With the full implementation of the federal Patient Protection and Affordable Care Act (PPACA) just months away, legislators in the 2013 session had a full plate of bills to work on to get the state ready.Some of the bills dealt with Medicaid expansion (Senate Bill 13-200), funding for the Colorado health benefits exchange (House Bill 13-245), bringing the state’s regulatory structure in line with the federal law (HB 1266), and another eliminating the state’s high-risk health insurance plan, to be replaced by the exchange (HB 1115).

Gov. John Hickenlooper signed on before the 2013 session started to support expansion of Medicaid, a key component of the PPACA. In a Jan. 3 press release, Hickenlooper noted the state would save $280 million over 10 years to fully fund Medicaid expansion, through a combination of savings and provider fees.

“We worked diligently over the past several months to find savings in order to expand coverage,” Hickenlooper said. “Not one dollar from the state’s general fund will be used for this expansion even in 2017 when the federal government begins to reduce its share.”

During his State of the State address a week later, the governor called upon legislators to take action, stating he looked forward “to working with you to expand Medicaid coverage, but in a way that increases value, reduces expenses and doesn’t require additional General Fund dollars.”

SB 200 increased the income eligibility for the Medicaid program to 133 percent of the federal poverty level. According to the Colorado Health Institute, that’s about $15,000 in annual income for an individual or $31,000 for a family of four. The bill’s fiscal note estimates the first-year cost at more than $304 million, increasing to more than $1 billion by 2015-16, the last year the federal government fully subsidizes the expansion.

The bill picked up just one Republican vote during its passage, from Sen. Larry Crowder, R-Alamosa.

Senate sponsor and physician Sen. Irene Aguilar, D-Denver, said during the bill’s first committee hearing in March that a 2011 survey showed 16 percent of the state’s residents lack health insurance, and 60 percent of the uninsured have jobs. But they can’t afford health insurance premiums, Aguilar said, that may range from more than $500 per month for individuals and up to $1,200 per month for families.

The bill drew no opposition testimony in that March 14 hearing in the Senate Health and Human Services committee. But that didn’t mean that Republicans were ready to acquiesce. During second reading debate on April 12, Sen. Ellen Roberts, R-Durango, questioned the federal government’s financial commitment to the expansion that the government has not done enough to eradicate Medicaid fraud. Sen. Owen Hill, R-Colorado Springs also noted that Medicaid patients have higher mortality rates. Aguilar, however, said Medicaid patients tend to live in poverty with resultant poor health, may be disabled, or from racial or ethnic groups with historically poorer health.

Speaker of the House Mark Ferrandino, D-Denver, sponsored SB 200 in the House. And just as it was in the Senate, SB 200 drew no formal opposition during its April 23 hearing in the Public Health and Human Services Committee. House Minority Leader Rep. Mark Waller, R-Colorado Springs, claimed the federal government would have to borrow money from China in order to pay for the expansion through at least 2015-16. Republicans also raised concerns that providers would be underpaid for Medicaid services; Rep. Spencer Swalm, R-Littleton, said the expansion would instead not be sustainable and would create a “house of cards.” A better solution, Swalm said, would be to expand the economy and create jobs that could pay for health insurance. Governor Hickenlooper signed the bill May 13.

Republicans tried to block the Medicaid expansion through other means. Sen. David Balmer, R-Centennial, sponsored SB 6, which would have blocked the General Assembly from paying for Medicaid expansion in 2014-15 and thereafter if it meant cutting funding to public education. That bill died in its first committee hearing Jan. 31. Rep. Brian DelGrosso, R-Loveland, introduced a similar bill in the House, HB 1175, which would have blocked funding for Medicaid expansion if it resulted in less funding for higher education. It died in its first committee hearing Feb. 19.

Less controversial were bills that dealt with the more technical side of the ACA.

The health benefits exchange, now known as Connect for Health Colorado, receives federal support through 2015-16, but must be self-supporting after that. To address its viability issues, legislators introduced HB 1245, which requires health insurers that provide small group and individual health plans to pay $1.80 per member per month for health insurance and 18 cents per month per member for dental plans. Insurance providers that voluntarily contribute to the exchange could earn up to a $5 million annual tax credit. HB 1245 gained some Republican support, including from Swalm, an insurance broker, and from Rep. Amy Stephens, R-Monument, the sponsor of the 2011 bill that created the exchange. It passed on party lines in the Senate and was signed into law by the governor May 13.

The governor also signed HB 1266 into law on May 13. The bill brings the state’s regulations on health insurance into compliance with the federal ACA law.

On May 28, the governor signed HB 1115, which eliminates CoverColorado, the state’s high-risk insurance pool that covers people with pre-existing conditions who cannot be otherwise covered by standard health insurance. The plan will be eliminated next year after the exchange goes live on Jan. 1, 2014. The bill, which had bipartisan sponsorship, passed with bipartisan support. 

Some of the children who need health care coverage under CHP+, the state’s last-resort health insurance for children, no longer have to wait three months to be covered, under SB 8. Sen. Linda Newell, D-Littleton, said “this bill makes sure kids have continuity of coverage. It’s costly to the system” for kids to not be covered for three months after applying for CHP+, and that sometimes results in trips to the emergency room for treatment. The bill got bipartisan support and was signed into law March 29.

Colorado finally got off the list of 10 states that don’t offer its Medicaid patients dental services with the passage of SB 242. The bill, sponsored by Rep. Dianne Primavera, D-Broomfield, and Sen. Jeanne Nicholson, D-Blackhawk, points out that untreated dental problems lead to other health issues, such as diabetes, heart attacks, strokes and mental illness. The bill passed largely along party lines and Hickenlooper signed it May 11.

The Department of Regulatory Agencies’ Office of Policy, Research and Regulatory Reform sent eight of its 24 sunset reviews to the General Assembly’s health committees in 2013. Those reviews dealt with reauthorization of regulations for acupuncture, occupational therapy and massage therapists; asbestos abatement programs, and advisory boards for dentistry and newborns.

Legislators also addressed Medicaid fraud concerns with a bill that seeks better data analysis. Roberts, who raised the issue of Medicaid fraud during the debate on Medicaid expansion, successfully sponsored SB 137. The bill requires the Department of State to issue a request for information for companies that can provide technologies to better identify utilization and billing patterns that could point to Medicaid fraud. Roberts drew strong bipartisan sponsorship for her bill, and got unanimous support from the General Assembly. Hickenlooper signed it May 24.

A bill that got only one “no” vote in its entire passage seeks to prevent children in foster care from identity theft. SB 47 provides a free annual credit report for children 16 years and older who are in foster care to the courts responsible for jurisdiction over that child. Previously, credit reports were issued for those 18 years and older or in the custody of a county or state department of social services. Newell, the bill’s Senate sponsor, explained that “30 percent of children in foster care are victims of identity theft,” either from family members or others, and the bill expands protection to those 16 and older as well as children in the custody of a county or state department of human services. The governor signed the bill May 28.

Marianne@coloradostatesman.com

See the June 21 print edition for a full listing of all the legislative enactments from the 2013 session.