5 Things Colorado: Public option comments, Rep. Susan Lontine, Prescription drug costs

Our team at State of Reform is about to head out for an ‘escape room’ as part of our holiday party. Maybe it says something about the state of things in 2019 that we’re choosing to lock ourselves in a room for an hour with no access to the world outside.

Thank you for your support and engagement this year as we’ve kicked off our first year of covering Colorado health care! Particular thanks go to HMA, Anthem, CHSM, Beacon, Wynne Health, and Optimetra for putting so much great wind in our sails in 2019!

Here’s to hoping 2020 leaves us all more fulfilled and supported. Now, on to 5 Things We’re Watching in Colorado health care for the month of December.





1. What the 5th Circuit decision means

The news last night that the 5th Circuit struck down the individual mandate belied a more nuanced reporting of the decision. I detail four things I think are worth noting in my post this morning. Here are a couple of thoughts that mainstream reporting might not share.

First, this isn’t a broad decision. It’s a careful one, pointing to a more conservative approach to jurisprudence than to politics. Moreover, it creates one interesting question for the Supreme Court, on when is a tax a tax. But, overall, I think it sets up more modest questions for the Supreme Court, which create an opportunity to strongly re-affirm the court’s precedent in NFIB (2012) that upholds the constitutionality of the ACA. It may be an unintended consequence of the legal strategy by the “Red States” that brought the case.

2. Video: Rep. Susan Lontine

Rep. Susan Lontine represents Colorado’s House District 1 and is the Chair of the House Health & Insurance Committee in the state legislature. Lontine also serves on the State, Veterans, & Military Affairs Committee. She joins us in this edition of “What They’re Watching” to discuss housing and the social determinants of health.

“What I’m looking to do is trying to address that narrow provision in the Telluride decision to say that inclusionary housing is not rent control. So that cities and counties can have that tool in their toolbox to start going to developers and through the permitting process so you have to put in a percentage of this development as affordable housing.”


3. Stakeholder input on the state option

There were 728 pages of public comments released regarding the proposed public option. We read most of them, and pulled out a few notable highlights. PhRMA said the approach to re-directing pharmacy rebates didn’t go far enough. The Colorado Academy of Family Physicians said the state option was an opportunity to be more directive about care, particularly in the primary care setting.

Children’s Hospital Colorado called it a “missed opportunity,” also asking for it to be more directive, in this case towards “target high-cost geographic regions and special populations.” Good Business Colorado applauded the proposed 9-18% reduction in insurance premiums, but warned of impacts to individual market subsidies.

All in all, most of these comments were asking for more activism by HCPF, not less. That’s in contrast to what is being said more publicly by some of Colorado’s larger stakeholders.


4. Lessons from CHI’s “Hot Issues” conference

Congratulations to the Colorado Health Institute for hosting a successful annual event, their “Hot Issues in Health” conference. During the “Legislative Preview” session, CHI staff noted “Governor Jared Polis has settled in to his role as the new sheriff in town.” They highlighted how Gov. Polis has two “tough deputies” – Mike Conway and Kim Bimstefer – who have “transformed their respective agencies.”

Jay Want, a former Coloradan and current Executive Director of the Peterson Center on Healthcare in NYC offered a slide that showed the drivers of health care spending in the US. It showed inpatient “price and intensity” increases had offset all savings from reduction in utilization of all health care services in the country during the period in review, 1996-2013.

5. The importance of Gov. Polis’s Rx report

Last week, Gov. Polis released a report on reducing prescription drug costs in Colorado. We’ve seen a lot of these in various states. This one is different. It cites poor price transparency, anti-competitive business practices, and marketing and lobbying as the central reasons Coloradans face high Rx costs.

By citing these reasons as the cause of high pricing, it sets up policy-making as the primary solution rather than the market. There aren’t talking points about making the market more competitive, which many of these reports cite. This absolves policy makers from responsibility if it’s the market’s fault. Instead, Gov. Polis’s report sets up a number of policy responses as incremental solutions, “quick wins that can be addressed through state policy.” It also includes intermediate term steps and needed federal action.