Bi-partisan love fest ends for health care exchanges bill

The Colorado Statesman

The bill that would start the process for setting up health care exchanges in Colorado debuted with a bi-partisan love fest among House and Senate leadership and the governor.

But the process hit a bit of a snag as the bill went through its first committee. The bill’s House and Senate sponsors this week told The Colorado Statesman that Senate Bill 11-200 will continue to move forward for now, but the question may be whether it survives in a form acceptable to both of its primary sponsors.

SB 200 was reviewed by the Senate Health and Human Services Committee on March 31 in a hearing that lasted about two hours. But less than an hour into the hearing, House Majority Leader Amy Stephens, R-Monument, one of the bill’s sponsors, publicly released a letter to her Senate co-sponsor that asked that an amendment be added to the bill that would require the state to seek a full waiver from the federal government’s health care reform law.

Senate President Pro Tem Betty Boyd, D-Lakewood, says she won’t budge on Amy Stephens’ amendment to the health care exchange bill.

Enactment of the Patient Protection and Affordable Care Act “has so thoroughly contaminated the public discourse about the nation’s health care system that even simple and common-sense ideas like health care exchanges have been toxic and fraught with public policy peril,” Stephens said in her letter to Senate President Pro Tem Betty Boyd, D-Lakewood. Stephens mentioned that her constituents and some of her House colleagues have said that the potential link between SB 200 and the federal law “is far more damaging than whatever benefit is derived from the bill… There is only one way to solve this problem, and that is to make absolutely sure that the health care exchanges are implemented only after the State of Colorado opts-out of Obamacare.”

If the committee chooses not to adopt the amendment, Stephens said she would put it on the bill when it gets to the House.

Stephens didn’t get her wish, at least where the human services committee was concerned. The committee rejected the amendment, offered by Sen. Shawn Mitchell, R-Broomfield, on a party-line 5-4 vote. Boyd noted that “the House sponsor and I had agreed that neither one of us would be in support of amendments that we did not both agree to. I have not agreed to this,” she said. Mitchell also lost on a second amendment that attempted to delete all references to the federal law in SB 200, and that Colorado would not apply for or accept federal dollars to implement the exchange.

SB 200, which passed the committee on the same 5-4 vote, now goes on to the Executive Committee of the Legislative Council because of its provision to set up a legislative oversight committee. Boyd said she believes the bill will get out of that committee unscathed and will then need to go to the Senate Appropriations Committee because of a $19,000 cost to set up the legislative oversight committee.

Business representatives spoke strongly in favor of SB 200 during the March 31 hearing, including the Metro Denver Chamber of Commerce, Colorado Association of Commerce and Industry, the Rocky Mountain Farmers Union and the Colorado chapter of the National Federation of Business. Tony Gagliardi of NFIB called the coalition backing the bill a “strange group of bedfellows” but one that finds the status quo on health care unacceptable. More than 60 percent of the NFIB membership supports a Colorado health care exchange rather than the federal one-size-fits-all plan, he said. SB 200 also was supported by a long line of representatives from consumer and medical groups, including AARP, the Colorado Coalition for the Medically Underserved, the Colorado Consumer Health Initiative, the Colorado Medical Society and the Colorado Hospital Association.

The bill drew little opposition in the March 31 hearing, with only two witnesses testifying against. Robert Rowland of the Elbert County Tea Party said the bill was too undefined in its goals, and asked that it be tabled for a year. “We have time. Let’s be more thoughtful” and bring in more people from the “grassroots,” he said.

Stephens told The Statesman this week she is still a believer in exchanges. “I would like to see us do it with our state interests in mind,” she said Wednesday. However, she is looking at private ways to fund the exchanges, and hints she still wants to bring back the amendment when SB 200 hits the House.

Stephens dismissed reports that the amendment was in response to Tea Party complaints, or that she was doing an “about-face” on the issue. The amendment is not inconsistent with her previous positions, she said, pointing to an opt-out bill on the Affordable Care Act that she is sponsoring with Rep. B.J. Nikkel, R-Loveland.

The request for the amendment came in part from Senate Republicans, she explained, who want clarity on the opt-out issue; and for her it is a matter of states’ rights.

She also supports the idea, contained in the Mitchell amendment, that would require the state to avoid federal funding for the exchanges. Federal dollars come with strings, Stephens said, and it’s a “problem if we don’t have a clear vision on the exchanges.” Applying for federal grants is probably premature, she said, preferring that the board dictate the direction of how the exchanges will be set up first. “I’m seeking private answers from private sources,” she said.

As to the Tea Party complaints, Stephens said they are concerned with setting up another bureaucracy, but she believes what will result is a “brain trust of experts on health care” with the perspective of a pro-market approach. “The idea of exchanges is a viable option for small business. To the naysayers, if you have a better solution, please let me know.”

“I’m committed to continue talking” with Boyd and representatives from the governor’s office, Stephens said. “We have a good product…we’ll keep working at it.”

In a press conference last month, Stephens trotted out several business leaders to show their support, including Gagliardi. He said this week NFIB is “firmly behind the bill as introduced… We would support it to get it passed [because] not passing the bill will do more damage than if it passes with the amendment or without it,” he said. “If we don’t pass an exchange bill now, we’re out of time. We don’t have time to run another bill and have the framework and governance in place by 2013, and once we pass that deadline, the federal government has the right to come in with the one-size-fits-all exchange.”

Negotiations between Boyd and Stephens have not resumed since the human services committee hearing, Boyd told The Statesman this week. When it gets to the House it’s Stephens’ bill to maneuver through the process, Boyd said, but she is not willing to compromise on the Stephens amendment. “That amendment is not something I can ever accept,” she said.

“If [the amendment] were to pass it would assume the whole Legislature is in support of pulling out of the federal health care law,” Boyd said.

Stephens said she understands that she’s working with people who support the federal legislation, but hopes that the end product is a Colorado-centric model. But if federal health care reform stays in law, Stephens said she hopes the bill could have some “protective measures” built into it.