Hickenlooper announces plan to save Medicaid dollars

Gov. John Hickenlooper thinks he can save taxpayers almost $300 million while extending Medicaid coverage to 160,000 more Coloradoans.

His plan has five elements and, except for one that focuses in part on eliminating redundant or unnecessary medical services, it does not contemplate a reduction in the extent of health care provided to participants in the program.

According to a Jan. 3 press release the cost savings would come from extending "clinically appropriate services" and "ensure use of the most effective care at the lowest cost." The proposal would also focus on rewarding better cooperation between healthcare providers and their achievement of "performance benchmarks." 

The plan will also include an effort to pay providers based on the "value" of their care, as opposed to the frequency with which care is given, and encourage the use of more sophisticated technology capable of improving the efficiency of claim administration. 

Finally, the governor's proposal suggests that additional efforts to reduce wasteful or inappropriate expenditures will help lower program costs. 

“We are focusing on transforming our health system to ensure all Medicaid recipients have access to the right services, at the right time, in the right setting and at the right price,” Susan E. Birch, the executive director of the state's Department of Health Care Policy and Financing, said in a statement.

The cost of the expansion would be about $1.4 billion, but according to DHCPF the steps outlined in the proposal would offset all but about 20 percent of that amount.

House speaker-designate Mark Ferrandino, D-Denver, thinks the governor's plan might work.

"If we combine cost controls and smarter, outcomes-oriented payment systems, we can expand Medicaid and not break the bank,” he said.

Republicans were less enthusiastic, with House minority leader-designate Mark Waller of Colorado Springs arguing that it might lead to an increase in spending on the program and cuts in the number of people who can be served.

"We’ve already scaled back Medicaid once because of costly and inaccurate forecasting, let us make sure we’re not repeating those mistakes under the Governor’s plan," he said.

Another leading GOP voice on health care issues, Rep. Cheri Gerou of Evergreen, said she is concerned that financing Hickenlooper's plan might mean a reduction in spending on education.

"The Governor will need to explain how adding 160,000 people to our Medicaid system will not further reduce the monies available to support our K-12 schools and institutions of higher education.”

If enacted into law, the governor's proposal would expand Medicaid eligibility up to an income level that equals 133 percent of Federal Poverty Level as of Jan. 1, 2014. That means a family earning no more than $30,657 per year could qualify.

Under current Colorado law children and pregnant mothers qualify for Medicaid coverage even if the income of their family is substantially higher than that threshold. Those two categories of beneficiaries are eligible if family income does not exceed 250 percent of FPL.

One sweetener of the proposed expansion could be a delay in Colorado's assumption of the expense it involves. Under the sweeping federal healthcare reform law passed in 2010 the U.S. government will pay for Medicaid expansion to the extent Hickenlooper has proposed until 2016. The federal treasury's contribution to the cost would then decline to a 90 percent share by 2020.

The state's general fund revenue is also not necessary to pay for the expansion. Legislation passed in 2009 that established a provider fee to be assessed on hospitals is the source of funds to pay for it.

Ferrandino and Sen. Irene Aguilar, D-Denver, will sponsor legislation aimed at implementing parts of Hickenlooper's proposal.

If enacted, according to a report published by the Colorado Center on Law & Policy in December, about 120,000 additional Coloradoans would gain access to health insurance coverage.

Kefalas Bill To Authorize Study of Single-Payer Health Care System in State Gets Committee Exam Today

A bill that would create a privately-funded review commission to study how a publicly-funded and privately-managed single-payer health system would work in Colorado was approved this evening by a House committee.

HB 1273, which is sponsored by Rep. John Kefalas, D-Fort Collins, would not create a single-payer health system. The measure does, however, include a schedule under which the legislature would consider whether to create such a delivery system in the state.

“Our objective is to create a more streamlined system that focuses on better-value, quality health care,” Kefalas said. “Almost 800,000 folks in Colorado are uninsured. We have to do better. The Health Care Authority will look for 21st century solutions. Right now, our medical industry is drowning in paperwork. Energy and resources are being wasted on inefficiencies when they ought to be directed toward building a healthy, insured Colorado workforce.”

If the bill becomes law, and the study commission it creates is formed, adequately financed, and prepares its report on time, the General Assembly would take up the question of establishing a single-payer health care system in 2011.

The commission would be made up of 23 members. It would explore how a single-payer system not managed or controlled by the state government would work and how, if the state is not paying for health care services on behalf of Colorado residents, the system could be financed.

The proposed Colorado Health Care Authority would have to raise funds privately to pay for its work. If enough funds were not raised by July 1, 2011, the work of the commission would end.

The cost of the commission's work is estimated to be about $1.4 million.

A commission established in 2007 by Gov. Bill Ritter, which also studied health care delivery in the state, said that a single-payer health care system merited further study but did not include it in a list of recommendations for reform Because members concluded existing federal law does not permit a state to adopt a single-payer delivery system.

A report issued by the Colorado Health Institute in 2006 said that 17 percent of the state's residents do not have health insurance.

The House Business Affairs & Labor Committee sent the bill to the House Appropriations Committee on a 5-4 vote.

With the exceptions of Rep. Joe Rice, D-Littleton, and Rep. Larry Liston, R-Colorado Springs, who were absent, all of the committee's Democrats supported the bill and all of the panel's GOP members opposed it.

Rocky Mountain News Examines Proposed Prescription Drugs Ethics Act

The Rocky Mountain News has published a good analysis of the proposed Prescription Drugs Ethics Act, which is scheduled for a committee hearing today.

SB 166, sponsored by Sen. Morgan Carroll, D-Aurora, would ban wholesale drug or medical device distributors from giving gifts to health care providers. It would also block drug manufacturers and distributors from gaining access to data about state health program patients' prescriptions for use in marketing efforts.

The measure would also require those distributors and manufacturers to disclose their advertising and marketing expenses if they participate in state-sponsored programs aimed at providing health care services.

The article by the Rocky's Ed Sealover says that opponents of the measure will argue that it could drive drug manufacturers out of the state and prevent drug companies from keeping doctors informed about new products.

Bill Authorizing Minors to Donate Blood Gets Preliminary House OK

A measure that would allow minors over the age of 16 to donate blood received preliminary approval in the House of Representatives today.

HB 1023, sponsored by Reps. Sara Gagliardi, D-Arvada, and Spencer Swalm, R-Centennial, and Sen. Betty Boyd, D-Lakewood, would open the door to teenager donations with parental consent.

According to an estimate by Bonfils Blood Center the bill, if enacted into law, would result in 2,600 more blood donors each year. The additional blood supply would benefit up to 7,800 patients each year.

Highlights from Tuesday at the General Assembly

Your reporter was taking a much-needed break during the middle part of this week and so there were no updates for happenings at the Capitol between Tuesday and Thursday. Here are some of the highlights from Tuesday, April 22.

The House gave final passage to a measure aimed at helping legal immigrants obtain necessary clearance to be able to work on the state's farms. A large bipartisan majority endorsed HB 1325 one day after a Colorado Springs Republican representative set off a kirfuffle after announcing during floor debate that he believed the bill would invite thousands of "illiterate peasants" to Colorado.

The bill, which is being carried by Calhan Republican Marsha Looper and Montrose Republican Ray Rose, allows Colorado to speed up the process of issuing H-2A visas. Currently, application processing by the relevant federal authorities is so backlogged that it is taking, in some cases, about five months to issue the visas to qualified legal immigrants. HB 1325 will allow the state to assist the federal government with the process, accelerating visa application processing by up to three months. The measure also allows Colorado to undertake criminal background checks and health screenings of legal temporary workers.

The aim of the bill is to increase the number of qualified, lawful immigrant workers to assist with Colorado harvests. It includes incentives intended to help assure that the temporary, visa-receiving workers return to their home countries after the growing season.

The House vote on third reading was 46-18, with the "no" votes coming from members of both parties. Aside from Rep. Douglas Bruce, who made known his opposition by means of his controversial statement on Monday, opponents included Reps. Morgan Carroll, D-Aurora, Mark Ferrandino, D-Denver, Sara Gagliardi, D-Arvada, Cory Gardner, R-Yuma, Jim Kerr, R-Lakewood, Steve King, R-Grand Junction, Rosemary Marshall, D-Denver, Mike May, R-Parker, Frank McNulty, R-Highlands Ranch, Victor Mitchell, R-Castle Pines Village, Jack Pommer, D-Boulder, Dianne Primavera, D-Broomfield, Amy Stephens, R-Monument, Ken Summers, R-Lakewood, Paul Weissman, D-Louisville, and Rob Witwer, R-Genesee, as well as speaker Andrew Romanoff, D-Denver.

Under an H-2A visa foreign temporary agriculture workers can work in the U.S. for up to one year, with a maximum of three years possible under a single visa.

The House also gave final clearance to a measure allowing some persons convicted of certain misdemeanor crimes, which are generally minor in nature, to ask a court to order the conviction records sealed ten years after completing his or her sentence. The bill does not apply to any sex crime and does not preclude access to the records by government agencies engaged in necessary criminal background checks of an individual.

HB 1082 passed, 36-28, with Democrats Bernie Buescher of Grand Junction, Sara Gagliardi of Arvada, Dianne Primavera of Broomfield, Jim Riesberg of Fort Collins, John Soper of Thornton and speaker Andrew Romanoff of Denver joining all but two Republicans in opposition. Reps. Ellen Roberts, R-Durango, and Al White, R-Hayden, were the only two GOP members to support the bill.

Freshman Rep. Mark Ferrandino, D-Denver, is the prime sponsor of HB 1082.

The House also gave preliminary approval to a comprehensive residential landlord-tenant bill. HB 1356, if enacted, would represent the culmination of more than twenty efforts over forty years to have Colorado join almost every other state in having a residential landlord-tenant code in the state law books. Rep. Mike Merrifield, D-Colorado Springs, is the lead sponsor of the bill.

Over in the Senate a Republican measure aimed at instituting incentive pay for teachers gained final approval. SB 65, sponsored by assistant minority leader Nancy Spence of Centennial, passed on a unanimous vote.

The measure creates a grant program available for school districts to use for teacher incentive pay.

SB 170, cleared on a 26-8 vote, expands from 30 to potentially 50 years the amount of time a municipality's downtown development area can take advantage of tax-increment financing. All the "no" votes came from Republicans, including Tom Wiens of Castle Rock. That town has recently commenced a process aimed at creating a downtown development authority and securing authorization for tax-increment financing to pay for a re-developed downtown.

The Senate also gave final approval to HB 1175, which authorizes a Fourth Infantry Division commemorative license plate. The vote was unanimous.

SB 217, which creates the "Centennial Care Choices" program aimed at expanding private health insurance coverage in the state, also passed on third reading in the Senate.

The bill, which is aimed at Coloradans too wealthy for Medicaid but who don't have enough income to buy private health insurance, relies on public-private partnerships to expand coverage. The proposal includes: (1) a request for health insurers to create a menu of “Value Benefit Plans” (VBPs) that would be evaluated and endorsed by the state and would be made available to all Coloradans; (2) assistance to low income individuals and employees of businesses through a state subsidy of a portion of the VBP premium for those who do not qualify for government programs and cannot afford health insurance; and (3) assurance that this program builds upon the existing employer-based health insurance system, does not encourage businesses currently offering coverage to discontinue it, and promotes administrative efficiencies.

The House and Senate approved a conference committee report on HB 1001, which would make grant funds available to biotechnology entrepreneurs. That meant the measure was on its way to Gov. Bill Ritter.

Speaker Andrew Romanoff introduced a bill that would penalize insurers for wrongfully denying or delaying claims. HB 1407 is part of a package of healthcare reform measures announced in March.

Rep. Morgan Carroll's FAIR Bill Clears First House Hurdle

A bill by Rep. Morgan Carroll, D-Aurora, that would require health and auto insurance companies to secure the approval of the state insurance commissioner before raising premiums cleared a House committee Thursday.

HB 1389, which has the co-sponsorship of 30 House Democrats, would also give the insurance commissioner authority to punish insurers for wrongfully denying claims.

Representatives of the health insurance industry testified in opposition to the bill, claiming that it is unnecessary because current law allows rejection of rate increases that are discriminatory or excessive.

However, Carroll told the committee that her bill is necessary to slow the high rate of premium increases in the state.

She said that data indicates that the average health insurance premium in Colorado rose 140 percent in the last five years, while the amount of coverage purchased by each dollar of premiums paid fell from $188 to $46 between 2002 and 2007.

According to the Kaiser Family Foundation Colorado has the seventh-highest health insurance premiums in the nation.

Thirty-eight other states require prior approval of a government regulator before insurance rate increases can take effect.

Senate Says “Yes” to Uniform Health Insurance Card Requirement

The Senate approved Wednesday a bill that would require health insurers and providers to use a standardized card containing information about the a patient's coverage.

The aim of SB 135 is to force use of electronic cards that can be easily read at hospitals, clinics, physician and nurse practitioner offices and pharmacies. The bill sponsor, Sen. Shawn Mitchell, R-Broomfield, says such uniformity would reduce mistakes and consequently lower costs.

The measure, which is supported by the Colorado Medical Society, Colorado Association of Health Plans, and Gov. Bill Ritter's administration, now moves on to the House.

Hagedorn Introduces Broad Healthcare Reform Legislation

A bill that aims to get health insurance coverage into the hands of 800,000 Colorado residents who don't currently have it was introduced in the Senate March 28.

SB 217 would allow health insurers to provide the state with plans to expand coverage. A commission to study ways of making participation in those plans available to people who don't have health insurance would be created and would have to report to the General Assembly in 2009.

The measure would call for the use of federal block grant funds provided Colorado for health and other purposes to subsidize the premiums needed to secure the participation in the private sector health plans by uninsured individuals.

A commission appointed last year issued a report in January that concluded that extending coverage to all of the state's uninsured could cost as much as $1.5 billion.

The measure also includes a coverage mandate. All residents of the state would be required by law, if the bill is enacted, to obtain private health insurance coverage. In exchange, health insurance providers would be required to issue a policy to anyone who applies for one.

In a report published in the Denver Business Journal, sponsor Sen. Bob Hagedorn, D-Aurora, said that the approach proposed by his bill is the only practical alternative to a single-payer, government-run health care system.

The report also quoted Hagedorn as saying he has secured bipartisan support for the measure, including from Sen. Steve Johnson, R-Fort Collins, and Reps. Tom Massey, R-Poncha Springs, and Ellen Roberts, R-Durango.

Massachusetts imposed a coverage mandate on its residents in 2007. According to a recent Boston Globe article, the program in that state is expected to cost $1.35 billion per year by 2011, up from $158 million in the first year of the program's life.

Vermont and Maine have also launched efforts at achieving universal private health insurance coverage in those states.

Ritter Announces Health Care Plan

Gov. Bill Ritter announced his plan to make improvements in Colorado's health care system Wednesday, proposing a "Building Blocks to Better Health Care" program that would allow 55,000 more children to be covered by health insurance within three years.

“Our health-care system is fundamentally broken, and the flaws touch every person and every business in Colorado,” Ritter said. “Costs are skyrocketing. The availability of quality care is limited. Too many people lack insurance, and our public and private health networks are too complicated for most people to navigate."

The governor is asking the General Assembly to spend $25 million in fiscal year 2008-2009 to put the plan in motion. In addition to increasing the number of kids in the state covered by the Child Health Plan Plus (CHP+) and Medicaid programs, the money would be used to create a new "Center for Improving Value in Health Care," build "greater efficiencies in public and private health care," and improve "transparency" in an effort to help health care consumers.

The expansion of children's health coverage would be achieved mainly by increasing the family income ceiling that limits eligibility for the CHP+ program. Ritter said that Sen. Bob Hagedorn, D-Aurora, and Rep. Anne McGihon, D-Denver, will introduce legislation raising that ceiling from 205% of the federal government's designated poverty level for a family of four, as of March 1, to 225%. That would mean that a family of four earning no more than $48,000 could qualify for CHP+ coverage.

The plan also calls for greater efforts to make the public aware of CHP+ and Medicaid programs, simplifying the enrollment process for CHP+ and Medicaid, and increasing reimbursement rates to physicians and dentists who provide care to children under the Medicaid program.

The proposed Center for Increasing Value in Health Care (CIVHC) would be an inter-agency and private sector joint effort to "develop long-term strategies for ensuring a better value for the $30 billion spent on health care in Colorado every year."

To improve efficiencies in the delivery of health care services, Ritter's proposal calls for the standardization of health insurance carrier ID cards and a requirement that all such cards include a magnetic strip that would facilitate electronic exchange of data.

Ritter said that Sen. Shawn Mitchell, R-Broomfield, and Rep. Sara Gagliardi, D-Arvada, had agreed to sponsor a bill implementing this aspect of his plan.

The plan also calls for increased investments in health information technology and disease management programs.

Ritter's program also includes measures aimed at increasing consumer knowledge of insurer choices and insurance broker relationships with insurance companies. The plan would establish a web-based "Report Card on Health Insurance Companies" to include relevant information about health insurers and require insurance brokers to disclose their source and extent of compensation.

In addition, Ritter will ask the legislature to fully fund the Colorado Immunization Information System, increase funding for people with developmental disabilities by more than $8 million, increase funding for community mental health services by $3 million, and provide support to families with children suffering from birth defects by funding a "Colorado Responds to Children With Special Needs" initiative.

The program also includes a request to fund dental care for low-income elderly Coloradans and asks the legislature to support a bill that would grant consumers a legal remedy in the event that a health insurer denies a claim for coverage.

Gagliardi, who is a nurse, praised the governor's proposal.

"I am confident that today, we have embarked on a path towards access to affordable, quality health care for Coloradans," Gagliardi said. "The Building Blocks for Health Care Reform represent meaningful and significant progress. We will be covering 55,000 children over the next 3 years-enough children to fill 1,000 school buses."

Primavera, too, said that she believes Ritter's requests to the General Assembly make sense in terms of improving health care coverage to needy families.

"Starting with kids is a smart investment," Primavera said. "By covering 55,000 children over the next three years, we will make a big dent in reducing the ranks of the uninsured."

Mitchell indicated that GOP legislators would be likely to support at least the efficiency aspects of the proposal.

“Too much of our health care dollar goes to administration and paper work,” Sen. Mitchell said. “Standardizing health plan ID cards should make things faster and easier for patients and doctors and help bring down costs.”

Ritter emphasized that any progress on health care reform in Colorado must take account of fiscal limitations.

“We must find solutions that are uniquely Colorado, solutions that are ambitious and realistic, solutions we can afford,” the governor said.