Q&A: CHA’s Joshua Ewing provides his outlook on the 2020 session

Joshua Ewing is the Associate Vice President of Legislative Affairs at the Colorado Hospital Association (CHA). We spoke with Joshua on the first day of Colorado’s 2020 legislative session to ask for his assessment of what policy issues are driving health care conversations in the state and new pieces of legislation to keep an eye on. 


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Michael Goldberg: What are your expectations for health care legislation this session, and apart from expectations, what are you hoping to see happen?

Joshua Ewing: I expect health care to be a top issue again this legislative session. What we heard in the opening day speeches is that it’s top of mind for policymakers, as it should be, since it’s a vitally important issue for our state. Our hope this year is that we can slow down the rush to solve problems and really focus on evidence-based solutions. We want to have substantive dialogue with everyone around the table. We are looking forward to doing that with anyone who will join us for these important conversations.”

MG: The governor’s public option proposal is top of mind for many Coloradans, both in and out of policymaking circles, do you think the state can raise enough revenue for creating what some refer to as a “true public option” under its current tax schedule, and with the TABOR amendment in place?

Joshua Ewing: The important piece to note here is that the administration’s option proposal doesn’t really do anything to expand coverage to Coloradans. This is a good question. I think it’s a question we thought we were going to discuss as a state through the public stakeholder process last year and ongoing. We have just under 375,000 people who are uninsured in the state. Our first priority should be getting coverage for those folks who still lack health insurance today. But that’s not what the state option is doing. It’s really an effort to exert more control for state government over how the health care system operates. So again, this is an important question but not one that’s really up for debate at the moment, unfortunately.

MG: Do you think the upcoming presidential election will be a deterrent to making significant changes this year on the state level as legislatures wait to see how the federal health care environment might change? 

JE: I do think the political dynamics at the federal level are driving the conversation at the state level. The sense of frustration and partisan divide that exists nationally, we haven’t typically seen in Colorado to a large degree. It does seem to be trickling down and influencing our policy debates in the state. For Democrats, who control the state legislature and the governor’s mansion, there is a lot of frustration with inaction at the federal level. The attempts to dismantle the Affordable Care Act have also been driving a lot of what you see at the state level in Colorado and driving a lot of concern among voters.”

MG: So, CHA opposes the administration’s recommendations that came out this fall for the public option and is planning on getting behind an alternative bill. What will that bill look like and in what ways does it diverge the administration’s recommendations?

JE: It remains to be seen if the recommendations in the report that came out this fall will be what the state bill looks like and we are looking forward to working with legislators on that. CHA is working with our hospital health systems and all stakeholders to examine a variety of potential alternatives, specifically evidence-based policies and tested ideas as opposed to what we’re seeing with the state option recommendations. Right now, the important factor from our perspective is that we bring everyone around the table and focus on working together to identify shared responsibility and a shared path to solving some of the challenges in our health care system. Our proposal is about looking at the entire health care system as opposed to individual silos. Looking at the entire system, how can we work together to address the cost of care and affordability challenges.

MG: What else should stakeholders and observers of Colorado health policy keep an eye on this session. 

JE: First, there is a bill that was introduced today, S.B. 5, around simplifying health care billing in Colorado. The concept is pretty straightforward. So, after you’ve been to the hospital and you’re billed, you get an explanation of benefits from your insurance carrier which says, “this is not a bill”. This legislation would strike the word “not” and make it one consolidated bill. We think this is a great way to help patients focus on getting healthier or taking care of their loved ones. It’s one way to simplify the process of dealing with the health care system for people.

Next, there is an effort coming from the Colorado Center on Law and Policy which is looking at the eligible but not-enrolled population in Colorado. These are folks who are either eligible for subsidies under the Affordable Care Act or eligible for Medicaid but for whatever reason they’re not enrolled, which is a little over half of our uninsured population in the state. This effort would add an option on tax forms for folks to opt in and ask for their eligibility to be checked. If they are eligible, they can get signed up for health insurance. This is a great way to bring more folks into the covered population.

This conversation has been edited for clarity and length.