The passage of many landmark health care reform bills by Colorado lawmakers over the past few years has provided many opportunities, though policy experts are wary of the challenges that come with their implementation.
Health policy insiders discussed those challenges at the 2023 Colorado Health Policy Conference. Joshua Ewing, vice president of government affairs at the Colorado Hospital Association, said lawmakers have passed 368 new bills affecting Colorado hospitals and health systems since 2019.
That’s a huge amount of change, Ewing said. A worrying trend developing here is the proliferation of model legislation here, particularly as a testing ground. When you have one-party control, you usually see a model bill emerge to build momentum. Last year we faced two model laws.
Ewing said that if House Bill 23-1215 (which was watered down before it was finally approved) was passed as introduced, it would ban hospital fees, removing $9 billion from the state’s hospital system.
[It] targeted facility fees that would impact our health care system to the tune of $9 billion. And the welfare bill would result in a cut of about half a billion dollars. Health care is becoming increasingly unaffordable (and) for many. We have a lot of work to do, but we have many common goals. I would argue that the model legislation, these one-size-fits-all laws that appear in Colorado, are very problematic.
Frontline Public Affairs President Jennifer Miles expressed concern about the implementation process of many of the health reform laws passed in recent years.
“We’ve done a lot in the last few years in terms of major legislative reform (in) the system and changes in care,” Miles said. Right now, what I’m seeing is a lot of government agencies trying to implement all of that, (and) a lot of providers trying to respond to that and figure out how to do things differently. I am excited and worried about the changes that have taken place.
Miles doesn’t think the Legislature will focus on health insurance and access to health care this year, unlike in years past. She believes she will focus on mental health, substance use disorder and homelessness.
“All of that is going to have an impact on our health care systems and it’s going to be on top of all these other things that have been going on for some time,” Miles said. I think we’ll also see a bit more attention to things like food access, crime and public safety.
Stakeholders may want to pay attention to the work of the Committee to Study Opioid and Other Substance Use Disorders and the Interim Committee to Study the Child Welfare System in the upcoming session, Miles said.
There are some major reforms that will come through those committees. The Committee for the Interim Study of the Child Protection System is interesting. Many of us think of children’s welfare as [relating to] children who are at risk of abuse and neglect, or children in foster care who are removed from their homes. The committee takes a much broader view of the youth behavior crisis. Not just those involved in the child welfare system.
Miles expects the committee to work on passing several systems of care bills, she said.
Both are establishing a whole new system of behavioral care for children, Miles said. While I’d like to think it’s done with major systemic reforms, I see more to come. One of the other things you’ll see this year is a series of compact interstate license laws. You will see the interstate licensing agreement for social workers, for dentists and dental assistants, and for physician assistants.
JLH Consulting & Public Affairs owner Jason Hopfer said he expects to pay attention to mandate bills (laws mandating new health benefits) related to diet drugs and opioids in the upcoming session.
They all come with significant price tags, Hopfer said. You can’t, as a policy maker, tell me you need it to be cheaper, and ask my friends who are providers or in the pharmaceutical industry about their costs, and still ignore inflation (and) ignore what those mandates do . Enough mandates. You can’t have it both ways.
Ewing said lawmakers need to focus more on reimbursement rates, since providers are consistently undercompensated for Medicare and Medicaid services.
The way we make up the difference is by increasing private insurance rates, Ewing said. And we had a particular focus on lowering 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 underpayment from our public payers. We value Medicare and Medicaid. They are vital cover mechanisms for the most vulnerable among us. But they also have to pay their fair share. Otherwise, they would only transfer cargo.
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