{"id":46562,"date":"2021-05-27T23:49:00","date_gmt":"2021-05-28T05:49:00","guid":{"rendered":"https:\/\/dh.durangoherald.com\/tj\/state-democrats-health-insurance-bill-amended-21-times-heres-how\/"},"modified":"2026-03-31T03:32:33","modified_gmt":"2026-03-31T09:32:33","slug":"state-democrats-health-insurance-bill-amended-21-times-heres-how","status":"publish","type":"post","link":"https:\/\/dh.durangoherald.com\/tj\/state-democrats-health-insurance-bill-amended-21-times-heres-how\/","title":{"rendered":"State Democrats\u2019 health insurance bill amended 21 times. Here\u2019s how."},"content":{"rendered":"

\"Republicans
Republicans listen to debate in the Colorado Senate on May 20, 2021. (Jesse Paul, The Colorado Sun)<\/span>Jesse Paul\/The Colorado Sun<\/span><\/figcaption><\/figure>\n<\/p>\n

It was a public option bill, and then it wasn\u2019t. It required the health care industry to cut costs by 20% at one point, but now that figure has been slashed by a quarter. For weeks, the legislation threatened doctors with fines and licensing consequences if they didn\u2019t participate in the initiative, but now physicians can\u2019t be penalized.<\/p>\n

As House Bill 1232, Colorado Democrats\u2019 sweeping measure to try to drive down health care costs, advanced through the Capitol, it went through a 21-amendment metamorphosis.<\/p>\n

\u201cIt\u2019s been changed four times when it came from the House to the Senate,\u201d complained Sen. Joann Ginal, a Fort Collins Democrat who is skeptical of the bill. \u201cBut even more in the House.\u201d<\/p>\n

The changes \u2014 some of which have been sweeping \u2014 have been added to win over industry groups and shore up lawmakers\u2019 votes, as well as to make technical tweaks.<\/p>\n

Some say the policy, which is now a single vote away from heading to Gov. Jared Polis\u2019 desk, has transformed from a lumbering caterpillar into a fluttering butterfly. Others think the end result is something more akin to an annoying miller moth.<\/p>\n

\u201cIt could have been a whole lot worse,\u201d quipped Sen. Jim Smallwood, a Centennial Republican who adamantly opposes the policy but has thanked Democrats for being open to amendments.<\/p>\n

The Colorado Sun scanned through the changes to create a timeline of how the policy has been dramatically altered:<\/p>\n

\"A
A room in the Denver Health emergency department where patients are treated on-demand for their opioid dependency. (Jesse Paul, The Colorado Sun)<\/span>Jesse Paul\/The Colorado Sun<\/span><\/figcaption><\/figure>\n<\/p>
Public option is dropped<\/div>\n

The House Health and Insurance Committee was where House Bill 1232 changed most dramatically.<\/p>\n

The introduced version called for a two-phase plan that would have required the health care industry to drive down costs by 20% by 2024 or trigger the state to form a nonprofit to offer a public health insurance plan that would be at least 20% cheaper in each county than the average premium rates offered by private insurers. Both of these applied only to the individual and small group markets, the places where people who don\u2019t have employer help in buying insurance and small companies shop for coverage.<\/p>\n

The original version of the measure also would have given the state power to set a fee schedule for the public option plan that providers were required to abide by. If they didn\u2019t, doctors and hospitals could potentially lose their licenses.<\/p>\n

However, the meat of the proposal was scrapped during its first committee hearing in what\u2019s referred to as a \u201cstrike below\u201d amendment. With the amendment, the sponsors of the bill moved to make it more about regulating private insurance than about getting government into the business of selling health coverage.<\/p>\n

The new version required the state commissioner of insurance to design a standard health insurance plan \u2014 dictating things like what benefits are covered and what consumers can get without having to pay toward their deductibles. Insurance companies would be required to offer the standard plan in counties where they already sold other plans in the individual or small group markets. And they would be required to sell the standard plans by 2025 at rates 18% below 2021 rates.<\/p>\n

The new version still gave the state the ability to set prices for hospitals and doctors. Doctors who didn\u2019t participate could be fined, and hospitals that didn\u2019t participate could have their licenses revoked.<\/p>\n

\u201cThe introduced version of the bill was a starting point,\u201d state Rep. Dylan Roberts, an Avon Democrat and prime sponsor of the measure, said at the time. He added that there was \u201calways a possibility we would end up here.\u201d<\/p>\n

Startup costs get added in<\/div>\n

In the House Appropriations Committee, the costs of the measure were set.<\/p>\n

The measure would spend $1.5 million, including $1.2 million allocated to the Division of Insurance to get the policy off the ground. The remaining funds would go to the Colorado Department of Law and the Colorado Department of Health Care Policy and Financing. The state would have to hire about seven full-time employees to manage the initiative.<\/p>\n

(The Senate later increased the bill\u2019s spending by about $200,000.)<\/p>\n

But that\u2019s not all the measure would cost.<\/p>\n

Colorado\u2019s insurance commissioner would have to seek what\u2019s called a 1332 waiver from the federal government to implement the bill and secure more money to get it up and running. In fact, the entire bill is contingent upon the Biden administration granting the waiver.<\/p>\n

Changes on House floor<\/div>\n

The House debated 28 amendments to the bill, but only eight passed. Several of those cleaned up small bits of language, and the rest made only minor tweaks.<\/p>\n

One amendment instructs the commissioner of insurance to write rules that make sure that companies looking to offer the standard plan in a county where they haven\u2019t previously offered coverage are not at a competitive disadvantage.<\/p>\n

Another allows insurance companies, hospitals and doctors to appeal decisions of the insurance commissioner related to price setting to state district court. Another deals with how to set hospital prices for \u201ca pediatric speciality hospital with a level one trauma center,\u201d a designation that refers to Children\u2019s Hospital Colorado.<\/p>\n

Changes in Senate committee<\/div>\n

Another 14 proposed amendments were brought in the Senate Health and Human Services Committee. Only four made it into the bill. Several of those \u2014 including one related to fines that could be charged to doctors who won\u2019t accept the standard plan and another on reports that the state needs to commission \u2014 were subsequently overwritten on the Senate floor.<\/p>\n

What survived out of the committee\u2019s changes were a couple of language clarifications and a typo fix.<\/p>\n

No more penalties for doctors<\/div>\n

The biggest change to the bill made on the Senate floor was to remove penalties for doctors who refuse to accept the standardized plan. The measure was also altered to allow hospitals\u2019 licenses to be suspended for not participating in the initiative, but not fully revoked as earlier versions of the legislation called for.<\/p>\n

The amendment helped to assuage the anxieties of some Senate Democrats who felt the punitive parts of the measure were a bridge too far.<\/p>\n

Sen. Rhonda Fields, an Aurora Democrat, said during a committee hearing that she didn\u2019t \u201clike the tone\u201d of the bill. \u201cI think that sends the wrong message when I think about the social and emotional support that I think our health care providers and our doctors and nurses need right now,\u201d she said.<\/p>\n

The change helped win Field\u2019s support. But it also angered private insurers, who said the alteration was untenable \u2014 making it more difficult for insurers to lower prices while still meeting requirements that they contract with an adequate network of doctors. As a result, the Colorado Association of Health Plans moved to an \u201coppose\u201d position on the bill.<\/p>\n

The state\u2019s insurance commissioner will, however, still be tasked with monitoring how many providers accept the standardized plan to determine financial viability.<\/p>\n

Finally, another change made on the Senate floor allows the insurance commissioner to set reimbursement rates for little-used services, after consulting with hospitals, providers and the Department of Health Care Policy and Financing.<\/p>\n

Savings mandate reduced to 15%<\/div>\n

The final amendment made to the bill in the Senate was to reduce the cost-savings mandate in the measure to 15% \u2014 a 5 percentage point reduction from where the legislation began.<\/p>\n

Sen. Kerry Donovan, a Vail Democrat and a prime sponsor of the measure in the Senate, said the change was made to ensure the bill has a reduction goal that\u2019s \u201ca reach, but achievable.\u201d<\/p>\n

\u201cIn order to set the plan up for success, we thought that it would be better to be able to really know that we can do 15% rather than fall short of a higher target,\u201d she said.<\/p>\n

Nineteen total amendments were offered during the Senate floor debate. Six were adopted.<\/p>\n

Where is the bill at?<\/div>\n

The bill passed the Senate on Wednesday by a 19-16 vote, with Democratic Sen. Rachel Zenzinger, of Arvada, joining all of the chamber\u2019s Republicans in opposition to the measure.<\/p>\n

The bill now heads back to the House, which will decide whether to accept the Senate\u2019s changes, reject them wholesale or launch a conference committee to work out the differences.<\/p>\n

The legislation could clear the legislature and be sent to the governor to be signed before the end of the week.<\/p>\n","protected":false},"excerpt":{"rendered":"

into a measure requiring private companies to offer a state-regulated plan with 15% lower costs<\/p>\n","protected":false},"author":1,"featured_media":46563,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[233,28,29],"naviga_topic":[],"class_list":["post-46562","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","tag-coloradosun-com","tag-headlines","tag-newsletter"],"acf":[],"author_name":"dh_admin","_links":{"self":[{"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/posts\/46562","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/comments?post=46562"}],"version-history":[{"count":1,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/posts\/46562\/revisions"}],"predecessor-version":[{"id":86933,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/posts\/46562\/revisions\/86933"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/media\/46563"}],"wp:attachment":[{"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/media?parent=46562"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/categories?post=46562"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/tags?post=46562"},{"taxonomy":"naviga_topic","embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/naviga_topic?post=46562"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}