Q&A: Rep. Susan Lontine, Chair of Colorado’s House Health & Insurance Committee

Rep. Susan Lontine represents Colorado’s House District 1, in Southwest Denver. Lontine chairs the House Health & Insurance Committee and serves on the Capitol Building Advisory Committee, State, Veterans, & Military Affairs Committee, and the Legislative Council.

For this Q&A, we talked to Lontine about health care legislation that’s moving this 2019 session.

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Sara Gentzler: I’d like to start broad, with what you see as the big issues in health care this session. And then, I’d like to know more about bills you’re sponsoring and championing. Does that sound good?

Susan Lontine: Sure. As Chair of a health committee in the House, I can tell you that I have what I consider as priority bills — about five big bills that are currently working their way through the legislative process.

None of them have made it to the governor’s desk yet, though I do anticipate that he will be supporting them all. He’s been publicly supportive.

The first bill is House Bill 1001, what we’re calling “the hospital transparency bill.”

We’ve had several sessions with really big conversations around what we call the hospital provider fee. In Colorado, we call it a hospital provider fee, because we have such a weird tax situation here. It’s federally known as a program that CMS administers, called the hospital provider tax.

Hospitals will put money into a fund that is matched, dollar-for-dollar, by the federal government. The original use of that money was to help cover uncompensated care for indigent patients, who had no health care. This is pre-Medicaid expansion.

Now, post-Medicaid expansion, we do use this money to help pay for some of that, but [hospitals] also use it to help take care of their uncompensated costs.

All the hospitals pay into it. Some, obviously, are larger players in it than others, from nonprofit to for-profit hospitals. For example, Denver Health gets a lot of money from the hospital provider fee. They take care of a lot of people. Smaller, rural hospitals don’t participate as much, because they just don’t have that kind of high-volume. But they do rely on that money quite a bit, to help cover some of their operations that they don’t get paid for.

We’ve had trouble tracking who really needs that money. Is it being used properly? Is it being distributed to hospitals in-need properly? There’s also the issue of whether hospitals are really doing a good job being transparent about their own costs for things, and then how that ends up being charged to patients.

So, this is an ability to look at their books and determine if they are being efficient, where they might be cost-shifting things or, maybe, profiting off of patients a little more than they should. And, whether or not they are properly using and/or need the support of the hospital provider fee. 

We just want to make sure that we’re administering that fund in the best way we can, because it’s a lot of money.

House Bill 1004 is the public option study.

We have 14 counties that only have one plan available to them on the Exchange. For people who are looking for coverage on the individual market, there’s really not any competition there. So, we wanted to look at trying to create a statewide public option.

This is a study of that. This would be putting real, actuarial figures behind it. What would they cover? How much would it cost? What kind of premiums would people expect to pay? And then, actually putting a plan up on the Exchange for purchase. Not just in the 14 counties, but statewide.

There are two other bills that have gotten a lot of attention. They have to do with trying to reduce our premiums, especially on the individual market. That’s where people have seen the most cost increases. Especially for those 14 counties I mentioned — they are some of the most expensive in the country to buy an individual plan.

House Bill 1168 is a reinsurance plan. I know other states have created these reinsurance plans, and they do require a wavier from the federal government to allow for that to happen.

We looked at this last year, and it didn’t pass. It was modeled after what other states have done. What those other states have done in a reinsurance model is used, I think, a 2-percent assessment on the large group plans to pay for the reinsurance pool. That didn’t go over so well here.

So, we are looking at using cost savings from taking out the most expensive patients and creating a rate structure that just affects those specific patients for specialty care, largely, which is where we were seeing the highest costs in the individual market.

We’re talking about a very small subset of people. So, taking those [people] out of that pool and putting them into a reinsurance plan — those rates for the specialty would kick in, and we would realize cost savings through that.

It’s a very unique model, but it appears that we have garnered the attention of the federal government. Apparently, they are looking at something like that from a federal point of view. The Director of Health and Human Services for our region attended the hearings and has shown great interest in this model.

The Division of Insurance Commissioner has been very integral in trying to put this together, and they are waiting on the actuarial numbers to model it out to see if it will work. We expect to have those any day now, and it has another committee hearing to go — I think Appropriations. They’re waiting for those actuarial numbers to go to Appropriations. I expect we’ll hear a second reading soon after that.

We have cost estimates of anywhere between 15- and 30-percent savings from health care premiums for the individual market, just by implementing a reinsurance program here in Colorado. So everybody’s super excited about that one.

And then, the other one is tackling the issue of out-of-network, surprise bills. That’s House Bill 1174. 

When you have these outliers charging outrageous rates, insurers end up getting stuck with that bill and they pass those costs along to everybody else, in terms of higher premiums. This is really to put a cap on that behavior of people who are out-of-network and often, through no fault of their own, end up with a surprise bill.

SG: I wrote an article about bills aimed at health care costs in Colorado, and those are the four bills I featured. It’s interesting that those are the four you mention, as well.

SL: I’ll tell you about one other bill. You have not found it, because it’s not been introduced yet. The fifth bill that’s not been introduced yet is what the sponsors are calling “The Prescription Drug Price Reduction Act.”

It’s basically the prescription drug transparency work we’ve done in the past, with some other pieces mixed in. 

In addition to looking at and trying to hold accountable these cost increases we’re all seeing, it also looks at different things that are happening that also end up costing consumers money. So, it’ll be transparency so we understand the cost-shift of drugs, and then there are also some pieces in this bill that’ll look at lowering the cost of prescription drugs that directly and immediately impact consumers. This will be achieved either through point-of-sale or in premium reductions.

I expect that bill to be introduced sometime this week.

SG: I’ll keep an eye out. In the governor’s State of the State Address, he mentioned importing drugs from Canada. I saw there’s a Senate bill proposing that, but it hasn’t gone far yet.

SL: It’s still sitting in the Senate Appropriations committee. I believe it is still a priority. I think those bills that are sitting in that committee are kind of waiting for the budget to go through before we see that log jam broken up.

SG: Are there other health care-related bills with momentum that maybe aren’t aimed at costs?

SL: There’s a lot of concern from the diabetes community about the cost of insulin. Representative Dylan Roberts has been very involved in this, because he had a younger brother who had Type I Diabetes, and he died. So, he’s personally invested in trying to figure out how to address the high cost of insulin. We’re hearing a bill about that this week.

And the Colorado Medical Society, along with the American Medical Association, has complained about an increase from the health plans on the amount of bureaucracy they get on prior authorizations. Especially for medications for patients.

Typically, we would think that would involve things that cost a little bit more than usual. We have a doctor on our committee who says she’s seeing it happen more and more often for things that are more routine.

She believes it’s becoming a problem, with the bureaucracy as means for the health insurers to try to control costs by requiring them to jump through all these hoops to get what their patients need. We’re hearing a bill about that.

SG: At the end of session, what do you expect the narrative, or the story, of health care legislation to be, looking back?

SL: I’m hoping all of those things pass, especially the big five bills we talked about and my sex-ed bill.

I think if you look back, we will have directly impacted and started work on some things that have really driven health care costs over the years.

It’s not something I think we’ll see a change in the day after they pass. I think we’ll start making progress. And then, within a year, I think we’ll definitely start to see some movement.

This interview has been edited for length and clarity.