May 18, 2018

Recent articles

2018 Legislative Wrap-Up: Health Care

by | May 18, 2018

Health care is no less contentious in Colorado than in the rest of the United States, with rising costs, the Affordable Care Act (ACA) and Medicaid galvanizing and sometimes polarizing the legislature. With health being such a hot-button topic, results were mixed during this session, but there were some notable victories.

This year, CCLP supported efforts to make health care costs more transparent to both payers and consumers, opposed efforts to undermine Medicaid eligibility and services, worked on programs to make coverage more affordable in rural parts of the state, and promoted legislation to better address the need for treatment for substance use and mental health disorders.

Here’s a brief recap of CCLP’s health care work during the 2018 legislative session:

Price transparency

Even though policymakers on both sides of the aisle have called for greater accountability in health pricing, legislation could not overcome industry opposition. House Bill 1260, the Drug Pricing Transparency Act, got further through the process than prior efforts in 2017 and 2016, but was ultimately defeated in the Senate Committee on State, Veterans & Military Affairs. Led by consumer groups, including CCLP, this bill would have required that carriers report on drugs that are most expensive for Coloradans and that manufacturers give advance notice of large price increases in drugs and explain price increases when they exceed a certain threshold. The legislation also called for annual reporting by the Division of Insurance on the effect of pharmaceutical pricing on plans regulated by the Division of Insurance (DOI).

Another transparency bill, HB 1207, would have required hospitals to report expenditures related to the receipt of hospital provider fee funds, which are intended to compensate hospitals for Medicaid underpayments and uncompensated care. CCLP supports access to information about the use of these funds, which have been less successful than hoped in deterring hospitals from shifting costs to the private insurance market. This was the second year this kind of legislation failed.

Improved consumer notice regarding pricing faced similar obstacles. For the third year in a row, CCLP supported a bill to protect consumers from “surprise billing” by out-of-network providers. Too often, Coloradans who have had surgery or other services at in-network or emergency facilities find themselves on the hook for surprise bills from out-of-network providers. These bills typically far exceed in-network costs. Senate Bill 237 would have required health care facilities, providers and health insurers to provide disclosures to consumers about the potential costs of receiving non-emergency services from an out-of-network provider or emergency services at an out-of-network facility. Ultimately, SB 237 failed — leaving consumers without clear information and at risk of paying bills for which they aren’t liable.

On a brighter note, in the third year of such efforts, two of three free-standing Emergency Department (FSED) bills passed. CCLP supported all three bills. Signed into law by the governor, HB 1282 now requires every hospital associated facility to acquire its own federal billing number, so that payers can better assess individual facility charges. Another bill signed by the governor, SB 146, requires FSEDs to provide consumers with information regarding potential charges, the right to ask questions about care and cost, and the in- or out-of-network status of the treating facility. HB 1212, an effort to require hospitals and FSEDs to justify facility fee charges, failed. FSEDs, which often locate in affluent areas and charge exorbitant fees, are credited with raising the cost of insurance as well as saddling consumers with high out-of-pocket obligations.

Coverage and benefits under public programs

This session, CCLP pushed for improved access to services for disabled and low-income Coloradans. SB 214 proposed adding work requirements and a life-time limit on Medicaid by requiring the Colorado Department of Health Care Policy and Financing (HCPF) to pursue a federal waiver to Colorado’s Medicaid program.

CCLP worked with other members of the Protect Our Care coalition to rally a broad and powerful showing of opposition to SB 214. The bill died on a bipartisan vote in its first committee in the Senate. CCLP also led the successful effort to pass SB 174, expanding the list of qualified mental health professionals who can verify eligibility for the Aid to Needy Disabled (AND) program for people with mental disorders.

In addition, we spearheaded HB 1192, which would have funded a program to assist people in applying for federal Social Security disability benefits (SSI/SSDI). That bill carried a fiscal note legislators were unwilling to fund this year, but we will try again in 2019. We were able to persuade lawmakers to amend SB 136, which allows brokers to charge customers for assistance with purchasing health coverage. The amendment bars brokers from charging those who are eligible for Medicaid or CHP+.

Finally, SB 266 was drafted by the Colorado Department of Health Care Policy and Finance (HCPF) to grant HCPF additional authority to control costs. Though CCLP supports efficiency in the program, we are concerned that the bill may signal a shift toward traditional managed care, a system that is not typically oriented toward delivering quality care to a population with special needs. We were unable to make modifications to the bill.

Health care affordability 

Efforts to address soaring health insurance premium costs across the state — but particularly in rural areas — took several forms. HB 1392, which would have established a state reinsurance program, failed in Senate State Affairs despite a many-month stakeholder process and bipartisan support. That bill would have authorized the Division of Insurance to submit a waiver for a state reinsurance program that would have reduced premium costs in the individual market, up to 35 percent in the highest-cost areas in the west, 25 percent in the east and mountain corridor, and 20 percent elsewhere. While the plan would appear to have both increased affordability and made those high-cost markets more attractive to carriers, opposition from the insurance industry and some business groups proved fatal.

HB 1384, proposed that DOI and HCPF study the feasibility of alternative insurance products, including a public-private plan option and a product that utilizes the low cost infrastructure of Medicaid/CHP+, with the goal of expanding affordable options for high-cost communities in Colorado. Both HB 1392 and HB 1384 were voted down in the last week of session.

SB 132 purported to increase insurance options, by aiming to expand the pool of people eligible to purchase catastrophic plans. Under the ACA, only adults under 30 and people who qualified for a hardship exemption could purchase such plans, which provide minimal coverage. However, catastrophic plans leave many enrollees under-insured, and greater availability of such plans may destabilize the individual market and deter people from getting the subsidies available for more robust plans. While the bill passed, giving the state authority to apply for a waiver of the ACA provisions, we were able to secure amendments that require an analysis of the potential risks and benefits of offering catastrophic plans and a three-year review prior to reauthorization of the program.

Substance use disorders 

A slate of bills addressing substance-use disorders and supported by CCLP had significant success this year.

The Opioid and Other Substance Use Disorders Interim Study Committee led by Rep. Brittany Pettersen, D-Lakewood, yielded six bipartisan bills, with one highlight being HB1136, which will add residential treatment and inpatient medical detox benefits to the Medicaid program via a Medicaid waiver. The waiver should also provide an opportunity to streamline and coordinate substance use disorder services, addressing fragmentation in the current delivery system.

SB 22 limits opioid prescribing practices, to ensure that fewer patients receive excess medication which increase the risk of misuse, while protecting access for those with chronic pain or disability. SB 24 provides loan forgiveness and funding for behavioral health providers, and HB 1003 establishes a legislative substance use disorder committee, allows school-based health centers to apply for grants to help with prevention and intervention services and increases SBIRT (screening, brief intervention and referral to treatment) services. HB 1007 requires coverage by commercial plans and Medicaid for certain medication-assisted treatments (MAT) without prior authorization or other obstacles to initiating care.

Of the six, only SB 40, which would have piloted a safe-injection site in Denver, failed.

– By Elisabeth Arenales

Recent articles

HEALTH:
HEALTH FIRST COLORADO (MEDICAID)

To maintain health and well-being, people of all ages need access to quality health care that improves outcomes and reduces costs for the community. Health First Colorado, the state's Medicaid program, is public health insurance for low-income Coloradans who qualify. The program is funded jointly by a federal-state partnership and is administered by the Colorado Department of Health Care Policy & Financing.

Benefits of the program include behavioral health, dental services, emergency care, family planning services, hospitalization, laboratory services, maternity care, newborn care, outpatient care, prescription drugs, preventive and wellness services, primary care and rehabilitative services.

In tandem with the Affordable Care Act, Colorado expanded Medicaid eligibility in 2013 - providing hundreds of thousands of adults with incomes less than 133% FPL with health insurance for the first time increasing the health and economic well-being of these Coloradans. Most of the money for newly eligible Medicaid clients has been covered by the federal government, which will gradually decrease its contribution to 90% by 2020.

Other populations eligible for Medicaid include children, who qualify with income up to 142% FPL, pregnant women with household income under 195% FPL, and adults with dependent children with household income under 68% FPL.

Some analyses indicate that Colorado's investment in Medicaid will pay off in the long run by reducing spending on programs for the uninsured.

FOOD SECURITY:
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)

Hunger, though often invisible, affects everyone. It impacts people's physical, mental and emotional health and can be a culprit of obesity, depression, acute and chronic illnesses and other preventable medical conditions. Hunger also hinders education and productivity, not only stunting a child's overall well-being and academic achievement, but consuming an adult's ability to be a focused, industrious member of society. Even those who have never worried about having enough food experience the ripple effects of hunger, which seeps into our communities and erodes our state's economy.

Community resources like the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, exist to ensure that families and individuals can purchase groceries, with the average benefit being about $1.40 per meal, per person.

Funding for SNAP comes from the USDA, but the administrative costs are split between local, state, and federal governments. Yet, the lack of investment in a strong, effective SNAP program impedes Colorado's progress in becoming the healthiest state in the nation and providing a better, brighter future for all. Indeed, Colorado ranks 44th in the nation for access to SNAP and lost out on more than $261 million in grocery sales due to a large access gap in SNAP enrollment.

See the Food Assistance (SNAP) Benefit Calculator to get an estimate of your eligibility for food benefits.

FOOD SECURITY:
SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC)

Every child deserves the nutritional resources needed to get a healthy start on life both inside and outside the mother's womb. In particular, good nutrition and health care is critical for establishing a strong foundation that could affect a child's future physical and mental health, academic achievement and economic productivity. Likewise, the inability to access good nutrition and health care endangers the very integrity of that foundation.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides federal grants to states for supplemental foods, health care referrals, and nutrition information for low-income pregnant, breastfeeding and non-breastfeeding postpartum women and to infants and children up to age five who are found to be at nutritional risk.

Research has shown that WIC has played an important role in improving birth outcomes and containing health care costs, resulting in longer pregnancies, fewer infant deaths, a greater likelihood of receiving prenatal care, improved infant-feeding practices, and immunization rates

Financial Security:
Colorado Works

In building a foundation for self-sufficiency, some Colorado families need some extra tools to ensure they can weather challenging financial circumstances and obtain basic resources to help them and their communities reach their potential.

Colorado Works is Colorado's Temporary Assistance for Needy Families (TANF) program and provides public assistance to families in need. The Colorado Works program is designed to assist participants in becoming self-sufficient by strengthening the economic and social stability of families. The program provides monthly cash assistance and support services to eligible Colorado families.

The program is primarily funded by a federal block grant to the state. Counties also contribute about 20% of the cost.

EARLY LEARNING:
COLORADO CHILD CARE ASSISTANCE PROGRAM (CCCAP)

Child care is a must for working families. Along with ensuring that parents can work or obtain job skills training to improve their families' economic security, studies show that quality child care improves children's academic performance, career development and health outcomes.

Yet despite these proven benefits, low-income families often struggle with the cost of child care. Colorado ranks among the top 10 most expensive states in the country for center-based child care. For families with an infant, full-time enrollment at a child care center cost an average of $15,140 a year-or about three-quarters of the total income of a family of three living at the Federal Poverty Level (FPL).

The Colorado Child Care Assistance Program (CCCAP) provides child care assistance to parents who are working, searching for employment or participating in training, and parents who are enrolled in the Colorado Works Program and need child care services to support their efforts toward self-sufficiency. Most of the money for CCCAP comes from the federal Child Care and Development Fund. Each county can set their own income eligibility limit as long as it is at or above 165% of the federal poverty level and does not exceed 85% of area median income.

Unfortunately, while the need is growing, only an estimated one-quarter of all eligible children in the state are served by CCCAP. Low reimbursement rates have also resulted in fewer providers willing to accept CCCAP subsidies.