Hospitals present a major roadblock to 'Medicare for All' push

On Wednesday, the state Senate passed House Bill 1232 to allow the commissioner of insurance to create a standardized healthcare plan for the individual and small group market that insurance companies would be mandated to offer and doctors and hospitals mandated to accept.

The vote was 19-16, with Sen. Rachel Zenzinger, D-Arvada, the only Democrat in the Senate (and the General Assembly) to vote against it. 

The bill must go back to the House for concurrence on nine amendments put on the bill by the Senate Health and Human Services Committee and by Democrats on the Senate floor. 

Wednesday's vote ended months of negotiations with the healthcare industry, all of whom were opposed to the bill at different times. As of Wednesday, hospitals and doctors are neutral, but the insurance industry remained opposed. 

Under HB 1232, insurers, health care providers and hospitals would have three years to reduce premiums by 15%. That savings will come through rate-setting by the commissioner on the services doctors and hospitals provide. The bill also sets fines for hospitals that refuse to participate, at $10,000 per day for 30 days and $40,000 a day after.

While fines for doctors were amended out, opponents claim refusal to participate is still a risk to a provider's license. Under the bill as amended, the commissioner would monitor for problem areas where health care providers are not participating. 

A frustrated Sen. Jim Smallwood, R-Parker, lambasted the bill as satisfying a political objective, rather than a genuine attempt to reduce healthcare costs. 

"The far left has to have this bill," Smallwood said. "All the amendments you did not vote for would have at least fixed the technical problems."

Smallwood said he thought some of the political forces around HB 1232 don't care what's in it. What matters is it passes, he said.

"That lets the forces of the far left build the infrastructure that they need to fulfill the governor's campaign promise of creating a multi-state single payer system," Smallwood said. "That's where this is all leading, and it's the only reason why we wouldn't make the bill better with amendments."

He also noted that the commissioner of insurance would have a form of authority, under the bill, to regulate hospitals (which is under state Department of Public Health and Environment) and doctors (who are regulated by another division within the Department of Regulatory Agencies.

"Who creates a system like this, with a health-care czar who can reach into all other segments of the economy and who can go into the hospitals and tell them how much they can get paid?" Smallwood said.

Sen. Sonya Jaquez Lewis, D-Longmont, countered: "We have the chance to do something big. Our constituents are begging us to reduce costs."

Cost drivers are hospitals, providers, new technology and pharmaceutical drugs (which isn't in the bill), she said.

"This is an attempt and a big step to control hospital costs," Jaquez Lewis said.

The bill helps the hospitals, she said, by paying them more from what they get from commercial plans. Jaquez Lewis noted the Rural Health Alliance, which supports rural hospitals, are neutral on the bill (as is the Colorado Hospital Association). 

There's nothing in the bill that forces health care providers (except for hospitals) to participate, according to Jaquez Lewis. "Those who are committed to this believe family doctors will want to participate," she said.

Dozens of doctors, part of the 7,000-member Colorado Medical Society, testified against the bill in committee hearings. Backing the bill is a group of health care professionals and medical students, about 44, who are tied to the Colorado Alliance for Health Care Options, an advocacy coalition. 

Despite their vote, some Democrats took issue with what is in the bill, and what isn't.

Sen. Rhonda Fields, D-Aurora, spoke at length against the bill. 

Fields said she consulted with the Black community and its leaders, such as former Denver Mayor Wellington Webb and Dr. Reggie Washington, who had concerns.

"Don't get [the bill] twisted; it isn't about health equity," she said.

Health equity is about prevention, not just  insurance, she said, explaining that equity is not included.

"When they talk about health equity, where is it?" Fields asked. There are structural disparities around health care in communities of color, she said.

"You might think you're getting insurance, but to get access, it will cost you some mileage," suggesting some would have to drive a long way to get what they need. 

A lot of Fields' questions went unanswered.

"Will this option build more hospitals?" she asked. Will more hospitals will be built to provide more access? Will the bill provide the opportunity to recruit and retain the brightest minds in Colorado? Will it provide the intervention and prevention approach in health equity disparities?"

Fields said she thought access to health insurance needs to be increased for the people of Colorado, so she announced she would vote for the bill. 

Sen. Joann Ginal, D-Fort Collins, was one of three Democrats thought to be wavering or even opposed to the bill before Wednesday (along with Fields and Zenzinger).

She said she supports the goals of HB 1232. She said she's spent most of her life in health care, and as a lawmaker she has worked on health care issues during her nine years in the legislature. 

HB 1232, however, needs more work.

Ginal agreed with Smallwood that the issue is political, but, like Fields, ultimately voted with her party. 

Sen. Dominick Moreno, D-Commerce City, told of a second cousin who died of leukemia when they were young. "My issue isn't with the medical care he received," Moreno said, calling the care phenomenal.

It was what happened after, when his aunt got the hospital bills and other medical expenses. While grieving for her child, she had to declare bankruptcy.

"Twenty-five years later, we still haven't fixed it," Moreno said, because people still go broke because someone gets sick.

"That's not OK," he added.

Something has to be done, he said. and HB 1232 "is at least something."

Sponsor Sen. Kerry Donovan, D-Vail, said the health care system isn't working for a lot of people, whether it's the neighborhood in which someone lives, the color of someone's skin or a problem of access.

"We would be hard-pressed to find someone who says 'health care is going great, we have bigger things to solve.'" she said.

The bill is silent on who would have regulatory oversight over the standardized plan created by the commissioner of insurance. State law vest that authority with the Division of Insurance, which is led by a commissioner.

"There's no question there's a massive conflict of interest," Smallwood told Colorado Politics. "What this bill has done is create an omnipotent force regarding all aspects of all health care in the state."

It's expanded the commissioner's role well outside of insurance, and in a de facto health care czar role over hospitals and every health care occupation in the state, he said.

What if the Division of Insurance employees find something wrong with the health care plan created by their boss, the commissioner?

"I have no idea why the proponents set up the bill that way with so much authority," Smallwood said.

Editor's note: For 16 months in 2011 and 2012, Marianne Goodland was the public information officer for the Division of Insurance.

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