New law requires more transparency at freestanding ERs

By Jennifer Meckles (April 25th, 2018)

It’s a misunderstanding that can costs patients thousands of dollars.

Two bills signed into law on Wednesday are designed to increase transparency around freestanding emergency rooms in Colorado.

For several years, 9NEWS has reported on complaints and confusion from patients who visit freestanding ERs. Many did not realize the difference between those facilities and the cheaper urgent care centers, or they did not realize the costs involved until receiving unexpectedly high bills.

“As a result of this becoming law, folks will get greater transparency, greater disclosure,” explained Senator John Kefalas (D-Fort Collins), one of the bill’s sponsors. “So folks, when they go in these facilities, they’ll be able to make informed decisions.”

The bill requires freestanding ERs to post a sign informing patients when they arrive that the facility is an emergency room that treats emergency medical conditions. The sign must explain whether or not the facility includes an urgent care. If not, the sign must explain the facility is not an urgent care or primary care facility.

Once the patient has completed his or her initial screening, they get more information under this new law.

If the patient is not experiencing an emergency medical condition, or the patient has been provided treatment to stabilize an emergency medical condition, the facility must provide information explaining what insurance it accepts.

The freestanding emergency room also has to specify the prices of the 25 most common health care services it provides, and let patients know that cost listed for each service is the maximum charge the patient would be billed.

“It’s great to have a freestanding emergency facility much closer to you than a hospital when you really, really need one,” said State Senator Jim Smallwood (R-Parker), another bill sponsor. “While at the same time making sure that they know if they have a mildly sprained ankle or a splinter… this probably isn’t appropriate care.”

The push for transparency was supported by lawmakers from both parties.

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Legislature considers raising fees on employer health plans to stabilize individual market

By Ed Sealover (April 20th, 2018)

Colorado’s individual health-insurance market is failing, with average premiums rising 20 percent in 2017 and another 27 percent this year.

As such, a bill moving through the Colorado Legislature asks this question: Is it fair to ask some 2 million people in this state to pay between 2 and 8 percent more for their insurance premiums next year in order to stabilize the individual market for roughly 140,000 people who face the prospect of even more skyrocketing costs without some kind of help?

The proposal, from Democratic Rep. Chris Kennedy of Lakewood and Republican Rep. Bob Rankin of Carbondale, would establish a reinsurance program that, in many ways, offers insurance to health insurers who have taken the sickest and most expensive patients into individual plans since the Affordable Care Act required all Americans to buy policies in 2014 and banned insurers from rejecting customers because of pre-existing conditions.

Reinsurance allows insurers to turn over to the state their highest claims once they exceed a certain cost, such as $25,000, and to have the state cover those bills until the claims reach $1 million. Doing so would reduce insurers’ risks and allow companies to bring down the overall costs of premiums between 10 and 25 percent as compared to what they otherwise would charge in 2019, Kennedy and interim Colorado Insurance Commissioner Michael Conway said.

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Bill would bank drone flights over wildfires

By Charles Ashby (April 19th, 2018)

DENVER — Drone users who fly their aerial craft over fires or emergency operations could find themselves facing misdemeanor charges under a bill that won preliminary approval in the Colorado House on Wednesday.

Reps. Polly Lawrence, R-Parker, and Joann Ginal, D-Fort Collins, said their measure, HB1314, is needed because when drone users fly those unmanned aerial vehicles over such events, they are only delaying important work in dealing with them.

Slurry aircraft have had to be grounded numerous times in recent years because drones have been getting in their way, the two lawmakers said.

“We want to make sure that nothing obstructs those air flight missions that are dropping slurry to help put those fires out,” Lawrence said. “This is a significant step to make sure that drone use by recreational users or professional users does not interfere with firefighting or emergency rescue operations.”

Fire departments, law enforcement and rescue workers increasingly have been using drone technology to help them in their efforts, but those flights are controlled and known by the personnel involved so as not to interfere with other operations.

An increasing number of people not involved in firefighting, law enforcement or rescue efforts, however, also have been flying them into such areas, causing problems. The U.S. Forest Service, for example, has started a new campaign called “If You Fly, We Can’t” to combat the dozens of incidents that agency deals with each fire season while fighting wildfires nationwide.

Under the bill, which still needs a final House vote before going to the Senate, anyone who obstructs a firefighter or emergency service worker with a drone could be charged with a class 2 misdemeanor, which is punishable by up to one year in jail and a $1,000 fine.

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Bill named for Arvada girl signed into law

Bill named for Arvada girl signed into law

Staff Report (April 17th, 2018)

Physicians often sign contract agreements to not actively tries to take patients with them, if they leave a group practice. Those that do, may be legally forced to pay monetary damages.

But a bill signed into law April 2 makes an exception in the case of patients with a rare disorder.

SB18-082 known as “Gracie’s Bill” is sponsored by Sen. Rachel Zenzinger, D-Arvada, and Rep. Chris Kennedy,D-Lakewood and was signed into law by Gov. John Hickenlooper.

The law was inspired by Arvada resident Grace Hoyt, 7 with a rare disease, posterior column ataxia with retinitis pigmentosa. This means that she has poor balance, she is legally blind, and she does not feel pain.

“Not feeling pain has been the hardest part of her condition to manage,’ said Susan Hoyt, Grace’s mother, in testimony supporting the bill. “Gracie has had many, many infections in her short life. She has been hospitalized about 15 times, always for some type of infection. Some of these infections were very serious, even requiring amputations of some of her fingertips.”

Hoyt continued to explain that her family has relied on infectious disease doctors to manage her daughter’s infections and find medications to prescribe that she is not resistant to.

“We have had mixed luck with infectious disease, but in 2013 we found Dr. Wendi Drummond at Rocky Mountain Hospital for Children.” Hoyt said. “Dr. Drummond was a Godsend. She understood the complexity of Gracie’s care. She listened to my concerns and answered my questions honestly, never getting offended if I questioned a particular treatment.”

But in January 2015, Drummond left Rocky Mountain and the terms of her non-compete agreement prevented her from talking to the Hoyts or having any influence on Gracie’s care.

“We still have not found an infectious disease specialist who understands Gracie like Dr. Drummond did,” Hoyt said. “Her new infectious disease doctors try to treat her like a 7-year-old with a normal immune system, not comprehending the seriousness of her condition. If Dr. Drummond could have continued to help with her care, I believe the doctors would have treated Gracie more quickly and she would not have spent as much time in the hospital.”

Hoyt encouraged members of congress to consider her daughter and other children and adults with rare diseases when making their votes.

“The idea that we would withhold critical healthcare from a child to protect a business made no sense to me,” Zenzinger said. “How do you justify that to the sick child? You can’t. I’m proud that my colleagues in the legislature saw the same logic and acted decisively to fix the problem.”

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Public Notices in Newspapers

Sen. John Cooke’s bill narrowing county disclosure requirements set for Colorado House floor hearing

By Tyler Silvy (April 07, 2018)

Two records-related bills sponsored by Sen. John Cooke, R-Greeley, could come to the floor of the Colorado House of Representatives this week.

Cooke’s own bill, Senate Bill 156, co-sponsored by Rep. Chris Kennedy, D-Lakewood, would allow counties to publish salary reports once per year instead of twice per year, and in 2020, would remove the requirement that those reports be published in a newspaper.

A previous version of Cooke’s bill also cut down the number of times counties must publish expense reports to once annually from once per month.

The current iteration still allows counties, beginning Jan. 1, 2020, to publish the expense report, salary report and financial statement on a county website with a link to the report published in at least one legal newspaper, according to the bill summary.

The amended bill passed the House State, Veterans and Military Affairs Committee 6-2 on Wednesday, and it’s scheduled to be heard on the House floor Monday.

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Colorado Legislature Considers ‘Public Notices’ in Newspapers

By Jeffrey A. Roberts (April 05, 2018)

State lawmakers took another step Wednesday toward phasing out the required publication of county public notices in Colorado newspapers.

The House State, Veterans and Military Affairs Committee passed an amended version of Senate Bill 18-156 on a 6-2 vote. Some committee members voted in favor of the measure while acknowledging that some newspapers may be hit hard by the loss of revenue.

“The last thing I want to do is contribute to what we’ve seen as a struggle for the newspaper industry to keep doing what they do, which is providing vital information to folks across the state,” said Rep. Chris Kennedy, the Lakewood Democrat who is sponsoring the bill in the House. “But I have to weigh that and balance it with how we are asking our counties to publish things that the population really is not looking in their newspaper for these days.”

The bill would change a century-old law that requires each county to publish a monthly expense report and a twice-a-year employee salary report in a local newspaper.

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Coverage of Opioid Bills

Coverage of Opioid Bills

Colorado House moving bills aimed at high health care costs

By Joey Bunch (March 23, 2018)

DENVER – House Democrats have made good, so far, on their promise to pass bills aimed at curbing health care costs, and Thursday they passed one out of committee to address the high cost of insulin.

House Bill 1009, sponsored by Rep. Dylan Roberts, D-Eagle, would require pharmaceutical companies, pharmacy benefit managers, insurers and nonprofits to make more information available on insulin pricing, including production costs, annual profits and wholesale costs.

Legislative analysts found that about 200,000 Coloradans take insulin to control their diabetes.

The bill passed the House Health, Insurance and Environment Committee on a 7-6 party-line vote.

Also last week, the House Public Health Care and Human Services passed three bills to address opioid addiction:

House Bill 1003, sponsored by Rep. Brittany Pettersen, D-Lakewood, would create a study committee on substance-use disorders to recommend legislative options on connecting resources with people who need help. The bill passed 9-2. 

House Bill 1007, sponsored by Reps. Chris Kennedy of Lakewood and Jonathan Singer of Longmont, would require insurance companies and Medicaid to provide faster approval of medication-assisted treatments for patients with substance-use disorders, so they don’t relapse into opioids. The bill passed 9-1.

 House Bill 1136, sponsored by Pettersen, would include extended residential and inpatient substance abuse treatment to the Medicaid program, using mostly federal funds. The bill passed 8-3.

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Recovering Opioid Addict Testifies For Coloradans ‘Left Behind”

By Shaun Boyd (March 13, 2018)

DENVER (CBS4) – A Colorado state lawmaker’s mother gives powerful testimony about the cost of opioid addiction as her daughter introduces legislation aimed at saving the lives of those addicted.

“I went from being a dedicated, loving mother of four with a career to someone who’s life became focused on feeding an addiction at the expense of everyone else,” Stacy Pettersen told a House committee on Tuesday.

Her daughter, Rep. Brittany Pettersen, has a package of bills aimed at addressing everything from overprescribing, to access to affordable treatment, and prevention and intervention in kids and families.

One of the bills would help with education and prevention in kids, provide training for health care professionals and $750,000 in grants for school based health centers.

Read Full Story at Denver CBS4

Bipartisan-sponsored bills target Colorado opioid epidemic

By Zach Thaxton (March 13, 2018)

A bipartisan group of Colorado lawmakers on Tuesday introduced five bills for the 2018 legislative session aimed at addressing the growing opioid epidemic in Colorado.  “42 Coloradans per day died from opioid overdoses in 2016,” said Dr. Rob Valuck, Director of the Colorado Consortium for Prescription Drug Abuse Prevention.  Valuck was among the featured speakers at a press conference Tuesday at the State Capitol in Denver.

The five bills cover a range of issues related to the opioid epidemic, including prevention and education, clinical practice, workforce development, payment reform, and Medicaid coverage for inpatient substance abuse treatment.  “We’re finding ways to cut the red tape in our medical system so people can get the help when they need it,” said Rep. Jonathan Singer (D-Longmont).  “These bills are going to find a way to help heal our individuals in our state and set this tone for the whole nation so we can solve this crisis once and for all.”

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Bill to link doctors to pharmacies online combats forgeries for opioids

By Joey Bunch (March 13, 2018)

A bipartisan bill filed in the Colorado House last week would make it harder for drug abusers to forge or duplicate prescriptions on paper to steal opioids, and it’s kind of simple: Prescribers and pharmacies should close the loop online.

The bill would require podiatrists, dentists, physicians, physician assistants, advanced practice nurses and optometrists, as well as medical professionals serving rural communities or those in a solo practice, to send opioid prescriptions directly to pharmacies using a secure online connection, except under a few exemptions.

The U.S. Drug Enforcement Administration approved the electronic-prescription system in 2010, and after years of federal reimbursement incentives, pharmacies are at or near 100 percent ready. In Colorado, however, only about 9 percent of prescribers are using it. The national average is 15 percent.

Six states have made it mandatory and 10 states are considering legislation.

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State Lawmakers Consider Bills To Address Rising Prescription Drug Prices

State Lawmakers Consider Bills To Address Rising Prescription Drug Prices

Denver CBS4 (March 9, 2018)

As a group at the Colorado Capitol tries to put the brakes on the runaway cost of health care, some lawmakers are demanding more transparency from insurers, hospitals and pharmaceutical companies.

A bill being heard this week would require pharmaceutical companies to give notice of big price increases and justify them. Insurers would also need to report which drugs had the highest price increases each year.

That prescription drug bill is one of three that were being considered in a committee Thursday that address the escalating cost of health care.

Read Full Story at Denver CBS4

Jeffco supports bill for online-only publication of fiscal information

By Corinne Westeman (February 27, 2018)

Jeffco Commissioner Tina Francone told the Colorado State Senate on Feb. 14 that she and her fellow commissioners support a bill that would no longer require counties to publish full financial reports in newspapers.

Instead, counties would only have to publish a link in the newspaper that would take readers to the corresponding information on the counties’ websites.

Those who oppose the bill have argued that the current system allows for more transparency, but Francone said she believes that — if the bill is passed — counties would still be transparent via their own websites while saving taxpayer dollars.

SB-156 is sponsored by Sen. John Cooke, R-Greeley, and Rep. Chris Kennedy, D-Lakewood. It was assigned to the Senate Committee on State, Veterans & Military Affairs on Jan. 29, and the committee moved it to the floor in a 5-0 vote on Feb. 14.

Currently, the law requires counties to publish reports regarding its expenses and contracts, the salaries of public employees and officials, and the financial statements for each fund kept by the county treasurer. The expense report is published monthly and the salary report is published twice a year.

But SB-156 would change these two reports to annual reports effective Jan. 1, 2020, and counties only would be required to publish links to the expense report, the salary report and the financial statement on their websites. They would still have the option to publish full reports in newspapers.

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Coverage of Rental Applications Bill

Session delivers bills on transportation, pension reform

By Ellis Arnold (May 18th, 2018)

n a work season buoyed up by unforeseen revenue, Colorado lawmakers passed a deal to put more money toward the state’s deep transportation needs, gave the green light to a last-minute compromise on its public-retirement system and made progress on curtailing the opioid epidemic.

As conservative lawmakers note, the Legislature passed heavy spending lifts without a tax hike — enabled by favorable forecasts to the tune of a $1.3 billion increase in state revenue from last fiscal year. Strong economic growth and changes in federal tax policy set the state up to take in more revenue.

But Democrats and Republicans still battled on how to split that pie, and compromises left both sides without their ideal path forward.

Meanwhile, developments were less noteworthy on affordable housing, as prices continue a years-long spike.

The regular session — the 120-day term when bills can be passed — ended May 9. Here’s a look at some of what was accomplished.

Wheels turn on transportation

Colorado landed itself in a $9 billion hole as of 2016, according to state projections of transportation-spending needs through 2025, and lawmakers aimed to chip further away at that price tag.

“Transportation was a — if not the — priority for Republicans this session,” said state House Minority Leader Patrick Neville, R-Castle Rock. Roads and bridges had been “neglected by the Democrats for 13 years,” he added.

For the Democrats’ part, state House Speaker Crisanta Duran supported an unsuccessful bill last year to ask voters to raise sales and use taxes by 0.62 percentage points to raise about $375 million per year for the Colorado Department of Transportation, with other revenue going to counties and municipalities.

Senate President Kevin Grantham, R-Cañon City, supported that bill along with Duran, D-Denver.

This time around, lawmakers passed a $645 million boost over the next two years in a bill that would also ask voters in 2019 to approve about $2.3 billion in bond funding for transportation. That option would put Colorado on the hook for up to $3.25 billion in borrowing costs over 20 years.

But before that, outside groups may ask voters in 2018 to approve either another spending requirement without taxes, or allow a sales-tax increase.

“The Legislature will have no choice, I think, but to spend more on transportation and spend less on other things” if the first option passed, said Chris Holbert, state Senate majority leader. Holbert, R-Parker, was skeptical of the tax increase passing, “given the voter reaction to prior tax increases.”

Senate Bill 18-001, the deal lawmakers passed, headed to the governor’s desk May 17.

Small steps on housing

Housing affordability, on the other hand, didn’t see a grand bargain that would move the needle much.

“There was more lip service than anything else,” said Eric Sondermann, a Colorado independent political analyst.

Democrats unsuccessfully tried to pass a tax on shopping bags to fund affordable-housing assistance, while Republicans focus on what they say are regulations that make construction unaffordable.

“House Republicans are optimistic that the construction-litigation reform law passed in 2017 will spur more affordable home construction, but we need to give the market time to adjust before enacting more legislation,” said Cole Wist, state House assistant minority leader, R-Centennial.

Lawmakers passed a bill that extends the state’s ability to allocate affordable-housing tax credits through the year 2024. It would have expired at the end of 2019, according to the Legislature’s website.

It was a welcome move, but Coloradans need more support, state Rep. Faith Winter said.

“I’m excited that we were able to (extend) affordable-housing tax credits so that more affordable-housing projects can get off the ground,” said Winter, D-Westminster. “However, the response from the Legislature was woefully inadequate in addressing the affordable-housing crisis in Colorado.”

The Legislature passed what state Rep. Chris Kennedy called a “renters’ rights bill” that would require landlords to provide a copy of a lease to each tenant, as well as receipts for cash rent payments, he said.

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State Bill Aims To Relieve Rental Applicants From Burden Of Multiple Fees

By Tyler Young (March 05, 2018)

GRAND JUNCTION, Colo. – Rental application fees, they can run as high as $50 to $60 dollars and do not have a cap on what a property management can charge.

“We do have a rental application fee of $35. That fee just covers our background checks which in covers credit criteria background check and felony criminal background check”, says Cindy Hoppe a property manager for Bray Property Management.

Every property management company charges an application fee to cover background check costs, with background checks pricing around $32 combined both credit and criminal background check.

“It’s making them fully disclose what their fees are and we’re already doing that”, says Hoppe, “Now, different companies have different fees and they’re probably using different processing companies and the fees will fluctuate based on who you use and how many credit applications you put through a month, that kind of thing.”

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Colorado landlords would have to limit rental application fees and explain why tenants were rejected under measure

By Jesse Paul (February 26, 2018)

Landlords would be required to tell prospective rental-property tenants more about their application costs and requirements in a measure that passed the Democratic-controlled House on Monday.

House Bill 1127 also seeks to limit rental application charges to the costs of background and credit checks and mandate that landlords spell out to applicants the requirements for approval — such as rental and credit histories and income.

The legislation would also require landlords to provide a written notice to rejected tenants, as well, explaining on what grounds they were turned away. Landlords, under the measure, would also be barred from charging different rental application fees to different applicants and from changing those fees between different properties they might be offering for rent.

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Dems try to ease cost of apartment screenings

By Charles Ashby (February 18, 2018)

DENVER — Landlords who charge for rental screening applications would be restricted on just how much they can charge under a bill the Colorado House is to debate this week.

The measure, HB1127, which has no support from House Republicans so far, is aimed at making it less expensive for low-income people to get affordable housing, said its main sponsor, Rep. Dominique Jackson, D-Denver.

“The fact of the matter is, this is pretty common-sense stuff,” Jackson said. “Everybody knows that we’ve got a massive affordable housing problem. If you can’t even get into a piece of property because you’re paying so much for application screening fees, the bill limits the amount that a landlord can charge to screen a prospective tenant to their actual cost of those screenings.”

Jackson said many people can’t afford to spend money on multiple screenings at different apartments they are considering renting, and then come up with first- and last-month’s rent along with a security deposit.

Rep. Chris Kennedy, D-Denver, who also is sponsoring the bill with Jackson, said he’s hopeful changes to this year’s bill will win the approval from the Colorado Apartment Association with some changes, which haven’t been worked out yet.

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State Lawmakers Push For ‘Renter’s Rights’ Bill

By Shaun Boyd (February 12, 2018)

DENVER (CBS4) – Finding an affordable apartment in Colorado is tough enough, but some people are spending hundreds of dollars just to apply for places.

Two state lawmakers say it’s time renters had some rights.

Rep. Dominique Jackson and Rep. Chris Kennedy are carrying a bill that would limit application fees to the actual cost of screening a prospective tenant.

“We talked about whether we wanted to set a specific dollar amount. We decided we did not, that it was okay for the landlords to figure out what those costs were,” said Kennedy.

Read full story at CBS Denver

Lawmakers seek to give renters more rights when applying for an apartment

By John Herrick (February 12, 2018)

Renters looking for a more affordable place to live are spending hundreds of dollars applying for apartments, prompting Democratic lawmakers to set limits on how much landlords can charge for these applications.

bill to cap apartment application fees cleared the House Finance committee on Monday by a 7-6 vote along party lines. The bill would cap the fee at the actual cost to screen the applicant.

There is no legal limit on how much landlords can charge for applications. Rep. Chris Kennedy, D-Lakewood, a lead sponsor on the bill, said he wants to make sure landlords are not profiting off these fees. He also said renters should have more rights.

“It’s tackling just another facet of the affordability problem,” Kennedy told The Colorado Independent.

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Capitol zeros in on opioid problem

By Charles Ashby (February 25, 2018)

The Colorado Legislature is slowly making progress on some of the measures that have been introduced this year to deal with the opioid crisis.

Last week, the Colorado Senate approved a bill designed to restrict the number of pills a health care provider can prescribe, to a seven-day supply.

While there are some exceptions to that restriction ­— such as patients that have chronic pain that lasts longer than three months — SB22 is designed to help prevent overprescribing, and prevent people from accumulating too many unused pills that others might find and abuse.

“The latent supply of prescription opioids in people’s cabinets, waiting to be acquired by those who may abuse and misuse, is a looming danger,” said Sen. Jack Tate, R-Parker, who introduced the bipartisan measure with Sen. Irene Aguilar, D-Denver, and Lakewood Democratic Reps. Brittany Petterson and Chris Kennedy. “Reducing these latent supplies that result from clinical opioid overprescribing is a critical first step.”

Seven Republican senators opposed the bill, including Sen. Randy Baumgardner, whose district includes Garfield County, saying they did so because partly it was unfair to rural patients who might have to travel miles to their local pharmacies to get medications.

The bill is one of six related measures recommended by the Opioid and Other Substance Abuse Disorders Interim Study Committee, which met last summer to discuss the issue.

That panel, of which Tate was a member, recommended this bill and several others:

■ HB1007 requiring all individual and group health benefit plans to similarly restrict certain opioid prescriptions.

■ HB1136 adding residential and inpatient substance abuse disorder services to be eligible for the state’s Medicaid program.

■ SB24 making several changes to the Colorado Health Service Corps Program, including adding grant money to substance abuse providers in underserved areas.

■ SB40 offering liability protection to health care providers who provide clean syringes.

■ HB1003 creating a permanent legislative committee to monitor the issue and recommend changes as needed.

The House measures aren’t scheduled to be discussed in the House Public Health Care and Human Services Committee until late March.

SB22 now heads to the House, while SB24 awaits approval in the Senate Appropriations Committee because of its $2.5 million price tag.

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Funding A Sticking Point As Colorado Debates Reinsurance Program

By Amy Lotven (January 29, 2018)

Stakeholders in Colorado continue to debate the development of a reinsurance program for the 2019 plan year that would cost about $346 million in order to significantly reduce premiums. Sources note that gathering the funding is a key sticking point in the debate because issuers are hitting back on using a premium assessment and other funding is elusive.

Colorado’s legislature approved a bill last year requiring the state’s Department of Insurance to look into options for setting up a reinsurance program through a 1332 waiver. The department commissioned a report to study how much a reinsurance program would cost, and its impact on claims, premiums and the morbidity of the risk pool.

While some states have opted to explore or implement condition-based programs, or so-called “invisible high-risk pools” that reimburse carriers claims for patients with certain high-cost diseases, Colorado has opted to do a claims-based approach under which plans typically are partially reimbursed for claims after a certain “attachment point” and up to a set threshold.

Milliman did an analysis and found that in order to achieve a 25 percent claims reduction, the program would cost $346 million in 2019. The firm says about half of the program costs would be covered by the federal pass-through money under the 1332 waiver, while Colorado would need to provide $178 million. The program would reduce premiums an average 21 percent statewide, boost enrollment by 17,000 and lower morbidity by 2.0 percent compared to the baseline, Milliman says in its final report. Importantly, Milliman notes, premiums would fall by 35 percent in the high-cost Western region and rural areas of the state; the average decrease in non-rural areas would be 17 percent (hence the 21 percent average).

The state legislature is now working to craft a bill that would create the reinsurance program, but the big question is funding, according to Mara Baer, president of AgoHealth, the lead author of the DOI’s report to the legislature.

The funding is tricky, says Colorado Democratic Rep. Chris Kennedy, who shepherded the legislation to get the study and is now working on the bill to create the program. A large problem, Kennedy says, is that unlike most other states, the Colorado legislature cannot legally raise taxes due to a 1992 state constitutional amendment. The state now requires voter approval for any tax hikes. In addition to its tax-raising restrictions, the legislature also faces budget caps, Kennedy notes, “so funding anything is challenging.”

Other funding possibilities have been discussed but each has their own drawbacks. Increasing the “provider fee” on hospitals would be difficult because the tax is already high and needed to support rural hospitals, Kennedy says. There are talks about getting private grants, but while that could help with start-up funds, the key is to find something that is sustainable over the years.

One funding source that Kennedy says should be on the table is related to the state’s income tax base. Kennedy explains the state’s taxable income base is anchored to the federal base, which was broadened under the tax law passed in December. According to the Denver Post, the base expanded due to the elimination of deductions and will bring in from $196 million to $346 million in state revenue.

However, Kennedy notes, GOP lawmakers want that money to go toward transportation.

This leaves the state with essentially one option, a per-member, per-month assessment on insurance plans, to collect a large portion of the funding. And because the state cannot tax self-insured employer-sponsored coverage, the fee would likely fall on fully insured group plans, individual plans, and stop-loss coverage.

According to Milliman, for the 25 percent claims impact, that fee would have to be set at $7.98 per-member, per month. And, Kennedy acknowledges, because Milliman conducted the report prior to enactment of the legislation repealing the individual mandate, that number could go up.

While insurers are supportive of the reinsurance proposal, they are less pleased with the price-tag. Issuers have argued that slapping a fee on plans basically re-circulates the dollars and does nothing for underlying costs, Baer says. State officials have acknowledged the concerns, but note that getting the program up and running is a good opportunity to help force a direct conversation on cost control.

Kennedy, who has been meeting with a wide range of stakeholders, says he often hears that industry agrees there is a crucial need to save the market, especially in the Western region. But issuers also complain that reinsurance funded by assessments is a cost-shift that fails to tackle the underlying issue.

For that reason, Kennedy says he is exploring some cost-control measures that could be added to the reinsurance bill. Details of those potential policies are being hashed out now, according to Kennedy, who declined to publicly discuss the options.

Other key details for the reinsurance program, including the attachment point and co-pay rate, are also unclear at this point. Kennedy says that once the funding level is clear, lawmakers can work backward to figure out the best design.

Meanwhile, at the federal level, lawmakers continue to work on legislation that would provide funding for reinsurance programs. In exchange for her support of the tax bill, Sen. Susan Collins (R-ME) secured an agreement with Majority Leader Mitch McConnell (R-KY) to back $10.5 billion in reinsurance funding, of which she wants $500 million available for seed money in 2018.

Collins and Senate health committee Chair Lamar Alexander (R-TN) and Patty Murray (D-WA) have said they are continuing to work on marketplace stabilization legislation and want to see it attached to the omnibus bill expected in March. Senate Minority Leader Charles Schumer (NY) said in floor remarks last week that he would like to see market stabilization legislation move along with an expected Feb. 8 continuing resolution.

Collins recently said that House Speaker Paul Ryan (R-WI) and his colleagues are warming to the idea of reinsurance legislation. Others have noted that the concept should carry support from House Republicans considering they all voted for it as part of their repeal-and-replace legislation: In April, the House attached to its repeal bill an amendment from Freedom Caucus members Rep. Gary Palmer (R-AL) and Rep. David Schweikert (R-AZ) that would have allocated $15 billion from that bill’s Patient and State Stability Fund from 2018 to 2026 to create a federal “invisible risk sharing program.”

Kennedy says he would appreciate federal reinsurance funding but is not wildly optimistic that it will come through. He notes he has had some initial conversations with Sen. Michael Bennet’s (D-CO) staff, and hopes to speak with other members of the Colorado delegation who could help push for funding.

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