A political advertisement, paid for by a Washington, D.C.-based group made up of mostly drugmakers, insurance companies and private hospitals, aired last month on television stations across the Front Range. It featured footage of the state Capitol and with a narrator who said, “Health care decisions should be made by Coloradans and their doctors — not politicians.”
That message hit the airwaves as Democratic lawmakers and Gov. Jared Polis seek to enact a so-called “public option” health insurance plan in Colorado. The plan aims to drive down health care costs by targeting hospitals and the price they can charge for health care. In addition to well-heeled, out-of-state trade groups, the Colorado Hospital Association opposes the proposal, saying it will destabilize the insurance market and could lead to unintended consequences.
In many ways, what is expected to be one of the most contentious battles of the 120-day 2020 legislative session has already begun.
The fight over health care costs, as well as multi-year efforts to repeal the death penalty and pass a paid family and medical leave program, have all but obliterated expectations of an election-year session in which ambitions might be tamped down to avoid later repercussions at the ballot box.
One reason for the loaded Democratic agenda this year, House Speaker KC Becker said, is inaction on the federal level and the Trump administration’s policies.
“That spills over into the legislature to get as much done as possible and to push back against Trump and his policies,” Becker said. “He’s not leading change in terms of health care costs. He’s not leading change in terms of providing paid family leave. He’s leading the wrong kind of change in terms of energy and the environment.”
In November 2018, Democrats won control of both legislative chambers and the governor’s office for the first time since 2014. In recent interviews, party leadership pointed out, unprompted, that more than 96% of bills passed last session had bipartisan support.
“There are always opportunities for collaboration,” said Senate President Leroy Garcia. “No one party has a monopoly over great ideas.”
Minority Leader Chris Holbert, a Republican from Parker, said he sees room to work with Democrats on transportation funding, specifically coming up with $300 million from the general fund — money collected from the state sales and income taxes — for roads and bridges. He also wants to work with Democrats on helping to drive down the cost of college tuition by making it easier for high school students to enroll in college classes, a program known as concurrent enrollment. Garcia, an ex-Marine who served in Iraq, wants to work with GOP lawmakers on reducing suicide among veterans.
Many of the same calls for across-the-aisle cooperation preceded the 2019 session. But it was later roiled by Republican stall tactics and threats of recalls. Republicans, who generally oppose greater regulation on businesses, will likely oppose many of the Democrat-backed bills this year, too, having them read at length to slow down the process and to force Democrats to triage priorities.
“The strategy remains the same. We only have one option: we can talk as long as we can about the bill,” Holbert said.
The session begins Jan. 8 and will run through May 6. Here’s a snapshot look at some of the bills likely to ignite fierce debate.
As mentioned, the Polis administration’s public option health insurance plan is likely to become one of the most controversial measures this session. The plan would be run by private insurance companies, but tightly controlled by the state. One key provision would set a cap on how much hospitals can charge for services to residents enrolled in the insurance plan. It would also require all hospitals and insurance companies to participate in the program.
These policy changes are coming up this year because Democrats and Polis have made driving down health care costs a key priority for the session. Democrats see hospital profits, lack of competition among insurance companies, and drug prices as the state’s top health care cost drivers.
In 2018, hospitals in the state netted $2 billion in profits, with average profit margins, as a percentage of net patient revenues, above 19%, according to a September study by researcher Allan Baumgarten. That profit margin is well above the 2-3% national average. In the Denver metro area, four health systems — HCA Holdings (which owns HealthONE), Catholic Health Initiatives (which owns Centura), UCHealth, and SCL Health — now make up 85% of total hospital admissions. That centralized ownership gives hospitals more negotiating leverage with insurance providers, experts say, which can allow them to increase the price of care. On average, hospitals bill private insurance companies about double what they bill Medicaid, according to a RAND Corporation study.
The Colorado Hospital Association attributes recent profit growth to the strong economic growth in the state.
“Colorado hospitals fully recognize that there is much work that needs to be done to address health care affordability,” said Chris Tholen, executive vice president for CHA, in a recent statement. “But embarking on a path that adds further uncertainty by destabilizing Colorado’s insurance market, on top of instituting government price controls, will likely cause consequences on the state’s health care system beyond what is intended.”
Lawmakers don’t expect the businesses to give up their profits without a fight.
“The status quo in the health care industry right now is powerful,” said Rep. Dylan Roberts, a Democrat from Avon. “Any legislation that tries to rein in those profits is going to be lobbied against.”
Another battle is brewing with pharmaceutical companies. Lawmakers want to require companies to disclose more information about the costs of their drugs and make that information public. They also plan to require the disclosure of certain fees companies charge and set up a board to oversee drug costs.
What to do about Colorado’s worst-in-the-nation childhood vaccination rates is likely to be another battle this session that could pit Democratic lawmakers against the governor. Last session, Democrats sought to pass House Bill 1312, which aimed to increase vaccination rates by requiring parents seeking personal exemptions to apply for them in person at local health departments. Polis, who has made clear he is “pro-choice” on whether parents should vaccinate their kids, threatened to veto the bill. He told Colorado Matters he saw the bill as heavy-handed, potentially creating more distrust in vaccinations.
Paid family leave
For the sixth time, Colorado will consider a bill to enact a paid family and medical leave program. Republicans, who controlled the state Senate from 2015 to 2018, killed early attempts to pass the program. During the 2019 legislative session, business trade groups worked to reduce the size of the program before Democrats, who squabbled over how much it would cost, ultimately punted the bill until 2020.
What the program would look like is not yet clear. It is likely to cost $1.2 billion to $2.3 billion to operate, depending on the level of benefits, according to a December 2019 actuarial analysis by AMI Risk Consultants of Miami. A task force set up to study the cost and scope of such a program will report back to lawmakers on Jan. 8, the first day of the session. There are also talks of requiring private insurance companies to set up a program.
“We’re looking at what is the most accessible and affordable plan that is fiscally responsible,” said Sen. Faith Winter, a Democrat from Westminster. “There is still friction to work through with the business community and the details of how expansive the benefits are.”
Death penalty repeal
Advocates are already laying the groundwork for the seventh effort to abolish the death penalty in Colorado.
If 2019’s debate is any measure, wrangling over the bill is sure to test moral convictions and personal relationships among lawmakers. Sen. Rhonda Fields, of Aurora, and Rep. Tom Sullivan, of Centennial, both lost their sons to gun violence and both support the death penalty. Two of the three men on death row were responsible for the 2005 murders of Fields’s son, Javad Marshall-Fields, and his fiancee, Vivian Wolfe. Marshall-Fields was scheduled to testify in a murder trial.
Democrats pulled the repeal bill last year when several Democrats left open the possibility of voting against it. Publically, the main argument used against the death penalty repeal at the time was one of process — that Democrats were rushing the bill to a vote less than a month after it was introduced. This year, supporters of the bill have been clear that it will come up for a vote. That effort began the day the bill was pulled last year.
Rep. Susan Lontine, a Democrat from Denver, is working on a bill that would amend a 2006 law to remove the word “illegal alien” and replace it with “undocumented immigrant.”
Last session, Lontine sought to pass a version of Virginia’s Law, which would have allowed undocumented immigrants to call 9-1-1 without fear of being referred to ICE. That fell apart, in large part because Polis opposed it. He is adamant on not being dubbed a governor of a so-called “sanctuary state,” an eye-of-the-beholder term that is already used in political attacks against him. The governor’s opposition to broad efforts to limit cooperation with ICE is one reason that bill is unlikely to resurface this year.
Separately, Rep. Adrienne Benavidez, a Democrat from Commerce City, said she wants to pass a law that would allow immigrants who have authorization to work legally in Colorado to obtain occupational licenses. Benavidez also wants to authorize the Colorado Department of Public Health and Environment to inspect and report back to lawmakers on the conditions in Colorado’s immigration detention centers and jails. Cases of mumps and a case of chickenpox were reported at Aurora’s immigration detention facility this year. Kamyar Samimi, a 64-year-old man from Thornton, died after doctors at the GEO Group-owned facility forced him into opioid addiction withdrawal.
When it comes to gun reforms, Democrats this year want to pass a law requiring gun owners to report lost and stolen firearms to law enforcement. They also want to require gun owners to keep their guns in a locked safe at home when not in use. These policies will draw opposition from Republicans, many of whom want to instead loosen gun laws and arm teachers in K-12 schools. And it’s unclear if all Democrats will support them. Senate President Garcia voted against the so-called red flag law in 2019, and was noncommittal when asked about safe storage and lost and stolen reporting on Thursday.
“I’m not sure on the specifics of the policy,” he said, but, “I think these are important conversations that we are having in the state.”
This story was updated on Jan. 6 with information about efforts to boost vaccination rates.