Health Policy Solutions

Want a fun diversion?

Play the budget game.

Zachary Barr of Colorado Public Radio makes it simple to understand why Colorado’s health programs and higher ed will take big hits as lawmakers slice and dice to balance the budget this year.

Christopher Bartkowicz, a Highlands Ranch man who ran a medical-marijuana-growing operation from the basement of his home, was sentenced this morning to five years in federal prison. Read the full report in the Denver Post.

Doctor asks, “Why did you come to the ER today?”

This question — emphasizing today is common practice in emergency departments — helps us figure out how urgent a patient’s illness might be. But it’s a loaded question. Rephrased, it could easily mean, “Do you really believe you are seriously ill, or is it just that you couldn’t wait to see a regular doctor?” Read the full report from Time.

Governors have deep differences over national health-care reform, but when it comes to insurance exchanges–a centerpiece of the sprawling new federal law intended to make it easier for individuals and small businesses to shop for comparable coverage–nearly every state is moving ahead with implementation. They are working under crushing deadlines, often with staffs thinned by layoffs. Read the report from Stateline.

The emotional health of college freshmen — who feel buffeted by the recession and stressed by the pressures of high school — has declined to the lowest level since an annual survey of incoming students started collecting data 25 years ago. Read the New York Times report.

Two of the central promises of President Barack Obama’s health care overhaul law are unlikely to be fulfilled, Medicare’s independent economic expert told Congress on Wednesday. The landmark legislation probably won’t hold costs down, and it won’t let everybody keep their current health insurance if they like it, Chief Actuary Richard Foster told the House Budget Committee. Read the Associated Press story.

The Houston hospital where Rep. Gabrielle Giffords is being treated is one of the few hospitals in the country using cognitive rehabilitation therapy.  The Pentagon’s health program, Tricare, has refused to cover cognitive rehabilitation therapy for the tens of thousands of service members who have suffered brain injuries in the line of duty. Read the report from ProPublica.

Federal health officials announced Wednesday that they were investigating a possible association between saline and silicone gel-filled breast implants and very rare form of cancer known as anaplastic large cell lymphoma (ALCL). Read the Washington Post report.

By Katie McCrimmon

Colorado lawmakers are targeting $50 million from the hospital provider fee to fund Medicaid spikes as the state faces a billion-dollar budget shortfall this year.

The themes of this year’s legislative session will likely be creative budget dances like the dip into the provider fee, and cuts, cuts and more cuts. Lawmakers must balance the budget and are considering slashing everything from the popular school breakfast program for poor children to pet programs for veterans, the unemployed and other interest groups.

During a Joint Budget Committee briefing with both the Senate and House health committees last week, Rep. Cheri Gerou, R-Evergreen, said “some of us are not sleeping at night” as lawmakers contemplate cuts. She urged fellow lawmakers to hunt for their own methods to trim the budget and ferret out government-funded health programs that don’t work.

The biggest health care bill coming in the 2011 session will be the one that establishes Colorado’s health exchange, the centerpiece of the new federal Affordable Care Act. Colorado is planning a statewide exchange, which will be a health insurance marketplace where individuals and small businesses can shop for insurance options by 2014.

This year, the state legislature will set up the framework for the exchange and appoint an oversight board. Tension is building now in Colorado’s split legislature; so far, the exchange bill doesn’t appear to be controversial. But watch for sharp divisions of opinion down the road as everyone from health companies and insurance brokers to advocates for the poor fights for a piece of the exchange action.

Solutions gives you an introduction to health-related bills on deck so far.

The Hospital Provider Fee: eradicate it or use it as a piggy bank?

The 2011 session opened with newly-elected Rep. Janek Joshi, a Republican former physician from Colorado Springs, firing a shot for budget slashers. Joshi introduced HB-11-1025, a bill to eradicate the hospital provider because he sees it as a tax and is concerned about the ballooning federal deficit.

The provider fee law passed in Colorado in 2009. Under it, hospitals throughout the state pay fees, which the federal government then matches. The money then flows back to the hospitals to fund care for the poor and to boost enrollment in public health programs for poor adults, pregnant women and children.

So far, Colorado’s Department of Health Care Policy and Financing estimates that the provider fee generated more than $146 million in new federal funds for Fiscal Year 2009-2010. It’s expected to result in more than $159 million in federal money for the current fiscal year. When the law is fully implemented, hospitals in Colorado will pay about $600 million annually and the federal government will provide an equal match, bringing $1.2 billion into the program.

For now, the Colorado Hospital Association has signed on to a plan to use $50 million from the provider fees this year and $25 million next year to help counteract hikes in Medicaid costs. The fees would draw the federal match, bringing a total of $100 million this year and $50 million next year.

This plan would require new legislation that has not been introduced yet.

Former Gov. Bill Ritter’s budget experts hatched the plan. Gov. John Hickenlooper has spoken out in support of the hospital provider fee in general, but hasn’t commented on the specific maneuvers being considered now.

Steven Summer, president and CEO of the Colorado Hospital Association, said tapping excess money from the provider fees makes sense.

“Our board of trustees and members believe that when you have a billion dollar deficit, everybody has a responsibility in fixing that,” Summer said. “For a defined period of time and a defined dollar amount, it can help pay for the growth in Medicaid.”

Aside from Rep. Joshi, most other lawmakers on both sides of the aisle seem to like the provider fee and are eager to find solutions to budget problems, which are especially severe in the health arena.

Costs for Colorado’s Medicaid program have risen over $1 billion from 2007 to 2010. The increases stem primarily from a 41 percent spike in the number of people needing Medicaid and a 47 percent increase in the number of clients in the Children’s Basic  Health Plan.

Colorado’s Medicaid program serves low-income elderly people and disabled adults and children. While the majority of the clients in the program are children, the majority of expenditures go towared programs for the elderly and the disabled.

Sen. Betty Boyd, D-Lakewood, chair of the Senate’s Health and Human Services Committee, supports tapping the $50 million from the provider fee.

“The hospitals have come forward and they are willing to do this. With the tight times we’re in, I don’t think we should pass up this opportunity. Let’s be good stewards of this money,” Boyd said.

So far, the fee has added about 30,000 previously uninsured people to Colorado’s Medicaid rolls and it has helped Colorado hospitals bear the burden of caring for the indigent.

In all, Summer said Colorado hospitals covered more than $1.7 billion in uncompensated care in 2009.  Before passage of the hospital provider fee program, hospitals had to cover 44 percent of the costs for Medicaid patients. That number has dropped to about 29 percent and many more hospitals are able to operate in the black now they have funds from the federal match.

The fact that the provider fee can bring federal money to the state during an economic crisis means that Joshi’s bill may never get out of committee. Stay tuned.

Colorado’s new health exchange

While national politicians continue to debate the new health law, Colorado lawmakers are moving forward to implement it. Democrats in the governor’s office and the statehouse are working to find a Republican sponsor in the House to build bipartisan support for Colorado’s new health exchange.

Sen. Boyd, is sponsoring the legislation and said a draft of the measure should be complete by Feb. 10.

“We’re setting up a framework and the process for putting the board together so they can get started on the creation of the health exchange,” Boyd said.

She anticipates that the board will have nine members. The legislature will then authorize the board to map out the details of the health exchange. They will do this under the direction of Joan Henneberry, Hickenlooper’s architect for the health exchange, who will be based at the Colorado Health Institute as the exchange takes shape.

Boyd said the legislation will prevent people with conflicts of interest from serving on the board. So, for instance, current health insurance executives or insurance brokers would not be allowed on the board, although they could serve on advisory committees.

“Perhaps a retiree would be fine,” said Boyd “But we are being cautious about current conflicts of interest.”

Lorez Meinhold, Hickenlooper’s director of health reform implementation, said there is consensus among stakeholders that Colorado should have one statewide exchange. It will need to gear up to serve about 300,000 people.

While working previously for Ritter, Meinhold released a roadmap on health care implementation and results of community forums on health care called Stakeholder Perspectives.

Dede De Percin, executive director for the Colorado Consumer Health Initiative, said the health exchange will be like an online shopping mall for health insurance. She hopes the exchange will give consumers choice and competitive pricing.

“Once you build the exchange, if you know that you have four basic plans, then you’ll be able to find out about the insurance carriers, service, and value,” de Percin said. “It should give small insurance companies the chance to be more competitive.”

She said Republicans, including President Bush, pioneered the concept of a competitive insurance marketplace, so it shouldn’t be difficult to get Colorado’s GOP lawmakers on board.

“I think there’s a lot of common ground and that we’ll be able to move forward,” de Percin said.

The health exchange will continue to take shape over the next two years, requiring new legislation each year.

“We expect that it will be an incremental process,” said Ben Price, executive director for the Colorado Association of Health Plans. “What we really need in Colorado this year is a bill that enables the state to start working on the exchange. We’re lucky we have a few years to work out all the issues.

Curbing concussions and making hospitals safer

Among the other health issues likely to emerge in the legislature:

• Reducing harm from concussions in youth sports. SB 11-040 would require coaches to attend training sessions on concussions and get immediate medical care for student athletes who have suffered concussions.
• Increasing physical activity in schools. Lawmakers have introduced HB 11-1069 which would require school boards and charter schools to set minimum minutes for physical activity each week.
• HB 11-1019 would eliminate copayments at school-based health clinics.
• SB 11-008 would eliminate the “stair step” problem for low-income families by increasing Medicaid eligibility for children ages 6 to 19 to match the income eligibility for pregnant women and children ages 5 and under.
• SB 11-019 allows small businesses with fewer than 50 employees to reimburse employees for health insurance premiums.
• Not yet introduced: a bill may emerge to thwart violence in hospitals. It may be similar to last year’s Senate Joint Resolution 10-035.
• Not yet introduced: a bill to boost patient safety by requiring hospitals to share information about disciplined employees. This issue emerged after a surgical nurse at Rose Medical Center infected patients with Hepatitis C when she replaced clean syringes with dirty ones while stealing Fentanyl.
• Not yet introduced: Colorado will need to make sure state health laws conform with the new federal health law.