On Tuesday, the state Senate will take on the last major fight — and opportunity to make big changes  — in House Bill 1232, the Colorado Option bill.

The bill would require healthcare providers and insurance plans to reduce premiums by 18% over three years. The commissioner of insurance would set up a standardized health plan, known as the Colorado Option, that providers, including doctors and hospitals, would be mandated to accept and insurance plans mandated to carry. The plan would be offered in the individual market, for those who must buy their own health insurance, and in the small group market, for companies with fewer than 100 employees. That’s about 15% of the total insured market. Eventually, however, supporters have said they want to see the plan offered in the large group market, for companies with 100 or more employees. 

Hospitals that refuse to accept the plan could be fined $10,000 per day for the first 30 days and $40,000 per day after that. However, the bill’s fiscal note said it anticipates a high level of compliance and doesn’t expect large revenues from the fines.

Doctors and other healthcare providers that refuse to accept the plan face a maximum annual fine of $5,000 plus a warning from the commissioner of insurance, although the bill said such warning would not constitute a disciplinary action against their license.

The intent is to reduce the cost of health insurance and to address issues of equity around health care for people of color and rural Coloradans, who pay some of the highest costs for health care.

HB 1232’s trip through the General Assembly has taken months, while backers, including the Polis administration, tried to come to agreement with opponents. The best they could do, however, was get the health plans to a position of amend, and the Colorado Hospital Association to a neutral position. Doctors, including the 7,000-member Colorado Medical Society, have been opposed from the beginning and never wavered.

That could all change on Tuesday. 

Among the amendments that are expected to be offered on Tuesday, one would take doctors out of the bill. That would leave hospitals with the responsibility for reducing costs that could lead to lower premiums. That’s been a major concern both for hospitals and hospital workers, whose unions have testified against the bill, fearing that hospitals, in effort to cut costs, would lay off staff.

While that amendment could bring into a position of support the last remaining wavering Democrats in the Senate, it will result in the Colorado Association of Health Plans moving to a position of opposition.

At least three Senate Democrats are believed to be on the fence about the bill: Sens. Rhonda Fields of Aurora, Joann Ginal of Fort Collins and Rachel Zenzinger of Arvada. During a May 19 hearing in the Senate Health & Human Services Committee that she chairs, Fields had nothing good to say about the bill. 

“I don’t like the tone and topic in the bill,” Fields said, particularly in the fines and punishments for doctors and hospitals. “You can’t rack up penalties and think it won’t catch up with you,” she said. Fields also noted that doctors and nurses have been the heroes of COVID-19, but in the bill, it mentions you can suspend, revoke or impose conditions on a hospital’s license.

“That’s punitive and sends the wrong message when we think about the emotional and social support our doctors and healthcare providers need right now…it is sending the wrong message at the wrong time,” she said.

Fields noted she has four major hospitals in her district that provide complex care, which also isn’t addressed in the bill. This would leave them navigating in the dark.

Quality care and outcomes are also important, Fields said, that patients have good health experience with doctors and hospitals.

“I’m concerned not just with expense, but with quality healthcare outcomes,” she said. “The bill is silent on prevention in health equity, and that’s how you eliminate health disparities. It changes the course of how doctors will do business.”

Ginal, the vice-chair of the committee, also expressed reservations during that May 19 hearing, including some of the strongest objections to the bill, based largely on the bill’s mandates on physicians. The 2020 version didn’t include physicians, so “why now?” she asked. Mandatory participation and fines show an inherent weakness, according to letters Ginal said she received from doctors. The state does not have the right to force doctors to participate, and should HB 1232 pass it will end up in the courts, they told her. 

HB 1232 is scheduled for second reading debate in the Senate Tuesday.