House lawmakers worked late into the evening and on into the early hours of Friday morning on amendments to House Bill 1232, the so-called public option bill. The bill won approval on a preliminary vote and heads to a recorded vote on Monday.
What they had to work with is a strike-below amendment, which essentially amounted to a rewrite of the bill approved by the House Health & Insurance Committee on April 27. And work they did, starting at 5 p.m. on Thursday and continuing on until just after 2:15 a.m. Friday morning with a 35-minute break shortly before midnight.
"This bill is a narrowly targeted, careful and deliberate approach to a problem we have in our state, particularly in rural Colorado," said bill sponsor Rep. Dylan Roberts, D-Eagle, in closing comments just before 2 a.m. "Every single one of us has constituents going to bed tonight, or already gone to bed, worrying about their family's health insurance because of the cost.
"To do nothing is unacceptable."
The radically changed bill dropped the "public" from public option: from a quasi-state run and developed standardized plan, known as the Colorado Option, to just the state-developed standardized plan. Under the amended bill, doctors and hospitals would be required to offer the Colorado Option or risk warnings and fines, up to $2.3 million for hospitals.
Health insurers are required under the bill to lower premiums by 18% over three years, which Republicans indicate is a made-up number with no actuarial data behind it.
The bill is intended to offer affordable health care to 18,000 more Coloradans in the individual and small group markets, about 15% of the total insured. The individual market is for people who have to buy their own insurance.
HB1232 has been more than a year in the making. A 2020 version was withdrawn by its sponsors. The 2021 version was introduced on March 18 but waited for nearly three weeks for its first hearing as furious negotiations went on among the sponsors, the Polis administration, health insurers, doctors and hospitals.
The strike-below moved the health insurers into an amend position; the Colorado Hospital Association is now monitoring a type of neutral position. The bill is still opposed by the 7,000-member Colorado Medical Society, although Healthier Colorado, one of the bill's advocates, sent out a letter this week from the Colorado chapter of the Committee to Protect Health Care in support of the bill. The letter was signed by 44 doctors, nurses and one medical student, almost all from the Denver metro area. None of the signatories were from the Eastern Plains and only three were from the Western Slope, which sponsors say has some of the highest health insurance costs in the state.
House Minority Leader Hugh McKean was hunkering down for a long night of debate as his dinner arrived at the Capitol Thursday evening. He said Republicans had 50 amendments that would improve the legislation and move the state toward cheaper healthcare without putting more of a vital service and industry under the government's thumb.
"We're talking about 15% of our market," he said. "We have an additional 50% that's Medicare and Medicaid. We're talking about 65% of our market that in some way, shape or form is going to be dependent on the government." The ask is too big right now, McKean said.
"You talk to anybody," he said. "They'll say, 'We don't have 18% right now. We might have 3, 4, 5% at most.' (Eighteen percent) is just an arbitrary number. There's no actuarial analysis. All there is is this sort of pie-in-the-sky 'here's what we like,' and the challenge is it just doesn't make sense." He said rural Colorado doctors are going to have to accept a rate from the government "that says 'go forth, but don't prosper,'" McKean surmised.
He thinks the state could lower rates without mandates and threats with cooperation and incentives. "Tell carriers if they can reduce by a certain amount, we'll increase the reimbursements for the providers in your network," McKean said. "It gives everybody an incentive to save. It gives providers to save on their billable costs, and even if it's a smaller amount, their percentage goes up."
The debate Thursday night and early Friday morning primarily focused on the 20 amendments offered by House Republicans. Among others, some included:
- Swapping the bill's safety clause, which would put the bill into effect upon the governor's signature, to a petition clause, which would allow voters to challenge the bill. While it's unusual, it's not unheard of; a citizen initiative challenged the National Popular Vote bill in the 2020 election (voters approved the bill). Roberts informed the chamber that the safety clause was added to the bill at the request of the health insurers, who must file insurance rates almost a year in advance and need the bill to go into effect as soon as possible
- Make the Commissioner of Insurance an elected position. The bill gives the commissioner a great deal of authority over the establishment of the standardized plan as well as setting price caps for health services. However, the commissioner's position is established in the state Constitution, which also states that the position is appointed by the governor and confirmed by the state Senate
- Requesting an actuarial analysis of the 18% premium reduction
- Eliminating additional health benefit mandates
- Allowing legislative leaders to appoint an oversight board tied to the standardized plan
- Removing penalties on hospitals and providers
- Requiring an actuarial analysis to set rates
House Republicans also ran through 13 committee of the whole amendments seeking to add their changes back into, but those efforts were foiled by the chamber's Democratic majority.
The majority had amendments of their own, including three from the chamber's only physician. But unlike the GOP amendments, those offered by Rep. Yadira Caraveo, a Democrat from Thornton who is a pediatrician, were adopted by the body.
Those included measures that would explicitly add a doctor to the advisory committee created by the bill; require a study on the impact the bill will have on health care providers workload; and add a conversion rate between Medicare and Medicaid to ensure pediatricians with patients covered by the new plan can charge for their care.
Roberts also added a handful of amendments of his own – some technical in nature, others more substantive. The more substantive changes moved by Roberts and approved by the House clarified the $5,000 fine that could be imposed on providers who refuse to participate in the new plan can only be levied once per calendar year; allow carriers and providers to appeal decisions made by the Commissioner of Insurance to district court; and require the Commissioner of Insurance to promulgate rules that ensure new insurance carriers don't gain an unfair advantage when entering a new county.
Joey Bunch of Colorado Politics contributed to this story.