Health Care Affordability Act dodges GOP bullets

By Richard Haugh

Despite a barrage of Republican attempts to amend it, a bill aimed at boosting state Medicaid funding by assessing a fee on hospitals will go to the Senate.

House Bill 1293, the Health Care Affordability Act of 2009, sponsored by Reps. Jim Riesberg, D-Greeley, and Mark Ferrandino, D-Denver, and by Sen. Moe Keller, D-Wheat Ridge, passed the House March 25 and goes to the Senate for consideration.

“This is a step forward, and we’re doing this without tax dollars and with a dedicated source of money coming in,” said Riesberg. “Plus, it’s being supported by those who are putting the money in.”

Under the bill, most hospitals in the state will be assessed a fee. The fee has yet to be determined, but Ferrandino said it could be between 2.4 percent and 2.5 percent of hospital net revenue. Federal regulations cap receipts from provider fees at 5.5 percent of net hospital revenue.

The money collected from each hospital would be pooled and used to draw down matching funds from the federal Medicaid program. The resulting money — as much as $1.2 billion, by some projections — would be used to expand health coverage for the uninsured. It’s estimated that about 800,000 Coloradans are uninsured, including 180,000 children.

The bill would bolster the state Medicaid and Child Health Plan Plus (CHP-Plus) programs. It also would provide enhanced funding for the current Medicaid system and for the Colorado Indigent Care Program (CICP). The bill also would allow single adults with no kids to be covered under the state’s Medicaid program if they make 100 percent or less of the federal poverty level, or $10,830 per year.

More than three-quarters of states use a similar system to generate additional Medicaid money, including 23 states that assess a provider fee specifically on hospitals. The measure is supported by hospitals, physicians, consumer groups and business representatives.

In floor debate Tuesday, Republicans were skeptical of assurances by the hospitals that the provider fee won’t be passed on to insurance companies and, ultimately, to consumers — a concern that has surfaced repeatedly as the bill has progressed through the House.

The bill specifically bans placing the fee on patient bills in the form of a line item charge. However, that won’t stop hospitals from hiding the fee in their overall cost structure when negotiating with insurers, critics charged.

“This isn’t a legislative solution, it’s a legislative colonoscopy,” said Rep. Cory Gardner, R-Yuma. “We know what that means to the taxpayer in the end.”

Rep. Spencer Swalm, R-Centennial, said the bill lacks transparency and there is little consumers can do to track the flow of money and assure the fees aren’t passed on. He suggested renaming the bill the Wizard of Oz Bill.

“The Great and Mighty Oz, this advisory board behind the curtain, is pulling and shifting levers, and the fire is going off, and they say they’re solving the problem,” Swalm said. “But every time we try to bring transparency into this bill, it’s resisted. The Great and Mighty Oz doesn’t like it.”

Supporters countered that the bill already has adequate reporting requirements, and that hospitals have little reason to pass on the fee to consumers. Ferrandino said the influx of Medicaid money will help hospitals cover costs of treating the uninsured that are going unpaid now, leaving little incentive for hospitals to try to recapture the fee.

Despite protests from Democrats, lawmakers voted to add an amendment to the bill setting a procedure for auditing the performance of the program and overseeing how revenues are received and spent — including whether hospitals are shifting the cost of the fee to others, such as insurance companies. The amendment calls for the legislative audit committee to assess the program after two years and after five years, as often as it deems necessary.

“This is the least we can do,” said Rep. Cindy Acree, R-Aurora. “There are too many ‘ifs’ not to have this safeguard.”

Democrats fended off a wave of other Republican amendment attempts. An amendment offered by Rep. Amy Stephens, R-Monument, would have placed the provider fee issue on the ballot for a public vote. She said the provider fee proposal is covered under the Taxpayer Bill of Rights (TABOR).

“This is not a fee, it’s a tax,” Stephens said. “It should go to a vote of the people. Let them decide.”

Stephens’ amendment was defeated.

Additional amendments would have added to the advisory committee overseeing the program an additional business representative, who would be from a business that self-insures its health care plan. Several other amendments would have sharply reduced the amount of fees that could be assessed to hospitals. A third would have restored funding for psychiatric beds at the University of Colorado Hospital, where 22 beds were eliminated recently in a budget-cutting move. All those amendments failed.



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