pelto.
• Lieutenant Governor Donna Lynne. In her first year in office, Lynne made a splash by involving the governor’s office in health policy to a degree not seen in years. She helped coordinate legislation to increase hospital transparency, boost competition in rural insurance markets and extend subsidies for customers with costly health insurance — and grew her own profile in the process. All the bills had bipartisan sponsors, and they passed the House. But for all Lynne’s work, she didn’t convince Grantham, the Senate president. He assigned the bills to the Senate State Affairs Committee, the place that leadership sends bills to be killed. No surprise – they all died.
• Colorado’s Medicaid program. It went almost unnoticed, but nearly every House Republican voted to repeal Colorado’s Affordable Care Act Medicaid expansion during the debate over the state budget. At the same time, a major Medicaid initiative received greater scrutiny but ultimately endorsement from the legislature. HB 1353 gives some additional legislative oversight to the Accountable Care Collaborative. It passed with a strong 33-2 majority in the Senate but a more partisan 39-26 vote in the House.

Missing the legislative session already? Take heart. We’re hard at work on CHI’s annual session wrap-up report, Legislation in Review. That publication discusses the most notable themes, debates and bills related to health this year. Watch for it in early June.

And keep watching this blog in the coming days as we dive deeper into some of the health issues that legislators considered this year.

Thanks for following along with us this year. Get some rest — before you know it, it will be time to shuffle the deck and deal the cards again.