5 Things Colorado: Last minute bill movement, Q&A w/Patrick Gordon, Biden budget proposal

This may be the calm before the storm.

Thursday is the last published day on the US Supreme Court calendar to release opinions from its current term (though they have a few more weeks for orders). It’s a term that saw a meaningful challenge to the ACA last November. It was a case many thought could not be overturned, based on the line of questioning from the justices. But for that to happen, Justices Roberts and Kavanaugh both will need to break from the 6-3 conservative majority to craft a majority opinion with the three more liberal justices to keep the ACA in some form. That seems a tough reach.

Anyone who tells you they know what’s coming should probably not be listened to, including me. But, for what it’s worth, I’d offer this is not a binary moment, keep or repeal. The range of options which I think may be on the table for the justices to land a majority with is wide. Like the first NFIB case, expect the unexpected. You can read my break down of the Texas v California case from 2019 here, or my half correct prediction of the 2012 NFIB case (and subsequent explanation of Roberts’ creative opinion here).





With help from Emily Boerger

1. Last minute bill movement

Lawmakers have had a busy final week of session, with several impactful health bills seeing last minute movement. Among these bills is the contested initiative to create a Prescription Drug Affordability Board. SB 175 – the latest bill in a broader legislative effort aimed at lowering Rx prices this session – passed the House yesterday and is on its way to Gov. Polis.

Rep. Dylan Roberts advanced a bill to build on Colorado’s insulin price cap by creating an emergency insulin access program for uninsured Coloradans. Lawmakers are also debating changes to marijuana regulations, which Rep. Dafna Michaelson Jenet says is among the most impactful health-related policies this session. HB 1317 would limit medical marijuana use, particularly among 18-20 year olds, out of concern for its potential negative health impacts. Both of these bills have passed and are pending Polis’s approval.


2. Health policy leaders look back on session

With the end of session approaching, State of Reform Reporter Eli Kirshbaum caught up with Rep. Susan Lontine, Chair of the House Health & Insurance Committee, and Rep. Dafna Michaelson Jenet, Chair of the Public & Behavioral Health & Human Services Committee, for a look back at the health policy conversations of the 2021 session. Both lawmakers say progress on PBM regulationsmental health, and housing are among the most notable accomplishments this year.

Lontine says the partisan — and at times, intra-party — disagreements that arose in her committee this year were simply part of creating good policy. When asked about interim plans, Lontine say she’s looking forward to conducting health policy training sessions for new committee members. Michaelson Janet says she’s planning to spend her interim time working on the implementation of the new Behavioral Health Administration.


3. Colorado Option heads to the governor

After receiving concurrence from the House on Monday, the Colorado Option bill now heads to Gov. Polis’s desk. What began as an effort to create a government-sponsored public health insurance option was watered down considerably by amendments during its time in the legislature. Of the over 70 amendments considered, 21 were adopted, with a select few changing the legislation considerably.

The most transformational amendment removed the “public option” part of the bill, requiring plans to offer an affordable, standardized plan in all of their markets instead of having them compete with a government-run plan. Another amendment lowered the premium reduction target for plans from 20 percent to 18 percent. Legislators also adopted an amendment that removed the penalty for providers if they don’t participate in the plan – a big win for physician advocates. Despite these changes, key stakeholder groups remain opposed to the initiative as it awaits final approval from the governor.


4. Q&A with RMHP’s Patrick Gordon

Rocky Mountain Health Plan’s CEO Patrick Gordon says Colorado needs to couple its reinsurance program with an affordability strategy. In this Q&A, Gordon highlights the positive impacts of the state’s reinsurance program, like the premium reductions seen in recent years, and offers his take on where the program may be headed next.

Considering the uncertain future of the state’s Medicaid 1332 waiver extension, Gordon emphasized the need for a “stable, secure, predictable” funding source for the program. “There’s a mix of [funding] options on the table – provider assessments, health insurer assessments and federal funds. We can’t be in a place where the level of reinsurance funding, and then the premiums, fluctuate wildly from year to year because the financing isn’t stable. So we need to find an equitable solution.”

5. Major health reforms absent in Biden’s budget

President Biden’s first budget submission is surprising in what it omits, says State of Reform Columnist Jim Capretta. Several of the high-profile health proposals from the 2020 campaign – like the public option and Medicare eligibility at age 60 – are mentioned in the budget’s text, but are not tied to specific funding proposals or plans in the budget.

“Perhaps the most glaring omission in the budget,” says Capretta, “is the absence of any proposals to change what Medicare pays hospitals, physicians, and other medical service providers.” Without this, he says Congress will find it difficult to advance cuts as potential offsets for legislation that adds spending elsewhere. Capretta reasons that the lack of detail in the budget for major health policy changes are a signal that Biden has “made the political calculation that it is not possible to get most of them enacted in this Congress.”