Health care bills face uncertain future

Lack of GOP majority could affect outcomes
The Colorado Statesman

Two bills dealing with Colorado health care rules and policy are likely to hit the House at nearly the same time, and possibly when the House Republicans have temporarily lost a member that gives them their one-seat majority.

Last weekend, Rep. Larry Liston, R-Colorado Springs, underwent emergency surgery to repair a detached retina. That surgery means Liston is unable to travel to the state Capitol for at least a week or possibly even two weeks, although the General Assembly is now in its final two weeks for the 2011 session.

Liston told The Colorado Statesman this week that in a best case scenario, he could be back as early as Tuesday, May 3. That’s just nine days before the scheduled session end.

While the Republicans have appointed replacements for Liston on the committees on which he serves, they can’t do anything about the loss of their one-seat majority.

And that could affect two major health care bills that are on the House’s agenda during the final weeks of the session. The first is Senate Bill 11-200, on health insurance exchanges, which passed the Senate Wednesday on a 20-15 party-line vote. The second is House Bill 11-1273, which would allow the state to enter into interstate compacts for health insurance with other states and would attempt to free Colorado from participation in federal health care reform. HB 1273 passed the House Health and Environment Committee Tuesday following a somewhat boisterous committee hearing and on a party-line 7-6 vote. The bill was sent to the House Appropriations Committee for further action.

SB 200 got preliminary approval from the Senate Monday, despite Republican efforts to attach amendments that had previously been rejected from the Senate Health and Human Services Committee on March 31. The bill passed on a 20-15 party-line vote on Wednesday.

SB 200 would establish a non-profit health benefit exchange, governed by a nine-member board of directors appointed by the governor and legislative leadership. The board would then be responsible for appointing an executive director, creating financial plans, applying for grants, developing the exchange’s structure, determining the size of the small employer market, and providing written reports to the General Assembly and governor. SB 200 also would set up a new legislative oversight committee that would review grants and the financial and operational plans developed by the board, and make recommendations on legislation. That oversight committee was approved on a 14-4 vote by the Executive Committee of the Legislative Council on April 19.

The bill has the support of Gov. John Hickenlooper and is sponsored by Senate President Pro Tem Betty Boyd, D-Lakewood, and House Majority Leader Amy Stephens, R-Monument, who also sponsors HB 1273.

SB 200 drew strong opposition from Senate Republicans Monday and again on Wednesday. Sen. Shawn Mitchell, R-Broomfield, had attempted to attach an amendment to SB 200 while it was in the Senate health committee that would require the state to seek a full waiver from the federal government’s health care reform law. The amendment came at Stephens’ prompting, and Monday, Mitchell tried twice to get that amendment onto the bill, to no avail.

Mitchell called the bill a “well-intentioned mistake we should not make” and one that he said represents a government solution to government problems. The government can’t be trusted to fix this problem, Mitchell said, and the solution to high health care costs is to allow for the purchase of health insurance across state lines. He also noted that the federal Patient Protection and Affordable Care Act is headed for the U.S. Supreme Court, although the Court this week denied a request from the Virginia Attorney General to fast-track his state’s lawsuit through the appeals process. As to the federal dollars offered to help set up the exchanges, federal dollars don’t come without federal strings, a “ring in our nose,” Mitchell said.

Sen. Morgan Carroll, D-Aurora, who also sits on the health committee, noted the bill has the bipartisan support of “one of the most impressive coalitions I’ve ever seen.” That included a wide variety of business and insurance organizations and health care providers, which Carroll called an “overwhelming voice” of support. She also reminded her Senate colleagues that the idea of a marketplace exchange predates the ACA; the bill’s sponsors have pointed to the idea coming from the 2007 Blue Ribbon Commission for Health Care Reform, also known as the 208 commission.

In a statement issued Wednesday afternoon, Boyd said the bill was “negotiated by a bipartisan coalition. The diversity of groups supporting this bill, which include business groups, consumer advocates, insurers and health care providers, demonstrates just how much broad based consensus there is for this proposal. This is a uniquely Colorado proposal and I’m proud to see it move through the Senate and head to the House.”

Tuesday’s hearing on HB 1273 pitted Tea Party members against each other, with some in support and just as many opposed.

HB 1273 was amended with a “strike-below” amendment that would allow Colorado to negotiate with other states to set up the interstate compact and to opt out of the ACA.

Rep. B.J. Nikkel, R-Loveland, told the House Health and Environment Committee that interstate compacts are common among states as a mechanism for collaboration. Two states, Arizona and Georgia, have already passed legislation to create those compacts and at least three others are working on similar legislation, Nikkel said. However, Rep. John Kefalas, D-Fort Collins, pointed out that Arizona’s governor had vetoed that legislation.

This is a states’ rights issue, said Stephens; a compact between states would be free of government intrusion and help Colorado find a way to cut health care costs. “States have the right to get together and decide the issue of health care,” she said. Colorado would “reinstate our state sovereignty in matters traditionally left to the state.”

Whether the bill would pass constitutional muster is another matter. HB 1273 sponsors said the strike-below would amend the bill to say that Congress would have to approve the compacts and that the compacts could be amended by the states at any time. A constitutional law scholar pointed out that the president also has to sign off on a compact; Scott Moss of the CU-Boulder law school noted that once approved, a compact becomes part of federal law and cannot be amended by states whenever they choose.

Democrats also made a point of calling Republicans and their supporters on the carpet over the use of the term “Obamacare.” Rep. Jim Riesberg, D-Greeley, pointed out that the term is used in a derogatory manner and asked that it stop.

Mario Loyola of the Center for Tenth Amendment Studies at the Texas Public Policy Foundation came to the hearing to testify in favor of HB 1273 and said that the idea that anything that needs to be done should be done by the federal government is incorrect. “The federal government has proven it should not regulate in this area,” he said, and all Americans would be better off if health care was returned to the states. Loyola also explained that compact funding would look at what a state pays to the federal government for health care, not just as part of a state’s budget but the taxes that its citizens pay to support programs such as Medicare. “We’re trying to avoid an unfair situation where Colorado opts out of Medicaid or a particular program but is still paying taxes into it,” said Loyola. “What this is trying to capture, [is] to give states the option of managing everything related to health care themselves. Equity demands that they control all of the money that their residents, through federal taxes or state budget, pay into those health care programs.”

But Loyola stumbled when asked about his knowledge of how Colorado citizens view the ACA. Last November, more than 53 percent of voters rejected an Independence Institute-backed initiative that would have taken Colorado out of the ACA. “I haven’t seen the measure in detail,” Loyola said, in response to a question from Rep. Beth McCann, D-Denver regarding the will of the people. “The voters of this state have voted,” McCann said. “Isn’t that an indication the state has already acted?”

“Not having seen the legislation or being familiar with Colorado politics, I’m not competent to answer that,” he replied.

Democrats also asked how having an interstate compact would reduce the number of uninsured Coloradans, estimated at 800,000. Stephens said states could get together under a compact and discuss the issue, such as on how they might combine forces. They also might discuss affordability, accessibility and value, “issues around health care we think are important,” she said.

Those testifying against HB 1273 made up an odd bunch — ranging from Tea Party representatives to health care providers and consumer groups like AARP. “Health care is a way to manipulate public sentiment,” said Nancy Rumfelt of Liberty Watch. Anyone who needs health care can get it, she said, and to her Facebook supporters Rumfelt wrote Wednesday that the compact as written “only furthers the position that a state must ask permission from the federal government to go somewhere when in reality the Feds do not have this authority to begin with.”

“I’ve never seen any government program that hasn’t overstepped its bounds,” said Gary Coats of Delta. “This is an intrusion into my private life… I’m not willing to turn my health care over to regulation.”

Committee Democrats and witnesses claimed that the issue was being pushed on Colorado by several conservative organizations, including the American Legislative Exchange Council, the Heritage Foundation and the Health Care Compact Alliance. “This doesn’t serve us well,” said Dede de Percin of the Colorado Consumer Health Initiative, and pointed out that states can already opt out of the ACA if they meet certain benchmarks.

In contrast, several members of the Tea Party Patriots said they supported HB 1273, although some of the testimony bordered on the unusual.

Betty Blanco of La Junta said she supported HB 1273 because it would restore health care decision-making power back to the state and its citizens. “We have no power, no control, no voice in the type of health care we want here,” she told the committee. HB 1273 also would restore the “state sovereignty we hold dear,” an idea echoed by several other Tea Party representatives.

Lois Stump of the Arkansas Valley Tea Party noted that she is on disability and on Medicare, and said she did not want the federal government putting her on a “death list. That’s how they’re going to afford it, they’re going to kill off all the old people… and I don’t want microchips, either.” Stump’s remarks drew nervous laughter from many at the hearing, including committee chair Rep. Ken Summers, R-Lakewood.

Democrats mounted strong opposition to the bill in their remarks prior to the vote, focusing on the November vote on Amendment 63 and where HB 1273 came from. Interstate compacts are done to encourage cooperation among states, not to block federal law, Riesberg said. They require the consent of Congress, which isn’t likely, and presidential approval, and there’s not much chance that will happen either, he said. “I respect the vote of the people” who voted against Amendment 63 last November.

Rep. Cindy Acree, R-Aurora, said she supported the bill because “Liberty is all about choice and our constitution clearly gives states choices. That health care is not mentioned” in the constitution abdicates that choice to the states, Acree said, adding that she believed in following the will of the people and that the majority of her constituents support HB 1273.

Marianne@coloradostatesman.com