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Your guide to all the ways health care may be about to change in Colorado

Health care looks to be one of the biggest -- if not the biggest -- fight in the coming legislative session. How it turns out will shape how you receive and pay for medical services in the future.

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Hey, Colorado, feeling a little blue that the Broncos won’t be in the Super Bowl this year? Well, dust off those foam fingers because there’s another Super Bowl coming our way in less than a week: the start of the legislative session.

“This is kind of the Super Bowl of Colorado health policy right now,” Allie Morgan, the Colorado Health Institute’s director of legislative services, said at her team’s conference recently.

Are you ready for some very complicated health care arguments?

To help with your pre-policymaking tailgating, here’s a guide to all of the looming changes in health care — which, combined, could put the state at the forefront of health reform in the country. 

Did we miss any? Let us know via email or on Twitter.

The Colorado Capitol, photographed on Monday, April 22, 2019. (Jesse Paul The Colorado Sun)

Public option

What is it? A new insurance choice for people who buy coverage without help from an employer — though state officials hope to expand it to small employers within a couple of years. It’s administered through insurance companies, just like any other plan, but it saves people money in theory because the state has the ability to limit the prices hospitals can charge to people covered under the public option.

What’s the latest? The Polis administration released its final proposal for the plan — which would require both hospitals and insurance companies to participate in it. Those industries aren’t on board, though, and a group that represents hospitals and insurers nationally has already dumped a whole bunch of money into ads against the plan.

What happens next? The passage of the public option bill last legislative session was not without opposition. But the real battle will be this session. Lawmakers must decide whether they will adopt the Polis public option plan — and that includes whether they will give state regulators the ability to set hospital prices and require participation. The Colorado Hospital Association, meanwhile, has said it has a different proposal to lower health care costs ready to put forth — one that involves capping the state’s total cost of care. Both ideas are still being drafted into legislation, so nobody really knows exactly what the contours of this fight will be.

Gov. Jared Polis announces a 20.2% average decrease in 2020 health insurance premiums as a result of the state’s new reinsurance program, on Oct. 10, 2019. The decreases apply only to people who buy coverage on their own. (John Ingold, The Colorado Sun)

Reinsurance

What is it? A program that uses state and federal dollars to help insurance companies pay their most expensive claims, thus allowing them to reduce health insurance prices for everybody. A big chunk of the state’s share comes from a new fee on hospitals. Like the public option, this is right now only for people who buy coverage on their own.

What’s the latest? The federal government approved Colorado’s plan for a two-year-long reinsurance program. The projected savings from the program in 2020 caused insurance companies to drop their premium prices by more than 20%. But, because of some complicated behind-the-scenes mechanisms, some people may end up paying more. (Exactly how many is currently unclear.) Meanwhile, the return of taxpayer refunds from the Taxpayer’s Bill of Rights is playing havoc with the budgeting for the program, and lawmakers may have to accept that the program will have a significantly higher impact on the state’s general fund than was initially projected — if they want to maintain the same level of savings in 2021. To alleviate some of the TABOR problems, the Polis administration has proposed collecting the first block of hospital fees entirely in the first half of 2020. Lastly, part of Gov. Jared Polis’ request for an extra $60 million to fund the program is meant to continue the program for a third year.

What happens next? The budget battle over reinsurance in the coming legislative session is looming largest. But there’s also plenty of other clashes. Extending the program to a third year would require legislative approval — and likely an additional approval from the federal government. And the Colorado Hospital Association, in a message to its members in late December, hinted that it is considering legal action over the timing of the fee collection.

The website for Connect for Health Colorado, the state’s health insurance exchange, shown in October 2018. (Eric Lubbers, The Colorado Sun)

Purchasing alliances

What is it? A system that allows businesses and individuals to team up and directly negotiate health care prices with hospitals. Then the alliances take those prices and negotiate with insurance companies to find which one can give them the best coverage rates. The model flips the current system — where insurance companies negotiate with hospitals — on its head. A bill passed last year cleared the road for more of these alliances. The most notable example is the Peak Health Alliance in Summit County, which will save some families thousands of dollars in 2020.

What’s the latest? The Peak Health Alliance is expanding to nine additional counties. Leaders in Eagle County and others are looking at forming their own alliances. And the Colorado Business Group on Health has also formed a purchasing alliance.

What happens next? Watch what happens with the Business Group on Health’s alliance. So far, most of the alliances are locally focused, working mostly within their own counties. But the Business Group on Health, which largely represents government employers, aims to be statewide. If the Polis administration announces that state employees will participate in the group’s purchasing alliance, that could change how tens of thousands of Coloradans get health care.

Prescription drug price transparency

What is it? It’s not really clear right now, but it looks like an effort to learn — and publish — information about why prescription drugs cost so much.

What’s the latest? The state’s Department of Health Care Policy and Financing released a 50-page report detailing what factors are driving the state Medicaid program’s spending on prescription drugs. At a news conference announcing the report, several lawmakers hinted at coming legislation that would try to tackle drug prices through greater transparency.

What happens next? The pharmaceutical industry has vigorously fought previous efforts on price transparency, so expect a high-dollar lobbying fight at the Capitol.

Truvada for PrEP, an HIV antiretroviral drug taken by HIV-negative persons in at-risk communities. (Tony Webser, via Creative Commons)

Drugs from Canada

What is it? A plan to bring lower-cost prescription drugs into Colorado by importing them from Canada.

What’s the latest? The Trump administration released its rules for states wanting to set up a Canadian drug importation program. That means Colorado could submit its plan to the feds for approval as early as this month. Canadian officials have expressed concerns about these efforts from their neighbors to the south, but Health Care Policy and Financing head Kim Bimestefer said last month that she didn’t hear a hard no when meeting with the local Canadian consul general.

What happens next? State Sen. Joann Ginal, D-Fort Collins, said she plans to introduce a bill that would expand the importation program to even more countries. The pharmaceutical industry is opposed to any importation plans, so expect it to lobby heavily against this idea by arguing safety concerns — which is exactly what it did with the Canadian importation bill.

Insulin price limits

What is it? The legislature last year passed a bill capping how much an insurance company could charge a patient for insulin at $100 for a 30-day supply, the first such insulin price cap in the country.

What’s the latest? When insurers filed their proposed rates for 2020, none said in public filings that they expected the insulin bill to increase insurance prices. But they expressed concern over subsequent proposed state regulations that interpreted the price cap as a hard $100 per month, no matter how many times a person refills the prescription in that month, so long as the refills are necessary to make sure the person has sufficient insulin for the month.

What happens next? The scuttlebut around the Capitol is that a new insulin bill will be forthcoming to address the regulatory issue. Whether lawmakers approve it is another matter.

Michael Conway speaks to Colorado Gov. Jared Polis at Red Rocks Community College on Thursday, Dec. 12, 2019, for a stop on his listening tour. (Jesse Paul, The Colorado Sun)

Affordability standard

What is it? The legislature last year passed a bill that gives the commissioner of insurance the authority to create a standard for what it means for a health insurance plan to be affordable. The standard means the commissioner, when approving insurance rates, can look at the underlying costs of health care services that hospitals are charging insurance companies.

What’s the latest? Commissioner Michael Conway said he plans to issue a rule that will give him the ability to look at the contracts between hospitals and insurers. And the rule would also allow him to deny a proposed insurance rate if he believes the hospital prices it’s based on are too expensive. That means state regulators would have a say in hospital prices for more than a million people.

What happens next? The rule has yet to be issued, but expect a big fight when it is. 

Out-of-network billing

What is it? The legislature last year moved to end so-called “surprise bills” — those super-expensive hospital bills that arrive when you unknowingly receive treatment from a doctor or nurse who is not covered in your insurance network. The bill limited how much hospitals could charge to patients who are out-of-network.

What’s the latest? The law took effect on Jan. 1 of this year. But state regulators are still hammering out the fine details of how it will work. What happens next? There’s a rulemaking hearing scheduled for Feb. 4 to address some specific details of the out-of-network regulations.

This story was updated on Jan. 2, 2020, to correct the number of counties that the Peak Health Alliance is expanding to for 2021.