It seems like every state senator and representative is trying to pass a health care bill this session.
Republicans, Democrats and the new governor all put lowering medical costs toward the top of their to-do lists in 2019, and the result of that has been dozens of bills — some of them overlapping — that seek to lower the cost of health care in different ways.
“It looks like total scattershot,” said Rep. Dylan Roberts, a Democrat from Eagle who is behind several major health care bills this session. “But hopefully by the time we get to the end of the day on May 3, we will have passed a comprehensive package of bills that address all aspects of the health care industry.”
Some of them, however, hinge on getting support not only at the Capitol but also from the Trump administration.
1. Public option
Status: House Bill 4 passed the House.
One of the biggest proposed changes is for Colorado to develop a plan to basically sell health insurance to any resident who wants to buy it.
“Nobody is forced onto the plan,” Roberts said. “It’s not single payer at all.”
The bill, which he is sponsoring with Republican Rep. Marc Catlin, R-Montrose, requires the state to develop a plan for a public option and present it lawmakers by mid-November.
Fourteen of Colorado’s counties — mostly on the Western Slope — have just one health insurance plan for their residents who buy through the individual marketplace, and they pay some of the highest insurance premiums in the country. Roberts said adding another plan would be “a huge change for the people that live in those counties.”
The challenge for Roberts and Catlin is likely going to be convincing the White House.
The Affordable Care Act allows states to ask permission to try different ideas for lowering health care costs through something called a 1332 waiver. No state has one for a public option plan, and President Donald Trump already is trying to have the ACA itself declared unconstitutional.
2. Reinsurance
Status: House Bill 1168 passed its second reading in the House.
The easiest way to explain reinsurance is to say it’s insurance for insurance companies. Colorado would pay some of the medical bills for the most expensive patients on the individual insurance market, and in return insurance companies would lower the premiums for everyone in that market by as much as 30 percent.
To pay those medical bills, Colorado would ask the federal government for money by applying for a 1332 waiver and by charging hospitals a fee.
That’s different from the way states such as Alaska and Minnesota run their reinsurance programs, in large part because Colorado wouldn’t be spending any of its own money on the program.
“I frankly don’t think the federal government will grant a waiver under the conditions we are asking for,” Rep. Collin Larson, R-Littleton, said during a debate on the bill.
Larson thinks putting all the state costs on providers is asking too much from them and is likely to cause cuts in services. The bill’s sponsors disagree.
Rep. Julie McCluskie, D-Dillion, said hospitals across the state sat down with her in good faith and “crafted a policy that works for them.” The Colorado Hospital Association is neutral on the bill.
She has been working with the Colorado Division of Insurance and the federal government for weeks and is optimistic the state will get that 1332 before the end of the year.
3. Insulin prices
Status: House Bill 1216 is working its way through House committees.
About one in four insulin users ration their medication because they can’t afford the out-of-pocket costs, according to a 2018 study at the Yale Diabetes Center.
That’s why two Democrats and a Republican have sponsored a bill to limit to $100 the amount Coloradans with health insurance pay for insulin each month. Roberts is one of those Democrats, and he said it could save Coloradans up to $800 per month.
Insurance carriers would absorb those costs, and Roberts said the estimates he has seen show the price of health care plan increasing by “a couple of cents, per person, per month.”
4. Prescription drug prices
Status: House Bill 1296 is working its way through House committees.
When Rep. Dominique Jackson, D-Aurora, ran out of manufacturer coupons for a medicine she takes, the price per month went from $25 to more than $1,500. She was shocked.
“It is really difficult for me to figure out why my prescription went up so much,” Jackson said. “This bill is hopefully going to get at the real reasons.”
Her bill, if passed, would authorize the state Department of Insurance to collect all kinds of data from everyone in the prescription drug supply chain, analyze it and report annually to lawmakers on ways to reduce costs. It also would require drug companies to publish certain price increases on the DOI’s website 30 days before they go into effect.
Jason Hopfer, a health care industry lobbyist, said the companies he represents are fine with all of that. What they’re concerned about is mandating that drug rebates be given to customers at the point of sale. The reason, Hopfer said, is some employers prefer to put those rebates towards lower monthly premiums for everyone in their company.
“You could raise the cost for everyone while trying saving some consumers money,” Hopfer said. “Give employers flexibility in deciding how they want to use it.”
5. Importing drugs from Canada
Status: Senate Bill 5 passed the Senate.
Gov. Jared Polis and a group of Democratic lawmakers want to spend $1.3 million developing a plan to convince the federal government to let the state buy medications from Canada starting in 2021.
Supporters say the United States pays twice as much as Canada for patented prescription drugs, and the federal government needs to start letting states work with their neighbors to the north. The answer from both the Obama and Bush administrations was no.
Vermont adopted a plan in 2018, but the state is still waiting on approval from the White House.
6. Out-of-network billing
Status: House Bill 1174 passed the House while Senate Bill 134 awaits its first hearing in the Senate.
Two different bills — one from each chamber — would limit how much money a person can be charged for out-of-network services they likely unknowingly received during an in-network hospital visit.
They’re called surprise or balance bills, and this is the fifth time lawmakers have tried to pass some kind of legislation to address the problem.
The difference between the two bills is the limits on the charges patients would face, Hopfer said.
7. Collective bargaining
Status: Senate Bill 4 has passed the Senate.
Sen. Kerry Donovan, D-Vail, has an idea she hopes will lower monthly premiums for folks in her district and elsewhere who want to try banding together into cooperatives to negotiate with hospitals and other providers.
For example, the bill would let a county government, local school district and a ski resort get together and bargain for better rates directly with providers.
Donovan said her local communities have asked for this tool.
8. Hospital transparency
Status: Signed into law by the governor.
A bipartisan group of lawmakers wanted to understand why hospital costs vary so much across the state, so they wrote a bill requiring hospitals to disclose more information about what they spend on patient care, administration, capital construction and payroll.
The Department of Health Care Policy and Financing will collect the data and use it to put together annual reports starting in 2020.
“We can’t work on reducing costs if we don’t see how these costs are determined in the first place, or what they are,” Polis said during a signing ceremony at the Capitol at the end of March.
