Opinion: Thriftiness wins, controversy kills: health policy lessons – so far – from the 2015 legislature

By Joe Hanel and Allie Morgan

The 2014 election left the Colorado legislature balanced on a knife’s edge, with Republicans winning a one-vote majority in the Senate and Democrats clinging to a three-vote margin in the House.

Many observers wondered what, if anything, could get done in 2015 with such small majorities. The question was especially relevant for health policy, which has endured a partisan fight since before the Affordable Care Act was passed five years ago.

Allie Morgan and Joe Hanel

Allie Morgan and Joe Hanel

With two-thirds of the legislative session behind us, we have insight on what’s getting done and what’s getting axed.

The Colorado Health Institute has been tracking all the health bills through the legislature this session, and we have found a pattern: bills that are passing don’t offend anyone’s political sensibilities, and most of all, they’re not too expensive.

Legislators are looking for ways to deliver more care for the same price. A number of successful bills aim to knock down regulatory barriers and stretch the supply of doctors, nurses and medications. This list includes bills that:

  • Expand telehealth to urban counties (House Bill 1029).
  • Increase the types of mental health professionals who can treat minors (House Bill 1032).
  • Make it easier to donate unused, unexpired medications (House Bill 1039).
  • Allow pharmacists to substitute biologically interchangeable drugs (Senate Bill 73).

Add to this list a bill to reduce the training time for advanced practice nurses to write prescriptions (Senate Bill 197) and a forthcoming bill to allow dental hygienists to put in temporary fillings.

Bills that are failing are deemed either too ideological or too expensive.

With each party in charge of one chamber, it’s easy for bill sponsors to step over an ideological line in the sand, which can spell trouble before bills can even make it to the House or Senate floor.

House Republicans proposed bills they had tried in previous years to restrict abortion (House Bills 1128 and 1041) and to shut down Connect for Health Colorado (House Bill 1066). Despite their gains in the 2014 election, the result was the same. All three bills died in their first hearings.

But even less overtly partisan bills are running into the buzzsaw. A bill to reauthorize a teen pregnancy and dropout prevention program (House Bill 1079) died in the Senate Finance Committee. It was sponsored by two Western Slope Republicans, but it might have suffered from being associated with the governor’s push for funding a more controversial birth control program for low-income women (House Bill 1194). And a plan by Sen. Pat Steadman, D-Denver, to create a statewide registry of advance medical directives (Senate Bill 125) failed about the same time that the media was fixed on House Bill 1135, which would have allowed physician-assisted dying in the state.

With this in mind, the future does not look promising for the contraception bill, HB 1194. The evidence shows that this program has worked very well to reduce unplanned pregnancies and abortions among young women who have participated. But no bill that has stoked partisan controversies has been able to pass this year. The contraception bill would be the first.

Bills that cost too much are failing, too.

Rep. Kathleen Conti, R-Littleton, sponsored a bill to give tax credits to seniors over the age of 75 to pay for home upgrades so they could age at home, instead of moving into expensive nursing facilities (House Bill 1143). Legislators on the House Health, Insurance and Environment Committee were supportive of the idea. Those on the House Finance Committee hated the price tag – an estimated $29.1 million next year – and killed the bill.

One exception to the thrifty ethic seems to be the Joint Budget Committee. The three Republicans and three Democrats granted much of the wish list submitted by state health agencies, including:

  • Addressing delays at the Medicaid call center by adding 25 new employees.
  • Reducing churn on Medicaid by using annual income, instead of monthly, to determine eligibility.
  • Allocating money for a state immunization registry.
  • Eliminating the waitlist for services for children with autism by spending $9 million over the next two years.

The Joint Budget Committee also voted to set aside $5 million for the contraception bill that has stirred up so much controversy. (The funding won’t take effect unless the legislature passes HB 1194.)

The lesson seems to be that if you want this divided legislature to do something big, your first stop should be the Joint Budget Committee. But with such thin margins of control in both chambers and competing ideological views, many health bills face an uphill battle.

Joe Hanel is a senior communications expert and Allie Morgan is a policy analyst at the Colorado Health Institute.

Opinions expressed in Health News Colorado represent the views of the individual authors.

Print Friendly

Leave a Reply