Q&A: Rep. Emily Sirota sounds off on the Colorado Public Option, universal coverage models, and the state budget.

Rep. Emily Sirota represents District 9 in the Colorado House. After assuming office in 2019, Sirota hasn’t shied away from introducing ambitious legislation.

This past session, she was a prime sponsor on HB 1420 – legislation which sought to generate several hundred million for public services by eliminating longstanding tax exemptions for businesses. While the final version of the bill was pared back, it will still generate $113 million in education funding for the next fiscal year, and $25 million in the 2021-22 fiscal year.  

On the health policy front, Sirota has been engaged in the effort to move Colorado to a universal health care system. She supported the Public Option proposal introduced by Colorado Democrats before it was put on pause due to the pandemic, and she passed legislation to create a task force to analyze different health care financing systems. I spoke with Rep. Sirota today to hear her main takeaways from the legislative session. We also discussed the Colorado Public Option proposal, universal coverage models, and the budget shortfall. 

 

Get the latest state-specific policy intelligence for the health care sector delivered to your inbox.

 

Michael Goldberg: Can you give your main takeaways from the legislative session, in terms of bills which either did or did not pass, that you think will have a lasting impact?

Rep. Emily Sirota: Well, I hate to kick it off with something that didn’t pass, but there is of course a lot that remains undone due to the necessary focus on the pandemic and the budget crisis it has caused. Our Public Option bill passed out of the House committee just before we adjourned in March and we weren’t able to revisit it when we came back. I hope we in Colorado will continue to work on a Public Option to expand access to health care.

Even in our abbreviated session, there were a number of bills to address health care. We had bills to address things like our school immunization rate, infertility treatment coverage, HIV prevention medication, equity in clinical trials for Medicaid, substance use disorder prevention, and nicotine product regulation.  

MG: Where did you see the Public Option debate going from here?

RES: We still have a number of Coloradans who are unable to access affordable health insurance. The Public Option was to be an access point to those who are living in a place where there isn’t really any competition so there’s only one insurer they’re able to access. That doesn’t lead to affordable options. The Public Option plan, which was proposed by Rep. Roberts and Rep. Kennedy, would have sought to increase competition there and lower the price of insurance while ensuring access to particular benefits. There was a huge campaign from the insurers, who spent massive amount of money on television ads, mail ads, and more to undermine that effort at the legislature.

While there was intense opposition from the health insurance industry, I would say there still is a commitment on the part of Colorado legislative Democrats to address the high cost of health insurance and health care, and expand access to those who can’t afford it. Of course, the pandemic has exacerbated the conditions that already existed and put into very stark relief the multitude of problems in our “system”. While the legislature is at the moment not considering a universal health care model, I think the situation this pandemic has created due to insurance being tied to employers – where now we have something like five million people who’ve lost their health insurance – it’s making these problems worse.

Last session, I sponsored a bill that put together a task force to study different models for achieving universal coverage in Colorado. That task force is still continuing its work in the hopes of coming up with a plan to present to the legislature.”

MG: Can you talk about some of the models the task force is looking at?

RES: So, the task force employs a consultant to conduct studies to demonstrate what different models would look like in the state of Colorado. One of those would be a publicly funded, privately delivered system – what you would call a single-payer model that is privately delivered. Another possible model, though the group is still deciding what another comparative model would look like, but it would be something like the German model. This would be a highly regulated nonprofit insurance model where there are multiple nonprofit insurers. The scope of what those insurers are able to offer in their product is pretty specifically tailored.  

MG: As you said earlier, there was a lot of well-funded opposition to the Public Option and there would almost certainly be strong opposition to any model that resembles the sort you just mentioned.Yet it seems Colorado might have undergone, or is in the process of undergoing, a shift politically. Bernie Sanders won the presidential primary and Andrew Romanoff’s US Senate campaign, while ultimately unsuccessful, picked up steam. While these public health insurance models tend to poll well, what is your sense being on the ground about where Coloradans are on this issue? 

RES: For a lot of folks, young folks in particular, you see quite a bit of support for a single-payer system and a whole host of other systemic changes because the current system is not working for them – they are having trouble finding work now. If work is how we access our health insurance, I think the fraught nature of that proposition is being exposed. 

It’s been a priority of the governor and the legislature to address the high cost of health care in Colorado. We passed a bill in 2019 on surprise medical billing, a bill for a reinsurance program to lower premiums for families in high cost areas of the state. This year we passed Senate Bill 215 to solidify and extend that program for another five years. So, we’re taking a lot of steps in Colorado but I think public support for a Medicare for All system only continues to increase, because people continue to find out that the current system doesn’t work for them. 

More and more people are tired of paying a lot for benefits only to be fought tooth and nail by insurance companies when they try to use the benefits they pay for. It’s not as though insurance companies have tremendously high approval ratings – people don’t love their insurers, they love their health care providers. The more we can talk about a different system that allows us to still access their health care providers while not having to deal with a health insurance industry that is set up to make as much money as possible off of human health, I think that starts to make more and more sense to people.”

MG: Since you mentioned the budget, I want to ask about HB 1420. On its way to passage in the Senate, it was watered down quite a bit. What are the implications of the bill’s passage, and the implications of a version passing that is markedly less sweeping than it was written to be? 

RES: So, there were portions of that bill that came from other bills. The piece on the TCJ deductions had been a bill that my cosponsor, Rep. Gray, and I had sponsored earlier in the session. We already had a hearing and it was waiting in appropriations. That would have closed that deduction at the state level in order fund the Colorado Child Tax Credit and double the Earned Income Tax Credit. Due to the changes we had to make in HB 1420 and the economic forecast, we had to alter that benefit. Ultimately, HB 1420 did increase the Colorado Earned Income Tax Credit by 50 percent and expanded it to include ITIN fillers. 

In terms of the other implications, we had a package that put together a number of different tax expenditures to close or reduce in order to ensure that our education system doesn’t continue to lose ground. Our teacher pay is abysmal in this state. Our per pupil funding is nowhere near where it ought to be. In large part, this is due to what has happened since the last recession the state experienced. While we saw many businesses recover from that recession, our education system has not. That’s due to a whole host of complicating factors about our tax code, the Taxpayer Bill of Rights, the Gallagher Amendments, etc. We have what is often referred to as a Gordian knot of tax policy that has constricted our ability to properly fund our priorities. 

This year, we found ourselves expecting a $3.3 billion revenue shortfall. We had to make a number of painful cuts to programs, but we also had a number of different cash reserves that we were able to use this budget cycle. We will not have that in the coming year. As far as why the bill was weakened, I think there was a confluence of a tremendous amount of pressure from business interests and a governor who did not want to support the bulk of the bill, and so the bill was negotiated in the Senate to become what it was. While it was $100 or so for public education, that’s not nearly enough and we’re going to be in a much worse place in the coming year. I think we will need to revisit many of the measures that were in HB 1420. 

In the last recession there were a number of tax expenditures that were closed, at least for a period of time, and I think that will be a part of the conversation going forward. There is a tax expenditure review committee that has, along with the state auditor, been reviewing a number of tax expenditures to investigate how much Colorado is forgoing in revenue, and if the expenditures meet the state’s interests. The bit that we had in HB 1420 on home offices for insurance companies is a great example of a total industry giveaway which can’t be justified. It’s simply a giveaway and it’s not meeting any real need in terms of creating jobs. 

We have to decide where our priorities are. Are we going to fund public education as we are expecting our educators to go back to school in the midst of a pandemic? Are we going to ensure that they have the resources to meet the needs of our students and protect public health and safety? These are real choices and I expect that we’ll revisit them.” 

This conversation has beed edited for clarity and length.