The passage of many significant healthcare reform laws by Colorado lawmakers over the past several years has provided many opportunities, although policy experts are wary of the challenges that come with implementing them.
Health policy insiders discussed those challenges at the 2023 Colorado State of Reform Health Policy Conference last month. Joshua Ewing, vice president of government affairs at the Colorado Hospital Association, said lawmakers have passed 368 new laws impacting hospitals and health systems in Colorado since 2019.
“That is a massive amount of change,” Ewing said. “The more troubling trend that has been developing here is the proliferation of model legislation here, particularly as a testing ground. When you have single-party control, you tend to see model legislation show up in order to build momentum. Last year, we faced two model bills.”
Ewing said that if House Bill 23-1215 (which was watered down before it was eventually approved) would have been passed as it was introduced, it would have prohibited hospital fees, removing $9 billion from the state’s hospital system.
“[It] targeted facility fees that would have impacted our healthcare system to the tune of $9 billion. And a community benefit bill would have resulted in cuts of about half a billion dollars. Healthcare is growing more unaffordable (and) inaccessible for many. We have a lot of work to do, but we have many shared goals. I would argue that model legislation, these one-size-fits-all bills that show up in Colorado, are hugely problematic.”
— Ewing
Frontline Public Affairs President Jennifer Miles expressed concern about the implementation process for many health reform bills that have passed in recent years.
“We’ve done a lot in recent years when it comes to major legislation (in) system reform and changes to care,” Miles said. “Right now, what I’m seeing is a lot of state agencies trying to implement all of that, (and) a lot of providers trying to respond to it and figure out how they need to be doing things differently. I’m excited and concerned about those changes that have happened.”
Miles does not think the legislature will focus on health insurance and healthcare access as much this year as opposed to previous years. She believes lawmakers will focus on mental health, substance use disorder, and homelessness.
“These are all going to have an impact on our health systems, and are going to go on top of all these other things that have been happening for a while,” Miles said. “I think we’re also going to see a little more focus on things like food access, crime, and public safety.”
Stakeholders may want to pay attention to the work of the Opioid and Other Substance Use Disorders Study Committee and the Child Welfare System Interim Study Committee in the upcoming session, Miles said.
“There’s some major reforms that are going to come through those committees. The Child Welfare System Interim Study Committee is an interesting one. A lot of us think of child welfare as [relating to] kids that are at risk of abuse and neglect, or those in foster care that have been removed from their homes. The committee is looking much more broadly at the behavioral health crisis for youth. Not just those involved in the child welfare system.”
— Miles
Miles expects the committee to work on passing a couple “system of care” bills, she said.
“They’re both establishing a whole new system of care for kids’ behavioral health,” Miles said. “While I’d like to think we’re done with big system reforms, I see more coming. One of the other things you’re going to see this year is a series of interstate licensure compact bills. You’re going to see an interstate licensure compact for social workers, for dentists and dental assistants, and for physician assistants.”
JLH Consulting & Public Affairs owner Jason Hopfer said he expects “mandate” bills (bills that mandate new health benefits) related to weight-loss drugs and opioids to receive attention in the upcoming session.
“They all have significant price tags,” Hopfer said. “You can’t, as a policymaker, tell me you need it to be cheaper, and go after my friends who are providers or are in the pharmaceutical industry about their costs, yet ignore inflation (and) ignore what those mandates do. Enough of the mandates. You can’t have it both ways.”
Ewing said legislators need to focus more on reimbursement rates, as providers are consistently undercompensated for Medicare and Medicaid services.
“The way we make up the difference is by increasing the privately-insured rates,” Ewing said. “And we’ve had a singular focus on bringing down the private insurance rates without addressing the elephant in the room. The single largest driver of increases we’ve seen in the private insurance market has been the underpayment from our public payers. We value Medicare and Medicaid. They’re vital coverage mechanisms for the most vulnerable among us. But they also have to pay their fair share. Otherwise we’re just shifting the burden.”