Gov. Jared Polis signed nine bills into law on Wednesday, but one came with a sharp warning to Democrats in the General Assembly: don’t send him any more bills that might increase health insurance costs. That message is not going over well with Democratic lawmakers.

Among the nine: House Bill 1158, which mandates health insurance providers cover the cost of infertility treatments. 

The measure was a controversial one during the first half of the 2020 session, but Polis said it’s the last bill he’ll sign that could increase the cost of health insurance, unless sponsors can prove the measures will save money rather than raise premium costs, or if they can make the case it will help with the COVID-19 pandemic.

In his signing statement for HB 1158, Polis tied the measure to COVID-19, stating that the law “will help families have children in the wake of COVID-19 and is important for our state’s future economic success.”

However, the governor pointed out, his top priority has been to lower the cost of health care, including health insurance. “Additional mandates, which may, by themselves, be important advancements in expanding coverage or reducing long-term costs, often do not meet the second goal of lowering health insurance costs for people today, and can have the unintended consequence of making coverage less accessible to those who need it most,” Polis wrote in the signing statement.

Polis said he would not sign any more insurance mandate bills in the 2020 session, “except where there is an urgent need for additional benefits related to COVID-19.”

Polis called on the General Assembly to establish a process for actuarial reviews of all new mandates. And in some of the strongest language he’s handed out publicly to General Assembly Democrats, who have been the main drivers on mandating coverage over the past two sessions, Polis warned that if they don’t do those actuarial reviews, “I will be disinclined to sign future legislation creating new insurance mandates.”

As it turns out, a bill mandating those actuarial reviews is already in the works. Senate Bill 127, sponsored by Sen. Jim Smallwood, a Parker Republican, and Senate President Pro tem Nancy Todd of Aurora, would set up a “health benefit plan design change review committee” within the Division of Insurance, tasked with reviewing bills that impose new requirements or amend existing requirement on health plans. The measure has been sitting in the Senate Appropriations Committee since Feb. 13. The bill doesn’t yet have a House sponsor, and it is likely headed for amendments on just who will do the actuarial review. 

Polis directed the Division of Insurance to work with the bill’s sponsors. 

The Colorado Association of Health Plans has raised the issue of insurance mandates for the past two sessions. A CAHP fact sheet obtained by Colorado Politics asserts that three laws passed in 2019 and those proposed in 2020 could balloon health insurance premiums by $185 million to $235 million in 2021. 

The three 2019 laws that CAHP said would drive up health insurance premiums:

• House Bill 1216, which reduced the price of insulin ($6 million),
• House Bill 1233, which directs health insurance providers to spend more of their premiums on medical benefits ($56 million in year one, $58 million in year two);
• House Bill 1301, which mandates noninvasive imaging for breast cancer screenings ($11 million).

There are at least five more bills mandating health insurance coverage working through the legislative process in the 2020 session:

• House Bill 1086, which calls for an annual mental health wellness exam ($6 million more in health insurance premiums);
• House Bill 1103, which requires insurers cover colorectal cancer screenings for those 45 years and older. The Affordable Care Act already requires those screenings, although federal guidelines don’t mandate them until age 50. CAHP estimates premiums would increase by $11 million to $22 million in 2021. 
• Senate Bill 156 requires health insurance providers to cover osteoporosis screening, urinary incontinence screening, and screening and treatment of a sexually transmitted infection. The bill carries almost a million dollars in state and federal costs, including more than $100,000 in state general and cash funds. Health insurance premiums could increase by $28 million, according to CAHP.
• House Bill 1061 requires health insurance providers pay for “HIV infection prevention drugs prescribed or dispensed by a pharmacist and to provide an adequate consultative fee to those pharmacists.” CAHP estimates the bill will drive up health insurance premiums by $11 million.
• House Bill 1085, which deals with substance abuse disorders, requires health insurers to provide the lowest copayment possible for physical and occupational therapy, visits for acupuncture and chiropractic care. The measure also carries substantial state costs, requiring $858,000 in general funds in 2020-21 and $3.1 from the state’s marijuana tax cash fund. Health insurance premiums would increase by $22 million to $39 million, according to CAHP estimates.

Polis’ announcement is taking Democratic lawmakers by surprise. 

Rep. Dafna Michaelson Jenet, a Commerce City Democrat, is one of sponsors of House Bill 1086, and told Colorado Politics she was “devastated” by the signing statement and its implications for the bill. “If I don’t have any other bills this year, this is the one” that she most wants to see signed. It’s her top priority, and “at a time like this, when we’re all locked in, some in bad situations, mental health will be the number one factor in rebuilding our society and economy. I will make that case until my lungs stop working,” and hope that someone else will pick up the fight should her lungs fail. 

“During this time of COVID-19 we are facing isolation and reduced access to services for victims of domestic violence,” she said in a later statement. “Accessing mental health care will continue to be as critical as facing off the invisible beast that is COVID-19 as a physical threat. The mind and body are connected and while only some bodies are being devastated, all of our minds are being impacted by this crisis. We will all need help,” she said.

Michaelson Jenet is quarantined at home, and despite an earlier statement that her doctor misread the results of a COVID-19 test, now says he firmly believes she has it.

Speaker Pro tem Janet Buckner, an Aurora Democrat, also was taken back by the signing statement. She’s the sponsor of House Bill 1103, and said she would be calling the governor’s office for clarification.

House Assistant Majority Leader Chris Kennedy of Lakewood, one of the sponsors of House Bill 1085, said the governor’s office raised concerns earlier in the session about the health insurance mandates. He had not seen the signing statement when contacted by Colorado Politics, but said “I think there’s still room to discuss how we can accomplish these incredibly important goals for the state,” adding that Polis has been supportive of addressing the opioid crisis and eager to work on solutions.

Calls to Sen. Brittany Petterson of Lakewood and Rep. Alex Valdez of Denver, sponsors of SB 156 and HB 1061, respectively, have not yet been returned.