These are all of the Healthcare bills proposed in the 2018 session. Each bill has its own bill number, please use your browser search feature to find the bill you are interested in. Return to the Colorado home page to pick a different bill category.

None of the text is the opinion of Engage. Each bill's description, pros, and cons are our best effort at describing what each bill does, arguments for, and arguments against the bill. If you believe we are missing something, please contact us with your suggestion. Some of these bills have the notation that they have been sent to the chamber's "kill" committee. This means that the leadership has decided to send the bill to the State committee even though it does not belong there based on its subject matter. This committee, in both chambers, is stacked with members from "safe" districts and the idea is to kill the bill without forcing any less safe members to take a hard vote. It is possible for a bill to survive the kill committee, but it is very rare.

Each bill has been given a "magnitude" category: Major, Medium and Minor. This is a combination of the change the bill would create and the "controversy" level of the bill. Some minor bills that are extending current programs would be major changes if they were introducing something new, but the entire goal here is to allow you to better curate your time. Something uncontroversial likely to pass nearly unanimously that continues a past program may not be worth your time (and please remember, you can still read all of the minor bills!).

House

Click on the House bill title to jump to its section:

MAJOR

HB18-1009: Diabetes Drug Pricing Transparency Act 2018 KILLED IN SENATE COMMITTEE
HB18-1082: A Woman's Right to Accurate Health Care Information KILLED IN HOUSE COMMITTEE
HB18-1120: The Prohibition of Dismemberment Abortions KILLED IN HOUSE COMMITTEE
HB18-1121 No Funding Trafficking Aborted Human Body Parts KILLED IN HOUSE COMMITTEE
HB18-1179: Prohibit Price Gouging on Prescription Drugs KILLED ON HOUSE CALENDAR
HB18-1205: Financial Relief Defray Individual Health Plan Costs KILLED IN SENATE COMMITTEE
HB18-1223: Declare Autism Epidemic in Colorado KILLED IN HOUSE COMMITTEE
HB18-1225: Protect Human Life at Conception KILLED IN HOUSE COMMITTEE
HB18-1284: Disclosure of Prescription Costs at Pharmacies SIGNED
HB18-1311: Single Geographic Rating Area Individual Health Plan KILLED IN HOUSE COMMITTEE
HB18-1392: State Innovation Waiver Reinsurance Program KILLED IN SENATE COMMITTEE
HB18-1438: Health Care Coverage Reproductive Health Care KILLED IN HOUSE COMMITTEE

MEDIUM

HB18-1003: Opioid Misuse Prevention SIGNED
HB18-1006: Infant Newborn Screening SIGNED
HB18-1007: Substance Use Disorder Payment and Coverage SIGNED
HB18-1040: Immediate Treatment Incentive Plans SIGNED
HB18-1091: Dementia Diseases and Related Disabilities SIGNED
HB18-1097: Patient Choice of Pharmacy KILLED IN SENATE COMMITTEE
HB18-1112: Pharmacist Health Care Services Coverage SIGNED
HB18-1136: Substance Use Disorder Treatment SIGNED
HB18-1177: Youth Suicide Prevention KILLED IN SENATE COMMITTEE
HB18-1207: Hospital Financial Transparency Measures KILLED IN SENATE COMMITTEE
HB18-1211: Medicaid Fraud Control Unit SIGNED
HB18-1212: Freestanding Emergency Departments Licensure KILLED IN SENATE COMMITTEE
HB18-1260: Prescription Drug Price Transparency KILLED IN SENATE COMMITTEE
HB18-1279: Electronic Prescribing Controlled Substances KILLED IN SENATE COMMITTEE
HB18-1288: Conflict-Free Case Management KILLED IN SENATE COMMITTEE
HB18-1321: Efficient Administration Medicaid Transportation SIGNED
HB18-1358: Health Care Charges Billing Required Disclosures KILLED IN HOUSE COMMITTEE
HB18-1365: Primary Care Infrastructure Creation KILLED IN HOUSE COMMITTEE
HB18-1370: Drug Coverage Health Plan KILLED IN HOUSE COMMITTEE
HB18-1384: Study Health Care Coverage Options KILLED IN SENATE COMMITTEE
HB18-1399: Regulation of Surgical Smoke KILLED IN HOUSE COMMITTEE

MINOR

HB18-1012: Vision Care Plans Carriers Eye Care Providers SIGNED
HB18-1017: Psychology Interjurisdictional Compact SIGNED
HB18-1032: Access Medical Records State Emergency Medical Services Patient Care Database SIGNED
HB18-1045: Dental Hygienist Apply Silver Diamine Fluoride SIGNED
HB18-1049: DHS Department of Human Services Authority to Lease Grand Junction Regional Center SIGNED
HB18-1068: Eliminate Registered in Naturopathic Doctor Title KILLED IN SENATE COMMITTEE
HB 18-1085: Health Effects Industrial Wind Turbines KILLED IN HOUSE COMMITTEE
HB18-1094: Children and Youth Mental Health Treatment Act SIGNED
HB18-1114: Require License Practice Genetic Counseling KILLED IN SENATE COMMITTEE
HB18-1148: Stage Four Advanced Metastatic Cancer Step Therapy SIGNED
HB18-1180: Mental Health Professional Dismissed Complaint Colorado Open Records Act Access KILLED IN SENATE COMMITTEE
HB18-1182: Statewide System for Advance Directives KILLED IN HOUSE COMMITTEE
HB18-1202: Income Tax Credit Leave of Absence Organ Donation SIGNED
HB18-1282: Health Care Provider Unique Identification Per Site or Service SIGNED
HB18-1307: Limit Access to Products With Dextromethorphan SIGNED
HB18-1357: Behavioral Health Care Ombudsperson Parity Reports SIGNED

Senate

Click on the Senate bill title to jump to its section:

MAJOR

SB18-022: Clinical Practice for Opioid Prescribing SIGNED
SB18-023: Promote Off-label Use Pharmaceutical Products KILLED IN SENATE COMMITTEE
SB18-040: Substance Use Disorder Harm Reduction KILLED IN SENATE COMMITTEE
SB18-080: Wholesale Canadian Drug Importation Program KILLED IN SENATE COMMITTEE
SB18-132: 1332 State Waiver Catastrophic Health Plans SIGNED
SB18-146: Freestanding Emergency Departments Required Consumer Notices SIGNED
SB18-152: Prohibit Price Gouging on Prescription Drugs KILLED IN SENATE COMMITTEE

SB18-214: Request Self-Sufficiency Waiver Medicaid Program KILLED IN SENATE COMMITTEE
SB18-234: Human Remains Disposition Sale Businesses SIGNED

MEDIUM

SB18-024: Expand Access Behavioral Health Care Providers SIGNED
SB18-115: Apply Stark Laws to Medical Referrals Outside Medicaid KILLED IN SENATE COMMITTEE
SB18-130: Repeal Carrier Reporting Requirements to Division of Insurance KILLED IN HOUSE COMMITTEE
SB18-136: Health Insurance Producer Fees and Fee Disclosure SIGNED
SB18-153: Behavioral Health Care Related to Suicide Ideation KILLED IN SENATE COMMITTEE
SB18-155: Hospital Community Benefits Reporting Requirements KILLED IN SENATE COMMITTEE
SB18-266: Controlling Medicaid Costs SIGNED

MINOR

SB18-020: Registered Psychotherapists Auricular Acudetox SIGNED
SB18-027: Enhanced Nurse Licensure Compact SIGNED INTO LAW
SB18-054: Cap Fee Increases Assisted Living Residences SIGNED INTO LAW
SB18-065: Add Health Maintenance Organizations Life and Health Insurance Protection Association KILLED IN SENATE COMMITTEE
SB18-081: Emergency Medical Service Providers Licensing KILLED IN SENATE COMMITTEE
SB18-082: Physician Noncompete Exemption for Rare Disorder SIGNED
SB18-113: Circle Substance Use Disorder Treatment Program KILLED IN SENATE COMMITTEE
SB18-148: Medical Benefits After State Employee Work-Related Death SIGNED
SB18-161: Repeal Behavioral Health Transformation Council SIGNED
SB18-168: Medication-Assisted Treatment Through Pharmacies KILLED IN SENATE COMMITTEE
SB18-237: Out-of-Network Providers Carriers Required Notices KILLED IN SENATE COMMITTEE
SB18-247: Local Government Medical Benefits in Work-Related Death SIGNED
SB18-270: Behavioral Health Crisis Transition Referral Program SIGNED

HB18-1003: Opioid Misuse Prevention

Creates an opioid and other substance use disorder study committee consisting of five senators and five representatives from the general assembly to study data and stats on substance abuse problems in Colorado, the current resources and support available, what other states are doing to combat the problem, identify additional steps Colorado could take, and create legislative options to bring these steps to life. The bill also expands school-based health center grant programs to include education, intervention and prevention of substance abuse, directs the department of health care policy to award grants to substance abuse screening, intervention, and referral programs, and directs the center of research into substance abuse to develop and implement medical education activities around prescribing pain killers, in particular opioids.

SIGNED

Pros

Life expectancy in the United States has fallen in each of the past few years, largely, experts believe, due to opioids. Colorado must meet this crisis with everything it has, and we must understand what we are doing now and what we could be doing better. This bill is designed to not only get the legislature going on finding out best practices, but also sets up multiple grant opportunities to attack the problem head-on. We all want to jump in and solve everything right away, but sometimes it takes a little bit more effort to find the right solutions.

Cons

The key word here is crisis, and a multi-year committee seems too slow (granted the committee can put out bills without regard to usual legislative rules about timing). This bill may cause legislators not on this committee to stop working at helping stem this crisis, thinking they need to wait for their colleagues. The worry is not that this bill is not well-intentioned or that the crisis isn’t real, it’s that it’s not enough and the legislature will think that it is.

How Should Your Representatives Vote on HB18-1003

HB18-1006: Infant Newborn Screening

Updates Colorado’s newborn screening laws to provide more resources for follow-up testing to rule out false positives and strengthen the hearing screening, from an intent of 95% (current law) to all newborns with provisions for follow-up services with infants at risk of hearing loss. The bill creates a newborn hearing cash fund, funded by fees implemented by the executive director of the department of public health.

SIGNED

Pros

Hearing loss occurs in infants more often than any other condition for which screening is required. Early detection, intervention, and treatment are effective in facilitating healthy child development. Children who do not receive early help frequently require extra educational services, which are largely publicly funded. So this bill will in the end, save the state money. But really, that’s incidental to making sure that every child has access to the health care they need.

Cons

This bill sets up a nebulous fee structure with no constraints. The executive director will have the power to set this fee, however they’d like, and it’s likely to end up being passed on to consumers, through either insurance or direct payments.

How Should Your Representatives Vote on HB18-1006

HB18-1007: Substance Use Disorder Payment And Coverage

Requires all individual and group health benefit plans to provide coverage without prior authorization for a five day supply of buprenorphine (opioid used to treat opioid addiction) for a first request within a 12 month period. It also prohibits carriers from taking adverse action against a provider based on a patient’s satisfaction with pain treatment, mandates that benefit plans do not discriminate monetarily against those with chronic pain or substance use disorder diagnosis, and prohibits carriers from requiring step therapy that includes opioids before covering non-opioid options. For pharmacists, the bill allows them to administer injectable medication-assisted treatment for substance abuse (only if they are in a collaborative agreement with one or more physicians).

SIGNED

Pros

There are many fronts in the battle against opioids. This bill attacks the payment side, by making sure that insurers provide the treatment substance abusers need without overly punitive costs to make sure that they can get the treatment they need to get better. It also prevents physicians who either refuse to prescribe opioids or don’t submit to the medication seeking behavior of their patients from being punished for doing the right thing.

Cons

Chronic pain and substance abuse users utilize far more services than many other individuals and it is a burden to insurance companies to not be able to charge them appropriately. This burden will get shifted onto the rest of the population.

How Should Your Representatives Vote on HB18-1007

HB18-1009: Diabetes Drug Pricing Transparency Act 2018

Drug manufacturers and pharmacy benefit managers must submit annual reports to the state board regarding drugs used to treat diabetes that are subject to price increases at or above a certain percentage point. The state will publish a report of their findings and may impose penalties on those who do not comply. Nonprofits that advocate for patients with diabetes or fund diabetes medical research that receive contributions from drug companies on a list kept by the state board.

KILLED IN SENATE COMMITTEE

Pros

Nearly 300,000 Colorado adults are diagnosed diabetics and it is estimated that another 110,000 are undiagnosed but live with the disease. The annual medical cost related to diabetes in Colorado is $4 billion, 18% of which is prescription drugs. Insulin prices rose by 45% between 2014 and 2017. So we need to get to the bottom of what these drug companies are doing, because it is becoming an increasingly expensive load on the backs of Coloradans. It is also important that the public is aware of how much any nonprofit relies on a drug company or companies for its funding.

Cons

This bill puts onerous regulations on drug companies to come up with all sorts of paperwork (any costs of which will likely get passed to consumers) and then does do not do anything other than issue a report. Drug companies have to spend enormous sums on medical research, much of which doesn’t end up going anywhere, and thus need to be able to set the price of their medications where they see fit.

How Should Your Representatives Vote on HB18-1009

HB18-1012: Vision Care Plans Carriers Eye Care Providers

Prohibits insurance carriers from requiring eye care providers to discriminate against covered individuals when it comes to non-covered services, require covered individuals to participate in any other carrier plans, or set or require fees from the eye care provider to covered individuals.

SIGNED

Pros

Those with eye care insurance should be treated the same as those without, this prevents insurance companies from leveraging their position to demand higher fees from those with their coverage or participation in other plans as a prerequisite for getting into an eye care plan. It’s basic fairness and lets the provider determine how much they want to charge, with the full knowledge of what the insurance carrier is willing to reimburse for.

Cons

Insurance carriers need the flexibility to charge providers what the insurance company needs. This bill inhibits that flexibility and may cause carriers to drop eye plans if they cannot get the money out of them they need.

How Should Your Representatives Vote on HB18-1012

HB18-1017: Psychology Interjurisdictional Compact

Joins Colorado to the Psychology Interjurisdictional Compact, which allows psychologists to practice in all states within the compact . This is a relatively new pact, and has three other members (AZ, NV, UT), with three pending (IL, MO, NE) and five states endorsed by psychology licensing board (NM, OH, RI, TX, WI).

SIGNED

Pros

Joining the pact would allow psychologists greater mobility, attract people from other states, and makes it easier to practice telehealth. Although this pact is fairly new, it probably will grow substantially and staying out of it would put Colorado at a disadvantage. Any individual moving to the state still has to obtain a Colorado license.

Cons

Being in an interstate compact yields some control for the state over the licensing process. While it is true that the bill specifies that the licensing standards of the state receiving telehealth are the ones that apply (so in the case of a Colorado resident being treated by someone from another state, Colorado's standards apply), the individual has still not been certified by the state of Colorado specifically and the assurance that they are qualified to have a license has not been granted by Colorado. Any potential remedies, which the bill does contain, would occur after at least some treatment has already occurred.

How Should Your Representatives Vote on HB18-1017

HB18-1032: Access Medical Records State Emergency Medical Services Patient Care Database

Requires the department of public health to provide individualized patient information from the department’s EMS agency patient care database to health information networks for any use allowed by HIPAA.

SIGNED

Pros

Health information networks are not getting the information out of this network that they need (to track patient behavior across the state to look for drug-seeking behavior, and to better coordinate patient care across multiple providers). In essence, the theory behind this database has not been implemented.

Cons

This bill provides no help to the department to implement this mandate, which is a goal that many believe in but has proven more complicated to create. For those that don’t believe in this concept, that patient information should not be accessible across providers, obviously this is a step in the wrong direction.

How Should Your Representatives Vote on HB18-1032

HB18-1040: Immediate Treatment Incentive Plans

Requires department of corrections to institute an incentive plan to contract for more mental health professionals in difficult to serve geographic areas if the number of inmates who need a treatment or service in the area exceeds the number of available spaces by 20%.

SIGNED

Pros

A large number of inmates are not receiving the treatment or services that were identified in their recommended rehabilitation reports. The department of corrections says this is because there are no enough mental health professionals who are interested in providing the treatment in difficult to serve areas. Inmates are therefore either being released without their treatment or denied parole and forced to remain in prison only because they can’t get this treatment. This is either dangerous or massively unfair. This bill helps the department by providing incentives including potentially increased fees, bonuses and travel reimbursements.

Cons

The bill doesn’t allocate the funds for these incentives, so the department is going to have to find the money somewhere, which is going to take it away from somewhere else.

How Should Your Representatives Vote on HB18-1040

HB18-1045: Dental Hygienist Apply Silver Diamine Fluoride

Allows a dental hygienist to apply silver diamine fluoride under the direct supervision of the dentist if they hygienist holds a license in good standing, completes a course on the use of silver diamine fluoride, is covered by professional liability insurance, and the dentist has a complete protocol setup.

SIGNED

Pros

This newer FDA approved treatment allows for noninvasive methods to stop tooth decay, particularly with young children. This leads to lower costs, fewer pediatric dental visits, and improved oral care. The treatment is safe, with the only negative a black staining in the tooth structure which should polish off. It is well within the abilities of a qualified dental hygienist to use.

Cons

The staining issue could be a problem if the treatment is misapplied, anything with this sort of negative downside should require the dentist, not a hygienist.

How Should Your Representatives Vote on HB18-1045

HB18-1049: DHS Department of Human Services Authority to Lease Grand Junction Regional Center

Authorizes the department of human services to continue leasing portions of the Grand Junction regional center campus to third-party behavioral health providers until 2020.

SIGNED

Pros

This is a beneficial arrangement for all, the department gaining funds and behavioral health providers continuing to have a physical location to use.

Cons

The state may be missing out on additional funds by not making these spaces available for lease to higher bidders.

How Should Your Representatives Vote on HB18-1049

HB18-1068: Eliminate Registered in Naturopathic Doctor Title

The law currently allows a naturopathic doctor to use the term “registered” in the doctor’s title. This law removes that ability.

KILLED IN SENATE COMMITTEE

Pros

This eliminates confusion for the public, who might reasonably believe that “registered” means that the doctor is registered in a similar manner to other doctors, when that is not the case.

Cons

This is part of a bias against holistic medicine. Naturopathic doctors get training, just like other doctors, and gain licensure from a governing body. This bill is an unnecessary swipe at the profession.

How Should Your Representatives Vote on HB18-1068

HB18-1082: A Woman's Right to Accurate Health Care Information

Requires that prior to having an abortion, a woman is given information about abortion alternatives and the option to see an ultrasound of the fetus. The woman must sign off that she was given this material. Makes it a crime for any abortion provider to not do it.

KILLED IN HOUSE COMMITTEE

Pros

Ultrasounds are already done routinely by abortion providers, not doing one puts the woman’s health at potential risk. If more mothers knew the full picture about their choices and what their unborn baby looks like and will experience, more of them would choose to forgo the abortion and take another option and more babies would live. This is about giving full information, the decision still rests with the mother in the end.

Cons

This bill is yet another attempt to browbeat women while they make perhaps the most difficult decision of their lives. The assumption that they haven’t thought it through is insulting. This just makes the entire experience worse and puts more barriers between women and their right to choose what they do with their own bodies.

How Should Your Representatives Vote on HB18-1082

HB 18-1085: Health Effects Industrial Wind Turbines

Requires the department of public health to research and compile reports on the health effects of noise and stray voltage from industrial wind turbines on people and animals.

KILLED IN HOUSE COMMITTEE

Pros

Amid some reports of health problems, the state owes its residents a complete investigation to makes sure that this rapidly growing industry does not have any adverse health effects.

Cons

This is more of a culling of publicly available information and thus not something we need to spend a lot of time and energy having a state department do. Finding out if there are published health risks is something the legislature can do on its own, or give the department funds to conduct its own research.

How Should Your Representatives Vote on HB18-1085

HB18-1091: Dementia Diseases and Related Disabilities

Updates language relating to Alzheimer’s to better reflect that there are other dementia diseases. Missing people with a dementia disease is added to the missing person alert program.

SIGNED

Pros

This update reflects reality. Alzheimer's is a terrible disease and deserves our focus, but so do other dementia diseases. Recasting it this way broadens the view. The missing alert part of this is obvious, people with dementia frequently cannot locate where they are and require help.

Cons

Changing the law in this way may lessen focus on Alzheimer's itself, which remains the leading dementia illness, accounting for over half of all cases.

How Should Your Representatives Vote on HB18-1091

HB18-1094: Children and Youth Mental Health Treatment Act

Permanently extends the child mental health treatment act, renaming it the children and youth mental health treatment act. Also changes the act in a few ways. Evaluating mental health agencies must use a standardized risk stratification tool, the definition of mental health agencies is widened to capture larger set of behavioral health agencies, reports are required from these agencies on their activities, the department of human services is requiring to maintain a list of providers on its website, and the advisory board is modified.

SIGNED

Pros

This act ran out of funding last year, so the permanent extension is welcome and should help prevent such occurrences in the future. Standardized assessment tools are a common requirement in this industry, they just haven’t been made a part of this act before. Adopting them will help ensure everyone is using the same tools to make these evaluations and won’t be a “new” thing for these agencies. Reporting helps measure how we are doing with the state’s money and is information these agencies should have ready anyway as part of being an operating business.

Cons

This renewal adds a lot of paperwork burden to these agencies. In addition to yet another standardized assessment, which may or may not be different from what they have to use for other funders, the agencies have to provide quite a bit of aggregated information to the state and it may require extra work to prepare.

How Should Your Representatives Vote on HB18-1094

HB18-1097: Patient Choice of Pharmacy

Prohibits health insurance carriers that offer prescription drug coverage from restricting the ability of the covered individual to use the pharmacy or pharmacist of their choice, impose any fees or cost-sharing requirements for selecting a particular pharmacy, imposing any other conditions on this, or denying a pharmacy or pharmacist the right to participate in any network contracts if the they agree to the network conditions. All of these requirements do not apply to pharmacies that are owned by the health insurance carrier or those in managed care programs and do require the pharmacy or pharmacist to have agreed to the contract terms of the carrier.

KILLED IN SENATE COMMITTEE

Pros

People should have the right to choose the pharmacy of their choice and not be boxed by any side deals or other inducements insurance carriers have with pharmacies. The bill makes the reasonable exemption for plans where the entire point is that everything is done in concert under one system (managed care) or where the carrier and pharmacy are owned by the same entity.

Cons

This is an unreasonable restriction on the ability for insurance carriers and pharmacies to work together to provide the best benefits to consumers. It makes it impossible for carriers to prioritize pharmacies that provide better service or lower costs to the consumer.

How Should Your Representatives Vote on HB18-1097

HB18-1112: Pharmacist Health Care Services Coverage

Requires a health benefit plan to provide coverage for health services provided by a pharmacist if the services are within a health professional shortage area and if the plan covers the same services provided by licensed physician or advanced practice nurse.

SIGNED

Pros

Many areas of rural Colorado have serious shortages of physicians and nurses and it becomes difficult to get some of the run-of-the-mill treatment that pharmacists are allowed to provide by law (laws covering what pharmacists can and cannot do are not affected by this bill). This bill forces insurance companies to give coverage for these services within these shortage areas.

Cons

This forces insurance companies to allow behavior they may not agree with, while the law may permit services by a pharmacist the insurance company may have a good reason to believe these services are best performed by a doctor or advanced practice nurse.

How Should Your Representatives Vote on HB18-1112

HB18-1114: Require License Practice Genetic Counseling

Creates a licensure requirement and structure for genetic counseling requiring an appropriate genetic counseling degree and national certification, with a few small exceptions. Also requires counselors to carry insurance and abide by mandatory disclosures of past activity required by the Michael Skolnik Medical Transparency Act.

KILLED IN SENATE COMMITTEE

Pros

Genetic counseling is a medical field and we regulate medical fields for obvious reasons. This bill treats genetic counseling like any other medical field in the state.

Cons

Requiring a license for this emerging field may stifle innovation and keep some people out.

How Should Your Representatives Vote on HB18-1114

HB18-1120: The Prohibition of Dismemberment Abortions

Prohibits the use of a sopher clamp to perform abortion by dismembering the fetus in order to remove it from the mother’s body unless it is required by a medical emergency. Makes the crime a misdemeanor with a fine between $50 and $500.

*This bill has been assigned to the House's "kill" committee, state affairs*

KILLED IN HOUSE COMMITTEE

Pros

Bad enough that an unborn child is being killed, but this procedure forces it to be mutilated as well. There are other ways, even if they are not as convenient for the mother and doctor. These types of abortions are extremely common, over 95% of second trimester abortions use them. The medical community needs to move to something else if it wants to keep doing these later-term abortions.

Cons

The use of this type of abortion in the first place is all about the health of the mother. It’s commonly done after 12 weeks so as to not damage the woman’s cervix and potentially undermine her future ability to have children, as well as being an out-patient procedure that carries less potential danger to the mother. This is a way to in effect ban abortion after 12 weeks since it cannot be done safely. A similar law in Texas was just blocked by federal courts, as were attempts in Alabama, Kansas, Louisiana, and Oklahoma. This won’t pass federal court scrutiny.

How Should Your Representatives Vote on HB18-1120

HB18-1121 No Funding Trafficking Aborted Human Body Parts

Bans any higher education institution that receives funding from the state from engaging directly or indirectly in the harvesting, trafficking, purchasing, or selling of aborted human body parts by removing funding if an institution does so.

KILLED IN HOUSE COMMITTEE

Pros

Harvesting the bodies of dead babies for research subsidizes the abortion industry and provides an incentive to perform abortions, particularly late-term abortions which are more “valuable” for research. Recent videos and whistleblowers have shown alarming evidence that the potential for an actual industry structured around this practice exists. Research can still be done on fetal tissue from miscarriages or still births.

Cons

Fetal tissue research is critical in the development of life-saving medicine. It is different from adult tissue and represents a specific period of development where the cells have unique properties: they are more flexible, less specialized, easier to grow, and more adaptable. It is currently being used to develop and test vaccines for potential treatment of influenza, dengue fever, HIV/AIDS, and hepatitis B and C. It is vital for research in other areas as well. Ongoing research using cells derived from fetal tissue includes work on neurodegenerative diseases such as Parkinson’s, Alzheimer’s, amyotrophic lateral sclerosis, spinal cord injury, stroke, retinal disease, and age-related macular degeneration. It has been used in the United States since the 1930s. Federal law requires consent from the mother for its use and prohibit profit from selling or trafficking it in any way. Nearly all of the video and whistleblower “evidence” that these laws are being broken has been thoroughly debunked, either highly selective editing or outright lying was involved. There is no evidence that the practice of using fetal tissue from abortions has any influence on a mother’s decision to terminate her pregnancy. As for miscarriages and still births, congressional research has shown that these are often unpredictable and can pose serious health risks to the mother so that tissue collected under these circumstances is often not suitable for research purposes.

How Should Your Representatives Vote on HB18-1121

HB18-1136: Substance Use Disorder Treatment

From the Opioid and Other Substance Use Disorders Study Committee. Adds residential and in-patient substance use disorder services to the state’s medical assistance program. Contingent on the department of health receiving federal authorization required to secure federal financial participation in the program. Managed service organizations (groups that help funnel government money toward treatment) would reprioritize money from marijuana taxes to assist in these treatments for people who are not otherwise covered by public or private insurance.

SIGNED

Pros

Part of dealing with the opioid crisis is getting addicts the treatment they need, which frequently is in a facility, not on an out-patient basis. This bill helps the state leverage federal funds to do just that.

Cons

The marijuna fund is not a bottomless pool, the tax is already maxed out and money moved out of there is coming from somewhere else.

How Should Your Representatives Vote on HB18-1136

HB18-1148: Stage Four Advanced Metastatic Cancer Step Therapy

Prohibits insurance carriers from requiring a patient undergoing treatment for stage four advanced metastatic cancer to undergo step therapy (trying less expensive drugs first) prior to receiving a drug approved by the FDA if the drug is consistent with best practices for cancer treatment.

SIGNED

Pros

People with this kind of cancer don’t have the time to go through step therapy treatments, they need the medication their doctor is prescribing now, not when they’ve already tried the less expensive options and found them lacking.

Cons

This inhibits the ability of insurers to keep costs down, the entire notion behind step therapy is that there are frequently less expensive drugs that provide the same benefit and we need to try those first. Cancer treatment is already incredibly expensive and we all pay these costs in a distributed manner, that’s how insurance works. This bill will increase costs for everyone.

How Should Your Representatives Vote on HB18-1148

HB18-1177: Youth Suicide Prevention

Requires office of suicide prevention to work with appropriate entities to develop and implement a training program for people who regularly interact with potentially at-risk youth but are not in a profession that typically receives training, like camp counselors, rec center employees, youth group leaders, clergy, and parents. Office must approve at least three non-profits statewide to participate. Classes must be free to the public, the state will reimburse for any associated expenses. The office must also implement a public awareness campaign. The bill also lowers the age of consent for psychotherapy services from 15 to 12, except for a minor seeking inpatient services in which case it stays at 15.

KILLED IN SENATE COMMITTEE

Pros

Unfortunately we cannot always choose who a teen will or will not feel comfortable opening up to, so it is critical that the training that can save lives is spread as broadly as possible. In addition, the ability for a teen to see a school counselor without a parent’s permission could be the critical difference for a child who is unable to talk to his or her parents, for instance in a case where a gay or lesbian 12 year-old cannot come out to their parents and needs help.

Cons

Lowering the age of consent may prevent parents and caregivers from being involved in treatment, which would decrease the effectiveness of the treatment. If a school-based person or therapist is having a hard time getting consent for treatment from a parent that is a neglect issue and is probably indicative of other more significant problems in their child’s life.

How Should Your Representatives Vote on HB18-1177

HB18-1179: Prohibit Price Gouging on Prescription Drugs

Prohibits increasing the price of an essential off-patent or generic drug if the price increase is not directly attributable to additional costs for the drug. Also gives the attorney general the ability to subpoena any manufacturer they believe is price gouging and gives guidance on what essential off-patent drugs are and what remedies the courts have for forcing prices back down.

(this bill is essentially identical to SB18-152)

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Pros

The entirely legal actions of Martin Shkreli, where he jacked Daraprim for $13.50 a tablet to $750 a tablet (a life saving drug that had no generic alternative in the US and cost as little as $0.10 a dose in other countries), are sadly not outliers. Consumers need protections from the laws of supply and demand when lives are at stake. People should not be forced to choose between bankruptcy and life saving medication. This bill would make actions like Shkreli’s illegal in Colorado. It is important to note that the alternative to Daraprim is not just Daraprim in different form: it’s the basic drugs compounded differently, with unknown efficacy and side effects in comparison. There is no FDA testing, as would be required for a generic version and obviously takes years. It might not be as good as Daraprim, which remains prohibitively expensive to this day.

Cons

This is price fixing by the government, pure and simple. The government should not be able to dictate what is and what is not a reasonable price increase in private industry. In cases like Daraprim, the obvious market solution is what in fact happened: another company stepped in and created the product that people actually wanted to buy, at a cost of $99 for 100 tablets.

How Should Your Representatives Vote on HB18-1179

HB18-1180: Mental Health Professional Dismissed Complaint Colorado Open Records Act Access

Currently, when a complaint against a mental health professional is dismissed, information contained in the files of the regulatory board is exempt from disclosure under public records law. This bill allows the mental health professional who was the subject of the complaint to access this information and the professional’s client names and other recipients of service cannot be redacted.

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Pros

Mental health professionals should have the right not to treat individuals who are filing false complaints against them, this bill would enable them to do that.

Cons

This bill opens up the person who filed the complaint to retaliation from the mental health provider. Particularly in the field of mental health, that is a concern too big to allow.

How Should Your Representatives Vote on HB18-1180

HB18-1182: Statewide System for Advance Directives

Directs the department of health to create an electronic system that allows medical professionals and individuals to upload and access advanced directives for medical treatment (or non-treatment). Paid for by grants, gifts, and donations.

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Pros

A paper system is an obvious problem in this area, where the whole point of an advanced directive is to enable an individual to make their wishes known when their medical condition makes it impossible for them to do so in the moment.

Cons

Electronic systems are more vulnerable to hacking and literal life and death decisions shouldn’t be exposed in this manner.

How Should Your Representatives Vote on HB18-1182

HB18-1202: Income Tax Credit Leave of Absence Organ Donation

Allows an employer a state income tax credit equal to 35% of their expenses incurred for paying an employee during a leave of absence to make an organ donation, not to exceed 10 working days, and the cost of temporary help during that absence. Not valid for employees who make more than $80,000 a year.

SIGNED

Pros

Nearly 2,400 Coloradans are on the waiting list for organ transplants and 96% could receive a donation from a living donor. The ability to get paid time off work is a large barrier for living organ donors. This bill would make it easier for the company to support short paid leave for an organ donation and hopefully will encourage more living organ donations.

Cons

Corporations already make too much money in this country and certainly don’t need yet more tax breaks.

How Should Your Representatives Vote on HB18-1202

HB18-1205: Financial Relief Defray Individual Health Plan Costs

Creates a program to help people who live in the three costliest counties in the state for health insurance premiums and who spend more than 20% of their household income on premiums. Individual or family must be between 400 and 500% household income above the poverty line (thus not eligible for federal subsidies) and not have access to Medicaid, Medicare, or an affordable employer sponsored plan. People who qualify will receive funds to bring their total cost back down to 20% for the lowest-cost Bronze level exchange plan. The state is limited to spending $6 million a year.

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Pros

Premiums in rural areas are considerably higher than in metropolitan areas and in some places there is only one carrier offering coverage. Because of these high costs, and not qualifying for federal subsidies, many people in these areas may choose to go without insurance which is not only bad for their health and financial stability, but bad for all of us, as the cost of any emergency medical treatment they cannot pay will get passed along to everyone. This bill should help some of those people get the insurance they need.

Cons

We cannot afford to bail out the state exchanges with more money. The solutions to our insurance problems are not in government money but in freedom from the requirements of the Affordable Care Act.

 

From the other side: The $6 million limit should not be here. If people need help, we need to help them all, not just the ones who were fast enough to sign up before we hit the ceiling.

How Should Your Representatives Vote on HB18-1205

HB18-1207: Hospital Financial Transparency Measures

Requires the department of health care policy and financing to prepare an annual report detailing uncompensated hospital costs and expenditures information by payer group.

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Pros

Getting a handle on our health care costs involves understanding where those costs are coming from, and one of the biggest cost centers is hospitals. This will allow us to have a better idea of not only what the landscape looks like, but if any changes are having an effect as we go forward.

Cons

This is too big an ask for hospitals, opening up their books for the government to examine and publicly parade around.

How Should Your Representatives Vote on HB18-1207

HB18-1211: Medicaid Fraud Control Unit

Establishes the Medicaid fraud control unit which will be responsible for investigating and prosecuting Medicaid fraud and waste, as well as patient abuse, neglect, and exploitation. Sets up penalties based on the amount of fraud, ranging from class 1 petty offense to class 2 felony.

SIGNED

Pros

Medicaid fraud is currently prosecuted under an executive order signed by Governor Roy Romer in 1987. It’s time to put it into state statute instead of relying on an executive order. The money saved will likely pay for the expenses of the new unit.

Cons

We already have a fraud unit inside the attorney general’s office, as well as a Colorado Medicaid False Claims Act to prosecute offenders under. This is not a widespread problem requiring this large change, the unit recovered over $22 million between 2013 and 2015. What we have is working fine.

How Should Your Representatives Vote on HB18-1211

HB18-1212: Freestanding Emergency Departments Licensure

Creates a new license specifically for freestanding emergency departments. The license prohibits freestanding emergency departments from charging a fee if the patient needs to be transported to another facility because the freestanding ER was unable to stabilize the patient. It also limits facility fees to be reasonably related to operating expenses and requires full reports on these fees to the state.

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Pros

Colorado is one of the top three states in the nation for the number of FSEDs in the state. They need their own licensure and we need protection from circumstances where they either are overcharging or end up sending patients to full emergency rooms.

Cons

This goes too far in limiting what these facilities can charge. If the market won’t support the fees these freestanding ERs are charging, then they won’t get enough traffic and go out of business. The market, not the government, should be the arbiter.

How Should Your Representatives Vote on HB18-1212

HB18-1223: Declare Autism Epidemic in Colorado

Directs the state to convene the governor’s expert emergency epidemic response committee to determine if there is an autism epidemic in Colorado, if the committee determines there is one, then reasonable steps must be taken to address it and protect public health.

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Pros

The number of children with autism in the state has grown at an alarming rate, with more than 7,000 school-age children reported in 2016. This bill makes the state confront this problem and commit real resources. Only one of the 18 recommendations of the 2009 autism commission’s recommendations have been taken up. It’s long past the time to act.

Cons

Autism does not spread. It is not a disease that is communicable and it is not something caused by the environment. The science is very clear on these points and the likeliest cause of the increase in diagnosis is simply that we are more aware as a society. Using communicable disease standards is therefore highly inappropriate.

How Should Your Representatives Vote on HB18-1223

HB18-1225: Protect Human Life at Conception

Prohibits abortion except in cases of protecting the mother’s health. Makes it a class 1 felony for the doctor, no punishment for the mother.

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Pros

If you are against abortion, you should not want it to be legal at all. We should not allow mothers to end pregnancies unless their own health is at risk.

Cons

This bill is unconstitutional. The current law of the United States makes abortion legal and federal law is supreme. This bill also contains no exception for rape or incest, forcing a woman to carry her abuser’s baby to full term and delivery. Women have the right to make their own decisions about their bodies, this bill strips them of those rights.

How Should Your Representatives Vote on HB18-1225

HB18-1260: Prescription Drug Price Transparency

Requires health insurers, as part of the annual report it must already file with the state’s insurance commissioner, to include the 25 most frequently prescribed prescription drugs, the 25 most costly drugs by total spending, and the 25 drugs with the largest increase in total spending compared with the previous year. Prescription drug manufacturers, for drugs with a wholesale cost of more than $40 for a course of treatment, must notify all purchasers (insurance plans, pharmacy benefit teams, state entities) of any price increase that is more than 10% at least 90 days before the increase. The manufacturers must report all of these increases to the state’s insurance commissioner, including the rationale for the increase and detailed history about the drug. This information will be put on the commissioner’s website.

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Pros

This bill is all about sunshine. It doesn’t prevent any drug company from charging what they would like, it just makes sure that all interested parties know about it and that the company’s reasons for the increase are out in the open. It also helps the state track prescription drug spending and look for spikes in particular drugs which might require more investigation.

Cons

This bill is about creating witch hunts. While it does not prevent any business from operating as it would like in a free market, it is designed to make the drug companies the bad guys any time there is a price increase, as well as throw a bunch of red tape into the process to make it more onerous.

How Should Your Representatives Vote on HB18-1260

HB18-1279: Electronic Prescribing Controlled Substances

Requires controlled substance prescriptions to be electronically transmitted to a pharmacy, with a few exceptions (tech failure at time of prescription, out-of-state dispensation, FDA requirements mandate non-electronic transmission, and a few others). Pharmacists do not have to verify non-electronic prescriptions.

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Pros

Part of getting a handle on our opioid epidemic is attacking prescriptions, which is generally the gateway into the addiction (not to mention all the rest of the prescription drug abuse that occurs in the state). We have the technology to make the much more secure and harder to forge electronic submission mandatory rather than optional. This bill does precisely that. It also should vastly reduce the chance for errors based on the notoriously poor handwriting of prescribers.

Cons

Allowing pharmacists to fill a written prescription without verification does remove a large administrative roadblock for pharmacists and prescribers offices but unfortunately undercuts the purpose behind the bill. People scamming prescriptions aren’t going to be overly affected by this at all.  It’s also a big burden on offices that haven’t transitioned yet to an electronic system, they’ll have a few years to do so under the bill’s terms but they’re going to have to eat whatever the associated costs are themselves.

How Should Your Representatives Vote on HB18-1279

HB18-1282: Health Care Provider Unique Identification Per Site or Service

Requires all off-campus hospital locations to obtain and use a unique National Provider Identifier (NPI). This must be distinct from the hospital’s NPI and used for all services performed at the off-campus location.

SIGNED

Pros

Off-campus locations, mainly in the form of free standing emergency rooms, have proliferated in the state recently. Getting a handle on the costs of these facilities is critically important, as many consumers are unaware of the potentially massive difference between an urgent care and a freestanding er until it is too late. When these off-campus locations share the same NPI as the main campus, it becomes nearly impossible to untangle the basis for charges and care provided.

Cons

This is akin to making a satellite branch report all of its costs and fees through an entirely separate system just so people can turn around and find ways to berate the satellite for the amount it charges. This is a free country and no one is forcing people to go to freestanding ers, which can serve a vital need in plugging holes in er availability, particularly in rural areas. All of this extra work on the backend is going to add some costs to these hospitals which will likely get passed on to consumers.

How Should Your Representatives Vote on HB18-1282

HB18-1284: Disclosure of Prescription Costs at Pharmacies

Prohibits a carrier from prohibiting or penalizing pharmacies for providing a covered individual information on the amount of their cost share of the prescription and the efficacy of more affordable alternatives that are equivalent. Also prohibits requiring the pharmacy to collect a copay that exceeds the total submitted charges by the pharmacy, which results in the extra money being kept by a pharmacy benefit management (PBM) company that negotiates between drug companies and pharmacies.

SIGNED

Pros

This is sadly necessary. One of the new tricks in the health care industry to force pharmacies not to disclose obvious and proven alternatives to consumers for their sometimes costly prescriptions. A survey of 650 pharmacists in 2016 found 38% were unable to tell their customers about cheaper options, including just paying cash and skipping using their plan altogether. This is all part of the vertical integration occurring in the health care industry. Another fun trick is the PBM firm that is in effect the middleman between the pharmacy and the drug company will take the copay on the drug, pocket a few dollars themselves, then send the rest on to the drug company. The requirement that the copay not exceed submitted charges will end this practice. This bill will save consumers money and give them the full range of options available to them.

Cons

It is not as nefarious as some make it out to be. This gets between a doctor and a patient. The pharmacist is not the prescribing doctor, does not know the individual’s medical history, and is thus not in the position to start offering alternative prescription options. Drug interaction effects are deeply complicated and we need to trust our doctors to make the best decisions. If a consumer doesn’t like the amount they are paying for a drug, they can try to work out an alternative with their doctor, not the pharmacist while they are hurriedly picking up their prescription. If they don’t like what their doctor is saying, they can change doctors. As for the copay part, it is not the PBM’s purview what an individual’s copay is, that’s up to the insurance company. The PBM’s job is to get the best rate for each drug, not artificially raise prices so that some people aren’t overpaying on their copay. Copays go against yearly and lifetime deductibles, a consumer might want to use their copay even if it is a bit more than just paying the entire price themselves so as to accrue against their deductible. This bill makes that impossible.

How Should Your Representatives Vote on HB18-1284

HB18-1288: Conflict-Free Case Management

Implements conflict-free case management for individuals enrolled in home- and community-based services under the state’s Medicaid program. This requires case management services to be provided to the enrollee by an agency that is not providing them services and support. Authorizes the state regulators to create rules for becoming certified as a case management agency. Phases in implementation with 100% compliance required by July 2022.

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Pros

This removes the potential for conflict of interest in these cases, by making sure there is a third-party deciding what services an individual needs and who can best fill those services rather than the agency itself deciding if the individual needs its own services (and obviously more hesitant to steer them to a different agency).

Cons

The trend in healthcare is to increase the coordination of care, which this bill will make more difficult by inserting another party into the works and potentially splintering care across multiple agencies rather than keeping it all in one place.

How Should Your Representatives Vote on HB18-1288

HB18-1307: Limit Access to Products With Dextromethorphan

Makes it illegal to sell products containing dextromethorphan (ingredient in many cough suppressant over the counter medications) to minors, unless it is part of a valid prescription.

SIGNED

Pros

This drug, when used recreationally and in higher amounts than recommended, can produce hallucinogenic states. It even has its own street name for substances infused with it, “Angel”. It easily belongs on the list of drugs minors should not be able to purchase and needing to show a valid ID to buy it is no real burden.

Cons

The drug has been proven to be non-dependent, so there is no worry about someone developing an addiction to it. We can only nanny our children so much, at some point an adult has to step in and take charge and responsibility. Kids are endlessly inventive and are always discovering the new thing to take to alter their mental state. We cannot as a society just keep adding to the list of things kids aren’t allowed to buy. They’ll always find something else. We need to attack the root of the problem instead of inconveniencing everyone (and what about people who do not have a valid ID?) else for no large benefit.

How Should Your Representatives Vote on HB18-1307

HB18-1311: Single Geographic Rating Area Individual Health Plan

Prohibits health insurers from considering geographic area when setting rates for individual and group plans, thus creating a state-wide single geographic area for Colorado.

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Pros

The state currently has nine geographic regions and rates can vary wildly. Premiums in rural areas are significantly higher and the number of plans offered can be extremely limited. This leads to a spiral where people in these areas don’t purchase insurance they cannot afford, leaving a small marketplace which requires higher rates. This bill would make sure that all of Colorado is able to access affordable health care and at its core is how large scale insurance works: you spread the risks around in as large a population as you can.

Cons

The only way this works is if the insurance companies raise the rates on those who do not live in these rural areas. There is no magic or discriminatory intent at work here: rates in rural areas are higher because the cost of health care in rural areas is much higher. Making the entire state one zone will have the effect of sharing those burdens across the entire state: raising the costs for most Coloradans to lower the cost for a few. In effect, punishing those who live in areas with lower health care costs.

How Should Your Representatives Vote on HB18-1311

HB18-1321: Efficient Administration Medicaid Transportation

Requires department of health care policy to create an implement a method for meeting urgent transportation needs within the nonemergency medical transportation benefit available under Medicaid.

SIGNED

Pros

There is a middle ground between needing an ambulance and being left on your own for transportation in medical situations. This bill makes the state come up with a solution for this problem, which should result in fewer non-necessary (and costly) ambulance rides and save everyone money.

Cons

The bill is very vague about how to achieve this, which means the actual solution the state comes up with (which will not require legislative approval so long as it meets the vague requirements of the bill) may not the best or even a good one.

How Should Your Representatives Vote on HB18-1321

HB18-1357: Behavioral Health Care Ombudsperson Parity Reports

Creates an ombudsperson to assist Coloradans with accessing behavioral health care. The ombudsperson will help consumers and providers resolve access and coverage issues, identify, track, and report concerns, complaints, and potential violations of rules and regulations, provide information to consumers, and develop points of contact for referrals. The bill also requires all insurance carriers to provide detailed reports proving why they need any non-quantitative treatment limitations for behavioral health care.

SIGNED

Pros

The behavioral system is complicated with a lot of different actors, both state and non. Having an individual tasked as a point person for consumers will help those in the system better navigate it and achieve better care outcomes. The insurance carrier reports are part of trying to achieve what is called mental health parity in insurance. Right now providers and consumers have to jump through many more hoops to obtain mental health care then is required for physical health care. The goal here is make sure that any extra barriers are truly necessary (many are not, and this will help us weed them out).

Cons

This is a toothless position. The ombudsperson has no authority, so they cannot actually referee any disputes. They have no budget, so they cannot perform actual outreach to consumers, who are extremely unlikely to know about this person at all without some sort of guidance. The carrier reports are just that, reports, with no recourse or mechanism to make changes if the explanations don’t make sense.

FROM THE OTHER SIDE

This is money better spent directly in the behavioral health system, rather than on a person to look over everyone’s shoulder and criticize. It is also an unreasonable burden on health insurance carriers, who will be required to do mountains of analysis to justify their procedures. That is surely going to cost some extra money (at the least in the form of time spent), and we all know they’ll try to pass that on to consumers.

How Should Your Representatives Vote on HB18-1357

HB18-1358: Health Care Charges Billing Required Disclosures

Requires all health care facilities to publish their fee schedules prior to applying any discounts, rebates or other adjustments, include itemized detail in any bill sent to a consumer which includes any insurance adjustments, and disclose if the facility is in or out of the consumer’s health insurance network (if applicable) and what effect that has on pricing. The bill also prohibits all facilities from billing any patient or third-party payer higher than its lowest negotiated rate if it has failed to publish its fee schedules. Pharmacies must also publish a list of their retail price drugs, again before any cost adjustments.

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Pros

It’s awfully hard to have a marketplace that reacts to pricing pressure when no one knows what anything really costs. This bill would make sure that everyone has access to the real prices charged by a health care facility before getting treatment, which should make the health industry function more like a real market where people can make informed decisions that include price.

Cons

The price before any adjustments are done is not the real price. People want to know what they are going to pay, period. Pretending that the health industry is like any other where you can check out twenty different options online and then pick the one that has the lowest price is just not realistic. Even in non-emergency situations, the way that pricing is done, for good or ill, is so complicated that trying to remove the insurance adjustments, rebates, and other negotiations from the “sticker price” is not going to give a realistic view of the situation.

How Should Your Representatives Vote on HB18-1358

HB18-1365: Primary Care Infrastructure Creation

Creates a primary care payment reform collaborative to consult with state departments that deal with insurance in order to analyze current insurance carrier methods of reimbursement to determine what practices direct more resources and investments toward innovation and care improvement and what barriers exist to adopting alternative payment methods to fee-for-service.  The collaborative is tasked with creating recommendations that will increase the use of other methods.

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Pros

The fee-for-service model does not work very well. We know this from years of research and moving toward fees for outcomes is a core part of most attempts to lower health care costs. Much of this effort has focused on hospitals, but primary care is where some of the biggest savings can be realized because it is where problems get found early, before they develop into even more difficult issues that cost much more money to resolve.

Cons

This bill stacks the deck by presuming that in the primary care setting, fee-for-service is a bad system and therefore the collaborative must look to alternatives. The prime flaw in fee-for-service is that it incentivizes doing work rather than incentivizing helping the patient. But this is more of a hospital problem, primary care providers are the patient’s doctor, the one they trust and go to first. They retain patients and get referrals by being a good doctor, so they already have the incentive to get the best outcome. Drastically changing the way they get paid for their work may cause them to refuse to even see higher-risk patients who by definition are more likely to end up with a worse outcome regardless of medical treatment.

How Should Your Representatives Vote on HB18-1365

HB18-1370: Drug Coverage Health Plan

Prohibits a health insurance carrier from excluding or limiting a drug under a health benefit plan and/or moving the drug to a disadvantaged tier if the drug was covered at the time the covered person enrolled in the plan. Also bans increasing the amount a covered person pays under same circumstances. Generics can only be used as a substitute if the covered person agrees.

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Pros

Pulling the rug out from underneath a consumer’s critical prescription drugs is not something insurance companies should be allowed to do. Entering into a plan agreement is a form of a contract, and deciding part of the way through that the insurance company no longer wants to uphold its end of the bargain is unacceptable. Since coverage tends to be a year-to-year thing, this only limits the insurance company for the rest of that year, if they then decide to change the plan they can. This affords the covered individual the opportunity to find a different plan.

Cons

Insurance companies do things like this for a very good reason: they need to make the math work. If your drug suddenly skyrockets in price, the insurance company needs a recourse to address the change. A hundred dollars per person can add up real fast, even if it’s only for a few months.

How Should Your Representatives Vote on HB18-1370

HB18-1384: Study Health Care Coverage Options

Requires the department of health care policy and division of insurance to study and report to the legislature the costs, benefits, and feasibility of implementing a Medicaid buy-in option, a public-private partnership option, or a community or regionally based option for health care coverage.

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Pros

Coloradans in 14 counties have access to only a single insurance carrier in the state exchange and the costs of health care are still too high for too many. Some form of state insurance may help these problems, but for something as complicated as health insurance, we must study it first. That’s what this bill does. As for the study options, we kind of already know what no government involvement in health insurance looks like. It was this country before 1965. We know what health care before the ACA looks like, it was this country in 2009.

Cons

This study is stacked in the wrong direction: rather than studying how yet more government interference in health care markets would impact us, it should be studying what less would do. It’s all well and good to point to our past and say we already know, but you can’t compare conditions in 2018 to 1964.

How Should Your Representatives Vote on HB18-1384

HB18-1392: State Innovation Waiver Reinsurance Program

Authorizes the state insurance commissioner to apply to the federal department of health and human services for authorization to use federal funds for a state reinsurance program to assist health insurers in paying high-cost insurance claims. The program is exempt from TABOR limits on revenues and can only be adopted if the federal government approves.  The program is designed to reimburse insurers to achieve a 30% reduction in claims costs in geographic regions in the state where average premiums are highest and a 20% reduction in claims costs in the rest of the state.

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Pros

The federal reinsurance program that was part of the Affordable Care Act died in Washington last year. It is a standard part of large federal health programs to help keep premiums affordable. Part of the ACA also prohibits insurance companies from using less than 80% of the premiums paid (or 85% for large group policies) on medical costs. So any additional money going to the insurance companies here is doing one thing: keeping premium costs down. The federal government was estimated to pay $3.3 billion in this program in 2016, that’s all money that’s gone now so premiums are going to rise. Alaska, Oregon and Minnesota have already successfully obtained waivers to continue state versions of the program.

Cons

We don’t need more insurance company bailouts, they are already highly profitable middlemen sucking money out of our health care system. If premiums are too high, we should be attacking them by addressing insurance company practices, not simply handing the companies more money so they will lower the premiums.

How Should Your Representatives Vote on HB18-1392

HB18-1399: Regulation of Surgical Smoke

Requires hospitals with surgical services to adopt a policy to prevent human exposure to surgical smoke (gas byproduct of energy-generating surgical devices). Also required state department of health to create rules for surgical smoke.

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Pros

Surgical smoke contains toxic chemicals including 16 that are listed as priority pollutants by the EPA and carcinogens. We need to make sure anyone in an operating room in protected. There’s absolutely no question that the smoke is irritating and can cause short-term illness (like nausea) and there is a debate over whether it causes much more serious long-term health risks with more study needed. Rather than waiting and continuing to expose people to what is at a minimum a nasty work environment and possibly much more, this bill acts now to protect the public.

Cons

The science here is early and still somewhat controversial. A review conducted by the British government found most published research on the topic was poor quality and larger longitudinal studies of OR nurses compares to other nurses have found no increased rates of cancer. Equipping all devices in operating rooms to capture the smoke will be very costly and we need a stronger foundation of evidence before taking a drastic step.

How Should Your Representatives Vote on HB18-1399

HB18-1438: Health Care Coverage Reproductive Health Care

Requires all individual and group health care plans to provide coverage for women’s preventative health services (which include screening for gender-specific cancers, expanding on what is currently required, and some counseling for genetic or STDs), abortion as permitted by the state of Colorado, voluntary sterilization, contraception approved by the FDA, including coverage without a prescription for all over-the-counter drugs. Requires companies to cover the contraceptive drug of the woman’s (and her doctor’s) choice. Bans copays, deductibles, coinsurance or any other cost-sharing mechanism for all of these services and drugs, unless it would disqualify a high-deductible plan from eligibility for a health savings account. Has a religious employer exception for abortion procedures only if the carrier notifies all employees of the exempted employer in writing of the procedures the employer is refusing to cover. Religious exemptions are only available to organizations where religion is the purpose of the entity and it primarily employs and serves people who share the same religious beliefs. Directs the state’s Medicaid program to implement all of the same coverage requirements to eligible individuals except for abortion payments (illegal under federal law) and expands postpartum Medicaid care from 60 days to 180 days. Also bans discrimination based on race, color, national origin, sex, sexual orientation, gender identity, religion, age, or disability in terms of benefits, coverage, or payments required.

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Pros

Women’s reproductive health is the private business of each individual woman and she is the one who gets to decide what legally available medical decisions to make about her body, not her boss and not the government. For true religious organizations, that are actually doing religious work, there is an exception build into the law. But beyond that, it is a critically important societal decision with enormous and far-reaching consequences. Adequate and affordable reproductive health care helps ensure healthy births, healthy babies, and healthy mothers. Women who lack adequate prenatal care are three to four times more likely to die of pregnancy related complications and maternal mortality rates in Colorado are rising, yes rising in the 21st century. In addition, preventing unwanted pregnancies has enormous societal benefits. Unwanted pregnancies lead to abortions, delayed prenatal care, increased risk of physical violence, and more post-birth negative outcomes as a family or just a woman on her own, has to handle the enormous emotional, physical, and monetary strains a child can bring. All of this care can be expensive, so it won’t matter if we have quality reproductive care available if it remains out of reach for too many women.

Cons

This bill discriminates against sincerely held religious beliefs by making a religious exemption only possible for very few entities outside of churches or missions. Even these exempt entities would still have to offer contraception coverage which goes against their sincerely held religious beliefs. Religious hospitals, schools, charities, and many other organizations are excluded by the bill’s definition and would have to offer health care that goes against their deeply held religious beliefs, going against the spirit of federal law, state law, and years of 1st amendment traditions. Or they have to not offer any health care at all to their employees and potentially, if they are large enough, run afoul of the federal Affordable Care Act requirements. On the financial side, it also goes against our generally accepted practice of trying to patients to use less-expensive drugs when a viable alternative is available that works just as well for the patient as the expensive drug.

How Should Your Representatives Vote on HB18-1438

SB18-020: Registered Psychotherapists Auricular Acudetox

Current law allows licensed mental health care professionals and level III certified addiction counselors who have documented that they have undergone auricular acudetox training (acupuncture addiction therapy) to perform auricular acudetox. This bill allows registered psychotherapists who can document that they have undergone the same training requirements to also perform the therapy.

SIGNED

Pros

In the midst of the opioid epidemic, the need for addiction counseling is stronger than ever. This bills allows those in the mental health field who can prove they have been trained in this therapy to perform it, regardless of licensure.

Cons

Licensure exists for a reason, the experience required to gain a license is just as important as the training in any particular therapy. This bill would open up therapy to those who are not required to have this experience and thus are not as well equipped to deal with the wide range of experiences that occur in the real world.

How Should Your Representatives Vote on SB18-020

SB18-022: Clinical Practice for Opioid Prescribing

Restricts the number of opioid pills a health care practitioner may prescribe for an initial prescription to a 7 day supply and one refill for a 7 day supply, with a few exceptions. The bill also requires practitioners to query the prescription drug monitoring program before prescribing the first refill, with a few exceptions. Current law only allows practitioners to query the database.

SIGNED

Pros

The gateway into the opioid epidemic is prescription painkillers. This bill takes some necessary steps to reign in abuses in prescribing while still allowing medical professionals to give opioid painkillers to those that truly need larger amounts.

Cons

The bill gets between doctors and patients by severely limiting the amount of opioids a health care professional can prescribe. There are exceptions that the medical professional can claim, but with the drug monitoring program the state is going to have the ability to see what medical professionals are taking these exceptions and may take further action in the future. Getting medical professionals out of the habit of prescribing opioids (something many are already doing on their own) is not the job of the government.

How Should Your Representatives Vote on SB18-022

SB18-023: Promote Off-label Use Pharmaceutical Products

Allows a pharmaceutical manufacturer or its representative to promote off-label use of a prescription drug, biological product, or device approved by the FDA.

KILLED IN SENATE COMMITTEE

Pros

The bill contains protections for consumers by requiring any promotion to be truthful and consistent with generally accepted scientific principles. It will allow companies to not have to apply to the FDA every time they find another use for one of their products and want to advertise that use to the public. This will greatly benefit public health, as consumers become aware of effective treatment options from products that already have FDA approval, just not for this exact usage.

Cons

The reason we have the FDA is to make sure that any promoted usage of these potentially dangerous products has been thoroughly examined by a neutral party, not the pharmaceutical company itself. This bill opens up Pandora’s Box, allowing pharmaceutical companies wide latitude in deeming what its products can be used for and the history of pharmaceutical companies does not indicate they will use this latitude wisely.

How Should Your Representatives Vote on SB18-023

SB18-024: Expand Access Behavioral Health Care Providers

This bill modifies the Colorado health services corps program, a loan repayment program that targets the need for primary care services in health care professional shortage areas in the state. The program provides loan repayment to professionals who commit to practicing and providing primary care in a shortage area for at least two years. The bill adds behavioral health providers to the program, prioritizing those that work in the non-profit sector. It also establishes a scholarship program for those obtaining addiction counseling certifications. It pays for these additions with $2.5 million from the marijuana tax fund.

SIGNED

Pros

Behavioral health counseling is just as needed as primary care and this bill allows the state to help underserved areas, just as it already does with primary care providers. These underserved areas are particularly hard hit by the opioid crisis since they do not have the treatment facilities to deal with it. The scholarship program will help address the crisis directly.

Cons

The bill opens up the program to licensure candidates, not just those with licenses already. While it is true that the bill requires the two year commitment to occur after licensure, it opens up the state to spending money on individuals who may never obtain licensure. It is not a guarantee and the bill does not address what happens if the licensure candidate fails to obtain a license. The marijuana tax fund is also not a bottomless well, we’ve already increased the tax to the maximum allowed and the money is already being used for a variety of purposes.

How Should Your Representatives Vote on SB18-024

SB18-027: Enhanced Nurse Licensure Compact

This bill replaces the current nurse licensure compact, which allows nurses to practice in all states within the compact, with the new enhanced compact. The state joins 26 other states in the compact.

SIGNED INTO LAW

Pros

Not joining this is devastating for nursing in Colorado: mobility, attracting people from other states, telehealth. We’d be stuck with just Wisconsin, New Mexico, and Rhode Island in the old compact and they will probably jump ship to the new compact too, leaving us by ourselves. We already have a shortage of nurses in the state, do not need to add more barriers. The license standards are robust and have worked great for the state already.

Cons

Being in an interstate compact yields some control for the state over licensing standards. Instead of creating our own we have to adhere to what this group of states has decided. While it is true that nurses moving here would have to obtain a Colorado license, we would be guaranteed they were up to Colorado standards.

How Should Your Representatives Vote on SB18-027

SB18-040: Substance Use Disorder Harm Reduction

Specifies that hospitals can be used as clean syringe exchange sites, provides civil immunity for participants in the clean syringe exchange program, creates a supervised injection facility pilot program in Denver and provides civil immunity for those in the program, allows schools to obtain opioid antagonists and train employees to administer them to counteract overdoses, requires sentencing commission to study opioid related sentencing offenses.

*This legislation has been sent to the Senate “Kill” committee, State Affairs*

KILLED IN SENATE COMMITTEE

Pros

Clean syringe exchanges are already operating in Colorado, this merely provides the best possible place for this exchange, a hospital, to be eligible. Schools should have the ability to stop overdoses if they can, there are literally lives at stake and the antagonists are not going to contribute to anyone using drugs more. The most controversial provision is undoubtedly the injection pilot program. We need to be realistic. Opioid addicts are going to shot themselves up with heroin. Doing it out in the streets just leads to more deaths. This provides a chance to keep them alive long enough to get them clean. It’s also an opportunity: users are going to come in and tell us they are addicts, giving us a chance to convince them to go into treatment.

Cons

The state should not be encouraging drug use. Syringe exchanges and injection facilities are all ways to make it easier to abuse drugs. How are we supposed to get people clean if we’re handing them needles and safe (and legal!) places to shoot up? No one wants people to die, but we cannot stop the behavior by encouraging it.

How Should Your Representatives Vote on SB18-040

SB18-054: Cap Fee Increases Assisted Living Residences

Fixes a loophole in the law for the state board of health’s fee assessment for assisted living residences. Currently the board can raise fees higher than the inflation rate, which is not the case for most department-regulated health facilities. The bill imposes the inflation limit on fees for assisted living residences.

SIGNED INTO LAW

Pros

This merely brings assisted living residences into the same system as most other department-regulated health facilities, a system that works just fine. Fees only need to keep pace with inflation in most circumstances and if something truly unique comes up that really does require a higher increase the legislature can always step in.

Cons

This makes it more difficult for the state board of health to accurately increase its fees to account for its costs. While it is true that the state legislature can always change the law, that is a slow process.

How Should Your Representatives Vote on SB18-054

SB18-065: Add Health Maintenance Organizations Life and Health Insurance Protection Association

Adds health maintenance organizations (HMOs) to the state’s life and health insurance protection association (a non-profit made up of member companies from life and health insurance companies to fulfill obligations of policies issued by carriers that become insolvent). To boost the association’s funds to deal with the new potential insolvency obligations, it adds a $2 fee for health benefit plans to charge the policy or contract holder, with all funds going into a special fund solely for health insurer insolvency.

KILLED IN SENATE COMMITTEE

Pros

It makes sense to add HMOs to this association and protect Coloradoans from facing the possibility of paying into insurance that suddenly no longer exists. Many residents don’t have the luxury of simply switching carriers, they have medical bills that need to be paid and most insurance plans don’t cover any expenses occurred before you signed up.

Cons

This is in effect a $2 fee hike on either Colorado residents (if they are self-insured) or Colorado businesses (if they provide insurance).

How Should Your Representatives Vote on SB18-065

SB18-080: Wholesale Canadian Drug Importation Program

Creates a program by which the department of health can import prescription pharmaceuticals from Canada. The program must ensure drug safety and cost savings for Coloradans and must be approved by the federal department of health and human services.

*This bill has been sent to the Senate “kill” committee, state affairs*

KILLED IN SENATE COMMITTEE

Pros

It is estimated that US citizens pay twice as much as Canadian citizens for patented prescription drugs and 20% more for generic drugs. Federal law allows this program to exist, so long as it ensures drug safety and cost savings. Canada has its own version of the FDA and the US and Canada have a memorandum of understanding on pharmaceutical regulation cooperation since 1973. So this can be done safely, with proper precautions against fraudsters. This is literally a matter of life and death for many people, who sometimes have to choose between medication and other basics like clothing and food. We need to provide our citizens some other way to get the life-saving medicine they need.

Cons

The FDA opposes this for safety concerns. Canada may have its own version but it is not the same as our FDA. Importation also greatly increases the risk of counterfeiting, particularly with Internet pharmacies. The state’s ability to construct some sort of monitoring system to ensure safety may either not exist or be extremely expensive. This bill makes no provisions for funding at all. Also, massive importation from Canada is just going to drive up the prices in Canada, since they aren’t sitting on massive stocks of drugs just to sell to Americans.

How Should Your Representatives Vote on SB18-080

SB18-081: Emergency Medical Service Providers Licensing

Changes emergency medical service provider regulation from “certification” to “license” and adds the group to the list of providers who must comply with the Michael Skolnik Medical Transparency Act, which requires individuals to disclose information about their work history, including disciplinary actions, malpractice settlements, and stipulations in their license (among others).

KILLED IN SENATE COMMITTEE

Pros

Emergency medical service providers are health care professionals and thus belong with other health care professionals in the transparency act.

Cons

The transparency act is designed to help consumers make better informed choices about their health care providers. But consumers generally don’t choose their emergency medical service providers, it’s a situation thrust upon them. So the transparency act will not help and will instead just cause more paperwork for emergency medical service providers.

How Should Your Representatives Vote on SB18-081

SB18-082: Physician Noncompete Exemption for Rare Disorder

Makes an exception to physician non-compete agreements (whereby a physician who leaves a group practice may be compelled to pay damages for soliciting former patients) for patients with a rare disorder, as defined by nationally recognized criteria, who would otherwise not have ready access to a physician for treatment.

*This bill has been assigned to the Senate’s “kill” committee, state affairs*

SIGNED

Pros

We should not be playing with people’s lives here. Rare disorders need specialized care and in some areas of the state there may not be another option beyond one doctor. This is an instance where the need of the patient trumps the financial needs of the profession.

Cons

The bill makes no attempt to define having access to another physician for treatment so there will be no burden for anyone to look. This is a case of the government meddling in the private sector. Non-compete clauses are essential for any form of business with clients or patients as they protect the business that help build up that client or patient list from huge losses if someone jumps ship. The more holes you put in the clauses the less effective they become.

How Should Your Representatives Vote on SB18-082

SB18-113: Circle Substance Use Disorder Treatment Program

Establishes in law the circle substance program in Pueblo, a 90-day inpatient treatment program for people with co-occurring mental health and substance use disorders. This program was closed last June by the department of human services because of staffing problems in the hospital where it is located.

KILLED IN SENATE COMMITTEE

Pros

The circle program was the gold standard in the state with a four-six month waiting period and a nearly 80% program completion rate. A 2011 study estimated it had saved the state nearly $3 million in just two years through treatment rather than incarceration.

Cons

This bill puts the program in statute but does nothing to fix the underlying problems at the state facility in Pueblo that caused it to close in the first place. The state hospital was at risk of losing federal funding due to violating required staffing ratios and had to make some hard choices. Perhaps the program needs to be funded separately or moved to another provider or another location.

How Should Your Representatives Vote on SB18-113

SB18-115: Apply Stark Laws to Medical Referrals Outside Medicaid

Currently health care providers who receive reimbursement through Medicaid are prohibited from making referrals to an entity owned or controlled by the provider or family members, with some exceptions. This bill extends the prohibition to all health care providers, not just those in Medicaid.

KILLED IN SENATE COMMITTEE

Pros

Federal law was constructed with these “Stark” laws for a reason: to keep health care providers from profiteering off of consumers who do not have the knowledge of the medical community (who does?) to make an informed decision that the referral is just to get money out of them. Prior to Stark laws being enacted in 1992 under a Republican president (so yeah, we’ve been living with them for a long time), the government found it was being overcharged by $28 million in Medicare in 1987 alone. So it does not make sense that this law does not extend to all health care providers, period. There is no reason only Medicaid consumers should enjoy this protection and everyone else should not.

Cons

This gets between a doctor and their patient. Doctors can choose not to accept Medicaid patients if they do not want to deal with these restrictions, this would force the restrictions on everyone. No one should be punished because they happen to be related to another physician or provider. Let the market expose and deal with anyone making phony referrals.

How Should Your Representatives Vote on SB18-115

SB18-130: Repeal Carrier Reporting Requirements to Division of Insurance

Repeals requirement that health insurance carriers report average reimbursement rates for inpatient day or 25 most common inpatient procedures.

KILLED IN SENATE COMMITTEE

Pros

Current law is an unreasonable burden on insurance carriers to develop all of this information.

Cons

This is a step in the wrong direction. We’ve been trying to increase price transparency in health care for years, to shine some sunlight on what can be wildly varying pricing in the industry. Without an average to compare to, it can be difficult for consumers to understand how expensive the treatment being proposed actually is.

How Should Your Representatives Vote on SB18-130

SB18-132: 1332 State Waiver Catastrophic Health Plans

Requires state to ask for federal waiver to allow catastrophic health plans (less expensive insurance designed only to cover catastrophes) to be sold to any individual on the state exchanges.

SIGNED

Pros

Some younger fitter people simply don’t need all of the bells and whistles of full insurance. They are forced to pay higher premiums (or simply don’t get insurance at all) rather than getting what they want and what the market can provide: insurance that protects them in case of some catastrophe but nothing else. People should be able to decide for themselves what kind of insurance they want in a free country.

Cons

Those under 30 can already get this insurance on the exchanges. Anyone over 30 needs real insurance. This isn’t just about protecting people from their own bad choices (we’ve sadly seen too much evidence that people don’t understand what their insurance does and does not cover until it’s too late), when someone can’t afford to pay their medical bills that cost rebounds to all of us. People who don’t have copays for routine preventative care tend not to get that preventative care at all. That’s bad for their long-term health and bad for all our pocketbooks when it results in dangerous situations not being addressed early.

How Should Your Representatives Vote on SB18-132

SB18-136: Health Insurance Producer Fees and Fee Disclosure

Allows health insurance brokers to charge a fee if they do not receive a commission related to the health plan selected and if the fee is disclosed.

SIGNED

Pros

Brokers are currently encouraged by the system to steer clients into products that will provide them a commission. This lets them make the best decision instead, since they will get paid either way.

Cons

This steers things in the opposite direction. With no guidance on the fee, the broker can charge more than they would receive in commission and steer clients in the opposite direction.

How Should Your Representatives Vote on SB18-136

SB18-146: Freestanding Emergency Departments Required Consumer Notices

Requires free standing emergency departments (FSED) to provide anyone who enters the facility a written declaration of their rights, including that the FSED will treat any individual regardless of ability to pay, that individuals have the right to ask questions and reject treatment, and that the facility is not an urgent care but an emergency facility. The FSED must also post a sign indicating what insurance plans it accepts and its price for the 25 most common health care services. After determining that a patient does not have an emergency, the FSED must provide in writing the information on the sign, as well as some additional information about making payments.

SIGNED

Pros

Emergency departments, including FSEDs are widely recognized as the most expensive setting for receiving nonemergency health care and data indicates that seven of the top ten reasons for visiting a FSED are for nonemergency situations. Furthermore, Colorado is one of the top three states in the nation for the number of FSEDs in the state. FSEDs are not urgent care replacements and too often patients are ending up at them when they have viable less expensive alternatives.

Cons

This is overly burdensome to FSEDs, who are basically directed to drive away their customers unless it is an emergency. If patients don’t realize they can get cheaper care elsewhere, that is not the responsibility of the FSED.

How Should Your Representatives Vote on SB18-146

SB18-148: Medical Benefits After State Employee Work-Related Death

Currently when any state employee dies, their family loses their benefits at the end of the month of their death. This bill changes this only if the employee dies in a work-related death. In this case the state must continue to give health and dental benefits (same coverage) for a full year after death and pay for their cost.

SIGNED

Pros

It’s really the least the state can do if an employee dies while at work for the state. Cutting off the family from all of their benefits right away is cruel.

Cons

While any death is of course tragic, this puts the state on the hook for tens of thousands of dollars for any work-related death without considering any sort of fault. Some state jobs, like police officer, are inherently dangerous and unfortunately tragedies happen. That is not the state’s fault.

How Should Your Representatives Vote on SB18-148

SB18-152: Prohibit Price Gouging on Prescription Drugs

Prohibits increasing the price of an essential off-patent or generic drug if the price increase is not directly attributable to additional costs for the drug. Also gives the attorney general the ability to subpoena any manufacturer they believe is price gouging and gives guidance on what essential off-patent drugs are and what remedies the courts have for forcing prices back down.

*This bill has been assigned to the Senate “kill” committee, state affairs*

KILLED IN SENATE COMMITTEE

Pros

The entirely legal actions of Martin Shkreli, where he jacked Daraprim for $13.50 a tablet to $750 a tablet (a life saving drug that had no generic alternative in the US and cost as little as $0.10 a dose in other countries), are sadly not outliers. Consumers need protections from the laws of supply and demand when lives are at stake. People should not be forced to choose between bankruptcy and life saving medication. This bill would make actions like Shkreli’s illegal in Colorado. It is important to note that the alternative to Daraprim is not just Daraprim in different form: it’s the basic drugs compounded differently, with unknown efficacy and side effects in comparison. There is no FDA testing, as would be required for a generic version and obviously takes years. It might not be as good as Daraprim, which remains prohibitively expensive to this day.

Cons

This is price fixing by the government, pure and simple. The government should not be able to dictate what is and what is not a reasonable price increase in private industry. In cases like Daraprim, the obvious market solution is what in fact happened: another company stepped in and created the product that people actually wanted to buy, at a cost of $99 for 100 tablets.

How Should Your Representatives Vote on SB18-152

SB18-153: Behavioral Health Care Related to Suicide Ideation

Requires the department of public health to identify and address any data gaps that may exist in the department’s office of suicide prevention. Also must collaborate with community partners to evaluate best practices for suicide prevention. The bill requires the implementation of the new federal Medicare payments codes designed to pay for performance rather than treatment. It also requires the department to create a universal outpatient mental health form that allows individuals to consent to the release of their health care information when transitioning from different environments to better coordinate care. Finally, health care facilities must have a plan in place for increased levels of community-based care and support for individuals transitioning from inpatient to community-based care who are being treated for suicide risk.

*This bill has been assigned to the Senate “kill” committee, state affairs*

KILLED IN SENATE COMMITTEE

Pros

Suicides in the state have been increasing and reached their highest rate ever in 2016, the last year for which we have data. The opioid epidemic is of course a factor in this as well. This bill addresses this problem by looking to fill in the gaps that can occur when a potentially suicidal person moves between treatment facilities.

Cons

The problem is not forms and plans for increased levels of care in community-based care, these basically already happen. The problem is the timely release of information from different providers which this bill does not address. It instead just adds more layers of bureaucracy.

How Should Your Representatives Vote on SB18-153

SB18-155: Hospital Community Benefits Reporting Requirements

Requires hospitals that are exempt from state or local taxes to report the tax benefits they receive and the community benefits they provide. The state would analyze the reports and make any recommended changes to the exemption system to the general assembly.

*This bill has been assigned to the Senate “kill” committee, state affairs*

KILLED IN SENATE COMMITTEE

Pros

We provide enormous exemptions to hospitals because they are obviously critical elements of our communities and provide benefits sometimes without payment, as they are required to treat anyone by law. However, there have been numerous examples throughout the country of supposedly non-profit hospitals taking advantage of these exemptions without providing the community benefits. A recent government accountability office study found no difference between non-profit and for-profit hospitals in their amount of uncompensated care. UC-Health got singled out for this behavior three years ago. We need to make sure taxpayers are not being taken advantage of.

Cons

This is a wasteful exercise. Any hospital that the state believes is violating any non-profit rules or regulations around seeing patients can be investigated for those violations. This bill is just added costs to the hospitals to prepare the report and added costs to the state to analyze it. Guess who will end up paying for all of that?

How Should Your Representatives Vote on SB18-155

SB18-161: Repeal Behavioral Health Transformation Council

Repeals the state’s behavioral health transformation council, which was created in 2010 and due to end in 2020.

SIGNED

Pros

The department of human services recommended at the SMART government hearings that this council be ended two years early (was due to end in 2020). The bill’s sponsors are legislative members of the council, so this is simply a temporary council that has served its purpose

Cons

The point of the council was to transform the state’s behavioral health treatment into a more integrated, coordinated, 21st century system. It seems like there is more work to do still on these fronts.

How Should Your Representatives Vote on SB18-161

SB18-168: Medication-Assisted Treatment Through Pharmacies

Requires extended-release opioid antagonists (drugs used to combat overdoses) for use in medication assisted treatment to be included as a pharmacy benefit for the state’s Medicaid, as well as require a pharmacist in a collaborative pharmacy practice with one or more prescribers that administer injectable medication-assisted treatment for substance use disorders receive an enhanced dispensing fee similar to the administration fee paid to a provider in a clinical setting.

KILLED IN SENATE COMMITTEE

Pros

This clarifies the state’s Medicaid position on extended-release antagonists, some of which are not currently covered by the state. The enhanced fee helps align the fees pharmacists are receiving for administering the medication to what doctors would get in a clinical setting, which is fair since the work provided is roughly the same.

Cons

This enhanced fee was originally part of one of the recommended bills from the state’s opioid abuse committee, but was taken out of the final version. A pharmacist is not a doctor, and a pharmacy is not a doctor’s office. It is not appropriate to equate the two together in terms of the treatment provided.

How Should Your Representatives Vote on SB18-168

SB18-214: Request Self-Sufficiency Waiver Medicaid Program

Directs the state to ask for a waiver from the federal government to require able-bodied adults to either be employed or be actively seeking employment and verify monthly income to qualify for Medicaid. Establishes a lifetime limit on Medicaid benefits of five years. All with exclusions for children, seniors, and the disabled.

KILLED IN SENATE COMMITTEE

Pros

While we should assist those who are in need, we cannot create a permanent underclass of moochers who live off of the rest of our citizens who have made better choices in their lives. If someone does not want to work, the rest of us should not be forced to subsidize their life choices. This may be the prod that they need to become a more productive member of society.

Cons

Of the people who are not already excluded, research has shown that a tiny amount of the people who are not working are doing so by choice. First, nearly 8 in 10 of those in this category are already working or living in a home where someone does. Most of the rest are going to school, taking care of a family member, or are ill but have not completed the arduous process to be officially “disabled”. The actual percentage of those this bill is looking to “help” is about 2% of the entire “able-bodied” population. In addition, the notion that providing people health care is somehow letting them live the high life is absurd. It has been proven over and over again that as a whole we save money by providing people with health care.

How Should Your Representatives Vote on SB18-214

SB18-234: Human Remains Disposition Sale Businesses

THIS BILL WAS DRAMATICALLY ALTERED FROM WHEN IT WAS INTRODUCED. THE ENTIRE CONCEPT OF VALUABLE CONSIDERATION WAS REMOVED AND THE SCOPE WAS DEFINED NARROWLY TO ADHERE TO THE ORIGINAL INTENT WHICH WAS TO KEEP PEOPLE FROM PROFITING OFF OF HUMAN REMAINS.

 

Makes it illegal to own more than 10% indirect interest in a funeral establishment or crematory while simultaneously owning interest in a nontransplant tissue bank. Prohibits an entity from profiting from the transfer, sale, storage, or leasing of human remains and defines profiting as getting any valuable consideration, including reimbursement for the reasonable direct and indirect costs associated with the removal of human remains, storage of human remains or transportation of human remains.

SIGNED

Pros

No one should be earning money off human remains and we certainly should not allow those who handle bodies to have an interest in pushing people toward tissue banks.

Cons

This is a stealth attempt at destroying scientific research using human tissue, which is extremely valuable to health breakthroughs, by making it impossible to get anything at all for getting it to the research facility. And by anything, it means anything. This isn’t an attempt to remove the ability to profit from this field, the bill makes it illegal to just meet any expenses.

How Should Your Representatives Vote on SB18-234

SB18-237: Out-of-Network Providers Carriers Required Notices

Currently if an out-of-network health care provider gives care at an in-network facility, insurers are required to cover the services at the in-network level. This bill clarifies that this applies emergency facilities as well. It also requires all facilities, providers, and insurers to provide disclosures to consumers about the potential effects of receiving nonemergency services from an out-of-network provider or facility. The bill also requires providers who accidentally bill an amount in excess of the required copay to repay the consumer within 45 days of notice or pay interest.

KILLED IN SENATE COMMITTEE

Pros

Prior law merely suggested these notices, which really are a necessity. There are few things worse than a surprise! enormous medical bill when the consumer thought they were in-network. And of course it goes without saying that emergency facilities are health care providers. As for the repayments, accidents can happen but 45 days is a reasonable time to hold someone else’s money without their consent before we start adding penalties.

Cons

Medical billing is very complicated and it’s not reasonable to expect that any error can be corrected that quickly and overkill to start charging interest. On the notices, at what point are we going to ask that people take some responsibility for themselves? All insurers provide complete lists of in-network providers, people need to be responsible consumers.

How Should Your Representatives Vote on SB18-237

SB18-247: Local Government Medical Benefits in Work-Related Death

Creates a benefits board for police firefighters to continue their benefit payments for one year after a work-related death, which is now law thanks to SB18-148. The board manages these benefit payouts and also allows any employer to enter into an agreement with the board to make quarterly contributions to the fund which would make its own employees eligible for the same continuation of benefits.

SIGNED

Pros

There was no funding mechanism for the continuation of benefits in the bill passed earlier in session so this bill provides. It also provides the opportunity for other employers to take advantage of the program which could turn into a nice incentive for workers in dangerous occupations.

Cons

You don’t necessarily need a fancy fund to make this work, the state agency where the individual worked simply has it as part of their costs. Bringing in private organizations makes this a much larger program in an unnecessary way.

How Should Your Representatives Vote on SB18-247

SB18-266: Controlling Medicaid Costs

Requires the department of health care policy to provide Medicaid providers participating in the accountable care collaborative: the costs and quality of medical services provided by hospitals and other providers, and cost and quality of available pharmaceuticals prescribed by other providers. Also authorizes the department to pursue cost-control strategies, value-based payments, and other approaches to reduce cost in Medicaid. Subject to federal approval, the department is also directed to design and implement an evidence-based review hospital review program to ensure utilization of hospital services is based on patient’s care needs.

SIGNED

Pros

The nonpartisan legislative council staff estimates this could save the state over $40 million dollars a year by 2019-20 by helping guide referrals to the higher quality and less expensive providers as well as better managed care in hospitals. This is a bipartisan bill that uses the marketplace to save taxpayers money (and provide Medicaid recipients better care).

Cons

Quality of care is an awfully nebulous concept and this bill might bring down a hammer on someone who sees Medicaid patients, which may result in fewer providers taking Medicaid (it is optional). We might also see less referrals to whomever a doctor believes is best for their patient. The cost savings are speculative at this point.

How Should Your Representatives Vote on SB18-266

SB18-270: Behavioral Health Crisis Transition Referral Program

Creates the community transition specialist program in the office of behavioral health to coordinate referrals of high-risk individuals (under an emergency or involuntary hold, have a significant mental health or substance use disorder, and are not in consistent behavioral health treatment) to transition specialists by behavioral health facilities.

SIGNED

Pros

There are many individuals who fall into this high-risk definition and our current system can be extremely confusing. Having a point person within the state government to help coordinate and navigate will be very helpful in getting people to the care that they need.

Cons

Adding another person to a confusing system may make the system even more confusing. There are already people at private facilities doing this basic thing: getting high-risk individuals into the correct facility, so there may also not be enough for a state program to do and it may therefore end up wasting money.

How Should Your Representatives Vote on SB18-270