New amendments threaten support for Colorado Option bill, would remove health equity provisions

As the Colorado Option bill awaits further discussion after Monday’s eight-hour hearing in the Senate Health and Human Services Committee, several “key committee members” are planning to propose four new amendments to the bill when discussions resume on Wednesday, according to Rayna Hetlage, policy manager for the Center for Health Progress (CHP).

The bill — which would require health plans to lower their premiums by specified amounts in the state — has gained more support after it was heavily amended last month, but it’s still receiving considerable opposition from stakeholders in the private market.



According to Hetlage, the proposed amendments would diminish the work CHP and other stakeholders have done to ensure the bill benefits underserved, racial minority Coloradans. Hetlage has been involved in the policymaking process for HB 21-1232 and told State of Reform these amendments were discussed behind closed doors on Monday night.

Hetlage explained one of the amendments will prohibit requiring providers to participate in the Colorado Option. As a result of systemic racism, minority communities are often located far away from hospitals or only have one hospital within traveling distance, she said. While hospitals would be required to offer the plan under this amendment, providers could choose to opt out, which Hetlage said will disproportionately impact rural communities and communities of color. 

There is also an amendment that would remove small businesses from the plan — a key component of the current version of HB 21-1232. Hetlage said this would harm thousands of small business owners who want to provide their employees with affordable health insurance.

Hetlage said another soon-to-be-proposed amendment would implement an acuity adjustment and change the reimbursement rate formula for all hospitals. According to her, this amendment is particularly detrimental because it will not only give a “leg up” to certain health systems over others, but it will reduce the amount of savings accumulated through premium reductions.

The final amendment would place a sunset date on the bill.

“It’s unclear what that would look like right now — if it would be three years or seven years. But essentially, this bill would only last for a certain number of years. And why that is a problem for health equity is … This is really the only option for undocumented folks to get access to health insurance that is also subsidized.”

She said that cutting off this program in the future when so many individuals of color would still rely on it would exacerbate the already existing mistrust communities of color have for the health sector.

CHP has supported the bill since its introduction, and has negotiated extensively with sponsors to ensure it includes provisions to address the racial inequities in Colorado’s health care system. If the committee adopts any of these amendments, however, CHP will change their position and advocate against the amendments.

“What we are seeing right now is that legislators are caving to industry pressure and silencing the health care providers who want this for their patients. We saw yesterday a lot of doctors speaking in opposition, but we also saw a lot of doctors and other providers speaking in support, and that was not lifted up very much by several of the key committee members.”

During Monday’s hearing, some testifiers disputed sponsors’ claims that the bill would improve health equity. Michael Cancro, chief strategy officer for UCHealth, said the bill would actually harm Colorado’s minority communities since the hospitals that serve the state’s most racially diverse populations will bear most of the cost reductions.

Hetlage contradicted Cancro’s statements, saying the bill is designed to benefit communities of color — and not just by making premiums more affordable. The Colorado Option would make certain critical services available before individuals need to pay deductibles. Perinatal care, for instance, is a service often needed by black mothers and — if covered pre-deductible — can help reduce the state’s maternal mortality rate.

“The bill was designed with BIPOC communities in mind by including pre-deductible coverage for health care services that people of color are more likely to need. And this is very innovative.”

The bill would also allocate the savings collected from premium reductions to the Health Insurance Affordability Enterprise, an entity focused on reducing health care costs for in-need Coloradans. These funds would be used to fund health insurance coverage for low-income individuals who are currently eligible for subsidies as well as individuals who aren’t eligible, such as undocumented immigrants and those who fall under the “family glitch.” Notably, people who testified against the bill were mostly white, and the majority of people who testified in support of it were people of color.

Hetlage believes committee members should prevent the adoption of any of these amendments in order to safeguard HB 21-1232’s improvements to health equity.

“The only way that we can get additional funding is through the Colorado Option passing in its current form and being as strong as it is right now. If that passes, we will be able to get more funding from the federal government to help support even more low-income Coloradans.”

The committee is scheduled to resume discussions on HB 21-1232 on Wednesday at 1:30pm.