These are all of the health care bills proposed in the 2021 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, arguments for, and arguments against are our best effort at describing what each bill does, arguments for, and arguments against the bill. The long description is hidden by design, you can click on it to expand it if you want to read more detail about 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.

Prime sponsors are given after each bill, with Senate sponsors in () and House sponsors in []. They are color-coded by party.

Some bills will have text highlighted in pink or highlighted in orange or highlighted in yellow. Pink highlights mean House amendments to the original bill; orange mean Senate amendments; yellow highlights mean conference committee amendments. The bill will say under the header if it has been amended.

Each bill has been given a "magnitude" category: Mega, Major, Medium, Minor+, Minor, and Technical. 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!). Technical bills are here to round out the list. They are non-substantive changes.

HB21-1005 Health Care Services Reserve Corps Task Force (Garcia (D)) [Mullica (D), Caraveo (D)]

Appropriation: None
Fiscal Impact: Not yet released

Goal:

  • Create a health care service reserve corps task force to study how to best create a health care services reserve corps program that could be deploy medical professionals in emergencies or disasters across the state and receive some sort of benefit in return, such as student loan relief

Description:

Report is due by December 2023. The task force must consider and make recommendations on:

  • Types of medical professionals who could be in the program
  • Types of emergencies the program could assist with and the skills that would be required, including floods, fires, extreme weather conditions that cut off access to communities, and infectious disease outbreaks
  • Any legal or regulatory barriers to the program concept, including licensing, liability, and scope of practice and what changes would be necessary for the program to function
  • How the program could be streamlined or integrated with existing programs
  • The name of the program and how to differentiate it from existing similar programs
  • Types of training and number of hours of cross-training that would be required and how that training would be provided
  • How to design cross-training to ensure they account for geographic location of participants and are accessible to rural professionals
  • Overall size of program and number of different types of professionals required
  • How to ensure program participants come from a variety of communities and settings such that deploying the corps would not lead to shortages in other places
  • How long professionals would serve in the program
  • How would deploying the corps work, under what circumstances could it be used and how would it be coordinated with other agencies and officials
  • Could the corps be deployed out-of-state
  • What would the record keeping and certification requirements be to run the corps
  • What would the costs of the program be, including training and compensation rates during deployments
  • Any considerations related to insurance coverage, including out-of-network issues
  • Liability protections for program participants
  • Type and scope of student loan relief that could be offered, including how it would be funded, whether some communities should be prioritized over others, and how to market the program

Additional Information:

Task force must start work by November 2021. It must meet at least once every two months until it submits its report. It must consult with medical and nursing schools when considering factors relating to cross-training. It can consult with additional stakeholders to examine any other questions. State must provide office space and staff services. Task force consists of 20 voting members, six are designated by office: Executive director of department of public health and environment; director of office of emergency management; director of the division of professions and occupations; director of the Colorado resiliency office; executive director of department of health care policy and financing; and commissioner of insurance. 14 are appointed by the governor, one member each from statewide organizations representing:

  • Paramedics
  • Nurses
  • Doctors
  • Physician assistants
  • Hospitals
  • Health insurance industry
  • Local public health officials
  • Plaintiff attorneys

And one member each:

  • With experience teaching nurses, physicians, or paramedics
  • With experience managing a health care clinic
  • Currently works in rural health care
  • From a community advocacy organization
  • With experience administering student loan relief to medical professionals
  • Representing an entity that provides medical malpractice insurance

Governor must make appointments by October 2021 and must fill any vacancies that arise. There is no compensation for serving and members are not entitled to reimbursement for expenses. Members select their own chair and vice chair.


Auto-Repeal: September 2024

Arguments For:

Bottom Line:

  • Currently we have no way of activating medical professionals who don’t have the specific training required to step in during an emergency outside of their specialty
  • There will be disasters in our future that require immediate medical aid, so we can create a win-win situation for the state and for medical professionals looking to get some student loan debt relief
  • This is a very complicated situation that requires careful study before jumping in

In Further Detail: Unfortunately we’ve all just gotten a first-hand look at how important having trained reserves of medical professionals can be in an emergency. The problem is that we’ve got a lot of medical professionals across the state who do not have the specific types of training required to step in during a disaster that involves something outside of their specialty. We of course also know that medical professionals frequently have a lot of student loan debt. So this could be a win-win situation for the state and its residents in the future. This could save lives, money, and offer student loan debt relief. But we can’t just jump in, look at the long list of issues in the Description section that need to be solved. This requires careful study first.

Arguments Against:

Bottom Line:

  • If there are existing programs such that one of the jobs of the task force is how to pick a name that won’t confuse people, maybe we can leverage existing programs instead

In Further Detail: No one denies this is a problem, but if there are existing programs to the degree that the legislature has to specifically charge the task force with figuring out a name that won’t cause confusion, perhaps we can work within existing programs to achieve the same end goal.

How Should Your Representatives Vote on HB21-1005

HB21-1020 Proton Beam Therapy For Cancer Treatment [McCormick (D)]

Appropriation: None
Fiscal Impact: None

Goal:

  • Require insurers to hold proton beam cancer treatment to the same standard of clinical evidence requirements for coverage as other cancer treatments. Does not require them to provide coverage

Description:

Proton are positively charged particles and proton beam treatment is the process of using those particles to destroy cancer cells. It is similar to radiation therapy.

Additional Information: n/a

Auto-Repeal: n/a

Arguments For:

Bottom Line:

  • Proton therapy offers the potential for safer treatment of cancers that is just as effective as radiation therapy.
  • It has been around for decades but is somewhat controversial because it is more expensive than traditional radiation therapy and so insurers have tried to claim it is unproven—multiple lawsuits around the country in recent years have found against insurance companies
  • Bill only forces insurers to use same standards for this therapy as for other therapies. One standard for all treatments

In Further Detail: This coverage offers the potential for safer treatment of cancers that is just as effective as radiation therapy. It has been around for a few years but is somewhat controversial because it is more expensive than traditional radiation therapy and so insurers have tried to claim it is unproven. But it was approved by the FDA in 1988 and is covered by Medicare. It is included in national cancer treatment standards. All the bill does is say that insurers have to use the same standards they apply for clinical evidence for proton therapy. Which means they will not be able to duck out of paying for claims by simply making vague evidentiary claims, as many have been successfully sued for doing so recently. As for clinical trials, it is rich for insurers to complain about a lack of clinical trial evidence when they are refusing to pay for the therapy which makes it nearly impossible for patients to enroll in trials. The bottom line remains simple: one standard for clinical evidence for any treatment.

Arguments Against:

Bottom Line:

  • This is vastly more expensive than radiation therapy and has the potential to be more lucrative for the medial industry
  • Insurers are not the only ones saying there is insufficient clinical evidence proving the treatment is more effective than radiation therapy

In Further Detail: This isn’t just a little more expensive, it is multiple times more expensive than radiation therapy to deliver and requires a lot of overhead in order to do properly, on the order of millions of dollars just for a single room. Multiroom facilities can cost hundreds of millions of dollars to construct. And insurers are not the only ways saying there is insufficient evidence. The Journal of Clinical Oncology has pointed to the need for more clinical trials, the gold standard of medicine. The National Institute of Health just last year noted the need for phase 3 clinical trials. This is important because it needs to be proven that the therapy is more effective than radiation therapy, not just that it works. Because it is a direct alternative and we only use more expensive options when they are better.

How Should Your Representatives Vote on HB21-1020

HB21-1033 Add Health Maintenance Organizations Life And Health Insurance Protection Association (Gardner (R)) [Ricks (D)]

Appropriation: None
Fiscal Impact: None

Goal:

  • Add health maintenance organizations (HMOs) to the state’s Life and Health Protection Association, which subjects them to membership dues
  • Requires the board to allocate assessment dues 50/50 between accident/health members and life/annuity members

Description:

This association exists to help pay out claims to Colorado residents whose insurers become insolvent or can no longer meet their obligations. It is in essence insurance for insurance. There are limits on what the association will cover. Assessments are made when the association has to pay residents due to a member insurer failure.

Additional Information: n/a

Auto-Repeal: n/a

Arguments For:

Bottom Line:

  • HMOs are health insurance, they belong in this association
  • It is only fair to spread assessments across the various types of insurance equitably

Arguments Against: n/a

How Should Your Representatives Vote on HB21-1033

HB21-1036 Local Control Of Health Orders [Pico (R)]

Appropriation: None
Fiscal Impact: None

Goal:

  • Allows the governing body of a county or city to reject health orders issued by state or local agencies by majority vote of the body. Also allows governing bodies to modify health orders by majority vote

Description: Nothing to add

Additional Information: n/a

Auto-Repeal: n/a

Arguments For:

Bottom Line:

  • Health orders can have huge negative impacts on a community, like the business-related closures due to COVID. The most representative body of any community is its elected representatives and they should be able to fulfill the people’s will
  • One size fits all health orders from the state may not apply to a particular community, it should be able to do what is best for it

In Further Detail: Health orders can have huge negative effects on a community, as we have seen with businesses forced to close due to COVID. Long-term disasters like the COVID pandemic affect different parts of the state in different ways. What might be necessary in one part of the state may not be in another, but one-size fits all health orders from the state treat everyplace nearly the same. This bill allows communities to use the representatives closest to them, local elected officials, to enact their wishes, as opposed to unelected officials, some of whom aren’t even in the local community.

Arguments Against:

Bottom Line:

  • Health agencies are experts and employ experts to create their health orders, local elected officials are not experts and neither is the public. In this case, safety must come first
  • For some disasters, like an infectious disease pandemic, the actions of people in one part of the state affect those in others, as people move around

In Further Detail: We have public health agencies because we recognize this is an area where expertise is really important. Local elected officials are not experts and neither is the public. When it comes to the basic safety of our citizens, expertise must come first. The idea that elected representatives are more accountable is less appealing when we are talking about something that might kill a lot of people before accountability is possible. Furthermore, the actions taken by people in one part of the state can affect all of the rest of us. The first discovery of the UK variant of the Coronavirus in the US was made in a rural part of the state in someone who didn’t live in that county. We also saw rural areas hit the hardest this winter, in terms of per capita infections, and that included Colorado. Right now the counties with the most cases per 100,000 people in the state are Bent, Crowley, Lake, Lincoln, Grand, Washington, Rio Blanco, Eagle, Summit, and Fremont. Bent County did not report more than 1 case on a single day until November. It now has reported 1,469, or 26,340 cases per 100,000 residents. That’s the 2nd highest rate in the entire state, second only to Crowley county, which also had a small spike in May. The virus took a little longer to spread into those communities, but as is typical with infectious disease patterns, it did not spare them.

How Should Your Representatives Vote on HB21-1036

SB21-003 Recreate Occupational Therapy Practice Act (Fields (D), Holbert (R)) [Ortiz (D), Larson (R)]

SIGNED INTO LAW

Appropriation: None
Fiscal Impact: No different than last year’s bill

Goal:

  • Fix a mistake in last year’s session that resulted in occupational therapy regulation disappearing entirely, instead of being extended (and slightly altered) through September 2030 as the bill intended.

Description: n/a

Additional Information: n/a

Auto-Repeal: September 2030

Arguments For:

This is pretty simple, there was an inadvertent error that had to with a petition clause in last year’s bill. This bill fixes it.

Arguments Against: n/a

How Should Your Representatives Vote on SB21-003

SB21-036 Additional Requirements Issue Emergency Public Health Order (Gardner (R))

Appropriation: None
Fiscal Impact: Negligible in an emergency, otherwise none

Goal:

  • Limit the ability for any agencies to issue emergency public health orders beyond their 120 day limit by requiring the agency to go through the regular rule making process to continue beyond that point

Description:

Basically we allow agencies to issue emergency orders because the rule making process takes time, as required by state law, so in an emergency we sometimes just have to act. These emergency rules have 120 lives, but right now they can be extended. This of course happened around COVID-19 related orders.

Additional Information: n/a

Auto-Repeal: n/a

Arguments For:

Bottom Line:

  • You can’t keep claiming an emergency to avoid the regular rule process. 120 days is enough time to go through the process if necessary. Allowing extensions nullifies the purpose of the rule making process and shuts out interested parties.

In Further Detail: We saw, and continue to see, a lot of this because of COVID. Health agencies issue emergency rules that impinge on the ability for businesses to operate, then the rules keep getting extended and tweaked, all without the regular rule making process required by Colorado law. Avoiding the process means avoiding public input. Of course we must be able to react to an emergency, but 120 days is a long time, plenty long enough to do the correct process for whatever is required going forward. The bill does not prevent emergency rules like those made for COVID from being made regular rules, it just forces state agencies to go through the proper process.

Arguments Against:

Bottom Line:

  • As we all know far too well right now, emergencies are not static. They change, and not according to any deadlines, so agencies must be able to adapt to that change as required. If the people or the legislature is not happy they have recourse: through laws and elections

In Further Detail: The problem with this bill’s approach is that it assumes that after 120 days we have a static situation that will not require future emergency changes. We all know from experience this past year that this is not the case. We have to allow our agencies the tools to adapt to the crisis as the crisis unfolds, not tie them down in red tape. And if we are unhappy with their actions, there are remedies at hand. State law trumps state rules. Agencies report to elected officials who can be voted out. We also know that this is not a system run amok because prior to the pandemic the state health agencies issued very few public health emergency orders.

How Should Your Representatives Vote on SB21-036

SB21-038 Expansion of Complementary And Alternative Medicine (Zenzinger (D), Smallwood (R)) [Kennedy (D), Van Winkle (R)]

Appropriation: None
Fiscal Impact: Small savings in Medicaid program

Goal:

  • Expand conditions eligible for the state’s complimentary or alternative medicine pilot program to genetic diseases and brain injuries and expand the program to the entire state.

Description:

Adds multiple sclerosis, brain injuries, spina bifida, muscular dystrophy, or cerebral palsy, all with total inability for independent ambulation due to the condition, to list of conditions eligible to participate in the state’s complimentary or alternative medicine pilot program. Opens the program to anyone in Colorado.

Additional Information: n/a

Auto-Repeal: Program still repeals in 2025

Arguments For:

Bottom Line:

  • This is proven to be an effective program at both keeping costs down and keeping people away from opioids, so it makes sense to expand it to those with genetic disorders and the entire state.

In Further Detail: This program allows people with spinal cord injuries to receive complimentary (not free, but additional) or alternative medicine for their injuries. These treatments provide additional benefits to the injured and help keep our Medicaid costs down, as well as preventing people from searching for alternative methods to manage pain, like opioids or other drugs. People in the program have reported higher quality of life from these treatments. But the program currently is only for injuries and does not allow those with genetic disorders to qualify. This bill fixes this, as well as open the program up for all Coloradans.

Arguments Against: n/a

How Should Your Representatives Vote on SB21-038

SB21-090 Small Group Health Insurance Plan Renewal (Smallwood (R)) [Hooton (D)]

Appropriation: None
Fiscal Impact: None

Goal:

  • Require insurers to continue to let employers keep a small-group insurance plan even if they now are in the large group category, so long as the employer keeps the same plan. If the insurer no longer offers the plan, the employer must be able to keep a similar plan.

Description:

Small-group insurance in Colorado is under 100 employees. Once an employer has 100 employees, they must go into a large group plan, unless this law passes. The rules and regulations are different for the different sizes. Small groups rates cannot be based upon anything but location of business, age of enrollees, and in some cases, tobacco usage. Large group plans can consider other factors. Small group plans also have flat pricing with no negotiation. Large group plans can be negotiated.

Bill also requires insurers to notify employers if they are no longer going to be eligible for small-group plans within 60 days of becoming aware of the change and no later than the anniversary date of the plan, and that all state laws governing small group benefits will cease to apply if the employer doesn’t renew their plan.

Additional Information: n/a

Auto-Repeal: n/a

Arguments For:

Bottom Line:

  • The big differences between the groups mean we should allow companies that are used to small business plan rules and their current health care plan to stay there. It could mean the difference between an employer keeping or dropping employee insurance coverage

In Further Detail: It can make a big difference to a business to go from the small to the large group bucket. And while of course we have to draw the line somewhere, jumping from 99 to 100 employees shouldn’t necessarily come with such drastic changes. So as long as the company keeps its old plan, we should allow it to continue to operate like a small business insurer. That we don’t right now may lead some companies to drop employer-based coverage completely, which is exactly what we don’t want to happen.

Arguments Against:

Bottom Line:

  • This isn’t fair to a business that is in the large group already
  • There are no thresholds in the bill—a company that jumps from 99 to 100 would be treated the same as one that jumped from 99 to 1,000 employees

In Further Detail: We have to draw the line somewhere and it isn’t fair to a business that is in the large group to have others businesses of the same size get treated differently. Also, while the story of adding just one employee to go from 99 to 100 may give some pause, the bill would treat a company that went from 99 to 1000 employees the exact same. We have these categories for a reason, we need to stick to them.

How Should Your Representatives Vote on SB21-090