Tri-partisanship is on life support in Washington, D.C.  The nation’s health-care system now has three irreconcilable options: Obamacare, RyanCare and MitchCare.  It’s barely possible to see a path to WeAgreeOnThisOneCare.

In our own square state, bipartisanship perked up at the end of the 2017 session, even though the bill that most carries the bipartisan brand is messy.  Work on the issues within the bill show under what conditions legislators will come together.

Issue one was the hospital fee put in place to support hospitals that provide lots of uncompensated care. From spring 2010 to September 2016, hospitals received $1.4 billion to make up for Medicaid and other patients unable to pay their medical bills, according to the Colorado Department of Health Care Policy and Financing.

That’s a lot of get-to-even money for mostly rural and urban hospitals.  But the funding comes with a catch.  The hospital fee, if considered a tax, pushes state tax revenues into Taxpayer Bill of Rights (TABOR) restrictions.

State Sen. Larry Crowder, R-Alamosa, has long supported exempting the uncompensated care hospital fee from TABOR.  At one time, he was the one Republican Senate vote that could preserve the fee.

Many GOP lawmakers do see the fee as a tax. If it is a tax, hospitals take a double hit because the state has to reduce the fees and thus matching federal dollars to ensure that total tax revenues don’t trip TABOR limits.

Rural hospitals and the citizens they serve argued to their Senate and House legislators, including Republicans Jerry Sonnenberg, senator from Sterling, and Jon Becker, representative from Fort Morgan, that they absolutely needed all the fee money or they would have to close.  That position put the anti-taxers Sonnenberg and Becker, along with Crowder and some other rural Senators, in conflict with their pro-TABOR colleagues.

Then came the second big issue:  state transportation funding.  HB17-1242 would create a transportation funding initiative to bring sales tax dollars to save the state’s degraded infrastructure.  The bill passed the Democratic House with some GOP votes but couldn’t get out of the Republican Senate, killed in the Finance committee by Republican Senators Tim Neville, Jeffco; Jack Tate, Arapahoe, and Owen Hill, El Paso.

It looked like the provider fee would lose and transportation was done.  But Sonnenberg and Becker hooked up with two Democrats, Senate Minority Leader Lucia Guzman and House Majority Leader K.C. Becker, as sponsors for the Sustainability of Rural Colorado bill.

In the last days of the 2017 session, the sponsors had to get creative.  They came up with a $2 billion tax go-around using state buildings for lease-to-purchase deals and a new Healthcare Affordability and Sustainability Enterprise for the provider fee.

Democrats and some Republicans went with the plan, including Sens. Owen Hill and Jack Tate, who earlier voted against the sales tax initiative in Senate Finance.  Democrats added some education money, but the pinch on affected lawmakers hurt enough to get enough to “yes.”

A world of urgent hurt for a large majority of constituents can get lawmakers to bipartisanship.  That may end up the only ticket at the national level.  Lots of constituents and interests from all over the nation are stirring the health care stew and the heat is on high.