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The Colorado State Capitol is seen on Thursday, August 19, 2021, in Denver. (Olivia Sun, The Colorado Sun via Report for America)

There are officially only two weeks left in the legislative session this year in Colorado, and state lawmakers are continuing to debate several major bills — including ones that could have a significant impact on the state’s health care system.

In recent legislative sessions, Colorado lawmakers passed eye-popping, heavily contested proposals to create a historic public health insurance option or to form a board with the power to set prescription drug prices. But this year, the health care bills are generally more technical and have flown under the radar.

That could change as two notable bills — one to expand the health care workforce and another, more controversial bill to regulate certain prescription drug practices — are scheduled for their first committee hearings Wednesday, while several others also still have many more votes to go.

The Sun polled advocates for hospitals, insurance companies and consumers to see what bills are at the top of their lists. Here’s a rundown:

Cracking down on pharmaceutical rebates

The bill: House Bill 1370

What it does: Among the more sweeping health care measures this session, this bill would crack down on rebates that drug companies often pay to purchasers of their medicines, effectively coupons that reduce their costs. The bill would require health insurers and pharmacy benefit managers to prove that drug rebates are being used to lower costs for consumers and not ending up in the companies’ pockets. 

The bill would also prohibit mid-year changes to an insurer’s prescription drug formulary — the list of approved medications that insurers will cover. And it would put restrictions around insurers’ use of “step therapy,” which is the practice of insurers requiring patients to try cheaper, often generic versions of a drug before stepping up to more expensive brand-name versions.

Who’s in favor: A number of patient organizations affiliated with the Chronic Care Collaborative support the bill. They say the bill will help patients afford their needed medicines and will also create consistency so patients aren’t getting bounced off of drugs that work well for them.

“By passing House Bill 1370, we will make sure that Colorado patients get the treatment recommended by their doctor — not their insurance company,” Sara Froelich, the executive director of the Chronic Care Collaborative, wrote in an email to The Sun.

Photo illustration by Mika Baumeister on Unsplash

Who’s opposed: Insurance companies say the bill will raise premium prices for everyone and is also a favor to the pharmaceutical industry. They say insurers would have no recourse if drug-makers jack up the price of their drugs during the year, and they note that the state Department of Health Care Policy and Financing called step therapy “an effective tool” at reducing prescription drug spending, in a report released last year that looked at ways to control health care costs.

Amanda Massey, the executive director of the Colorado Association of Health Plans, said insurers estimate that the bill would increase premiums by $17 to $36 per member per month.

“The increased costs to Coloradans will go directly into Big Pharma’s pockets,” she wrote in an email.

What’s next: The bill is scheduled to be heard in the House Health and Insurance Committee on Wednesday.

Reinvigorating the health care workforce

The bill: Senate Bill 226

What it does: Just introduced Friday, this bill pours more than $60 million from federal coronavirus relief funds into programs to recruit and train new health care workers and retain existing ones. One program would expand clinical training opportunities for health care students. Another would try to re-engage health care workers not currently working in the field. Another would expand a grant program for school nurses. And yet another would create a “resilience and retention program” to help health care providers care for their employees and keep them on the job.

Who’s in favor: The bill is part of a package of legislation Gov. Jared Polis and legislative Democrats announced last week.

“Colorado’s nurses, doctors and hospital employees saved countless lives during the pandemic and faced unimaginable stress from staffing shortages and several near breaches of our hospital bed capacity,” state Rep. Kyle Mullica, a Federal Heights Democrat who is also a nurse, said in the announcement. “Today, we unveiled legislation to support our frontline health care workers and ensure we are better prepared for the next COVID wave or other public health crisis.”

The emergency room entrance to Saint Joseph Hospital in Denver, photographed on Oct. 22, 2019. (John Ingold, The Colorado Sun)

Hospitals are also psyched about the bill.

Joshua Ewing, the vice president of legislative affairs at the Colorado Hospital Association, said the bill is about “taking care of those who have taken care of us.”

“We’re really worried that we’re about to hit a cliff,” he said. “As the public and our elected leaders put (the pandemic) out of sight, out of mind, that’s when our workforce is really going to be hit by this.”

Who’s opposed: So far, no lobbying groups have registered opposition to the bill.

What’s next: The bill is scheduled to be heard by the Senate Health and Human Services Committee on Wednesday.

Gathering information on health care sharing ministries

The bill: House Bill 1269

What it does: This bill requires health care cost-sharing ministries — a kind of quasi health insurance that doesn’t have to follow Affordable Care Act rules — to report data to the state on the number of members they have, the amount of premiums they take in and the amount of claims they pay out in Colorado. Sharing ministries have a religious component — Amish or Mennonite communities make up the vast majority nationwide. But, after the implementation of the Affordable Care Act, large ministries that look and market themselves more like insurance companies have proliferated.

Who’s in favor: Consumer advocates have been skeptical of health care sharing ministries for years, arguing that consumers are sometimes under the impression the ministries operate like regular health insurance only to find that the ministries have no obligation to cover medical claims that they don’t want to.

“We have run into a few cases from consumers who were either misled into what they were purchasing or understood what they were purchasing but didn’t understand they really had no protections when choosing one of these programs,” said Adam Fox, the interim executive director of the Colorado Consumer Health Initiative.

Fox said the bill will provide the state with a better understanding of the sharing ministries operating in the state.

Who’s opposed: The bill generated a surprising amount of debate in the House when it was passed last week, and ultimately garnered no Republican support. GOP lawmakers expressed concerns that the bill infringes on religious liberty and is a prelude to further regulation.

“This challenges the First Amendment to the United States Constitution and the separation between the church and the state,” Rep. Mark Baisley, R-Roxborough Park, said during the debate Friday. “I do not believe that we can uphold our oath of office and vote for this bill simultaneously.”

What’s next: The bill is scheduled to be heard by the Senate Business, Labor and Technology Committee on Monday.

Lawmakers and lobbyists are seen at the Capitol on Jan. 12, 2022 in Denver at the start of Colorado’s General Assembly’s 2022 session. (Olivia Sun, The Colorado Sun)

Other bills to watch

  • House Bill 1122: This bill sets minimum rates for what a pharmacy benefit manager — an intermediary between a drug seller and a patient — can pay to a pharmacy for a drug. A whopping 181 lobbyists and lobbying groups have registered a position on the bill, most in a “monitoring” stance, which is fitting because of how much confusion there is over what pharmacy benefit managers do. The Colorado Association of Health Plans, which represents insurance companies, is opposed, saying the bill will raise premium prices.
  • House Bill 1284: Last year, Congress passed the No Surprises Act, which created new protections for consumers from receiving surprise medical bills when they receive care from providers outside their insurance network. This bill brings state law in line with federal law, ensuring that emergency care will always be considered in-network regardless of where a patient receives it, in addition to other protections.
  • House Bill 1285: Another bill that springboards off federal policies, this seeks to put some teeth into new federal rules that require hospitals to post their prices on their websites. The bill prohibits Colorado hospitals from going to debt collection against a patient who received care during a period in which the hospital wasn’t in compliance with the price transparency rules. An amendment adopted in its first committee hearing stripped out some of the bill’s bite by removing a section that also would have allowed state regulators to consider compliance with the transparency rules when renewing a hospital’s license.
  • Senate Bill 40: Centennial Republican Sen. Jim Smallwood has had a long-running quest to get the state to quantify the impacts of insurance mandates that lawmakers propose. This year, it looks like he might finally succeed — with a catch. This bill, which has bipartisan sponsorship and passed its first committee hearing unanimously, would allow for an actuarial review of up to six bills per session to measure how they would affect health insurance costs for consumers. The catch? The requests for an actuarial review must be submitted in the fall before the session in which the bills will be proposed, meaning the typical flurry of major bills filed late in the session wouldn’t qualify for review.

John Ingold is a co-founder of The Colorado Sun and a reporter currently specializing in health care coverage. Born and raised in Colorado Springs, John spent 18 years working at The Denver Post. Prior to that, he held internships at...