Medicaid expansion moves toward passage without Republicans

By Katie Kerwin McCrimmon

A bill that would expand Medicaid to about 200,000 more low-income Coloradans continues to move through the Colorado legislature without support from Republicans in the House.

Bill sponsor and House Speaker Mark Ferrandino, D-Denver, said Medicaid expansion would boost Colorados economy by $4.4 billion and add up to 22,000 jobs by 2026 while saving taxpayers money in the long run.

Ferrandino sold Medicaid expansion as a measure that is winning support from Republican governors around the country.

But in Colorado, members of the GOP are not biting. While no opponents spoke against the bill just like an earlier Senate hearing Republicans remained deeply opposed. They said Medicaid doesnt pay doctors enough and that in future years the federal government could break its promise to pay the bulk of the costs to add new patients.

The Medicaid expansion measure, SB 13-200,squeaked through a House health committee by a 7-to-6 party-line vote on Tuesday. With continuing Democratic support, the Appropriations Committee and the full House are likely to pass the measure and Gov. John Hickenlooper has pledged his support.

Advocates for business groups, needy patients, children, hospital groups and insurance industry representatives all spoke in support of Medicaid expansion.

Ferrandino pointed out that taxpayers are paying for health care for the poor now. Were just doing it by forcing people to wait until they are extremely sick; then they seek care in the most costly place: hospital emergency rooms.

These people are getting health care, but what theyre getting is the most expensive health care by waiting until it becomes a big issue and going to the emergency room, Ferrandino said.

By ensuring that they have insurance and coverage, two things will happen. (Providers) will get paid for that care and it will reduce uncompensated care. Thats why you see a broad range of support from providers, the hospital association and the business community, Ferrandino said.

Its a fundamental issue that everyone does get health care, he said.

The question is, How do we get it at the lowest costs with the best outcomes?

That didnt convince Rep. Kathleen Conti, R-Littleton.

She said the federal government is failing to provide adequate health care to returning wounded warriors, and that reimbursement rates for Medicaid and Medicare have continued to fall, spurring providers to stop taking patients with government insurance.

Theres the old adage: fool me once, shame on you; fool me twice, shame on me. Why is it were willing to now go down this road and have faith and confidence in that same federal government that time and time and time again has committed to care for so many populations only to renege on each and every one of them? Conti asked.

Rep. Lois Landgraf, R-Fountain, also decried the growing costs of health care overall.

She said health costs continue to climb while Colorado is cutting education expenditures.

So the math to me just doesnt work out. We cant keep spending more and more money on health care and less and less on education and have things balance out, Landgraf said.

Ferrandino responded that education groups also support Medicaid expansion.

In order to have good educated kids in school, they need to have health care, Ferrandino said, adding that a significant percentage of people who will be added to the rolls will be children.

A new study from the Colorado Health Institute found that one in six Coloradans between the ages of 19 and 64 would become newly eligible for Medicaid if the expansion passes. The study estimates that about half of newly eligible people would actually enroll.

Working-age adults, who historically have not had access to Medicaid, would benefit most, the study found.

New Medicaid recipients would be younger than the Colorado population in general, mostly white, less educated and generally in worse health than the average Coloradan.

They are likely to be employed with nearly half of the adults without dependent children and nearly 70 percent of the parents indicating they have jobs, the Colorado Health Institute report found.

Among those speaking in support of the measure was John Gardner, CEO of the Yuma District Hospital and Clinics, which serves about 14,000 people in rural Yuma and Washington counties.

Gardner said many of his systems patients simply cant afford to pay for health care and that his hospital system has wracked up over $800,000 in bad debt over the past year.

Much of it is from uninsured patients, he said. Were providing coverage to high risk populationsThis bill will improve the health of the uninsured in my community.

Dr. Jeff Sankoff, an emergency physician from an opposite urban health system, Denver Health, also predicted that Medicaid expansion would improve the health of his patients.

We see patients in the emergency department every day. We make diagnoses knowing full well that theyre never going to see anyone in follow-up. If I had any regret, its that this bill doesnt go far enough, Sankoff said. There are too many people without access to care.

Editors note: An earlier version of this story said that Medicaid expansion was moving forward in the Colorado legislature without support from a single Republican. That was incorrect. Sen. Larry Crowder, R-Alamosa, supported the bill in the Senate. No Republicans in the House Public Health Care and Human Services Committee voted for the bill on Tuesday.