2018 Legislation in Review Analyzing Key Health Policy Trends MAY 2018 CHI Bills Watched by Primary Topic Area: 2018 Session by the Numbers Aging: 5 Behavioral Health: 27 Bills ALL-TIME RECORD Budget and Fiscal Policy: 9 721introduced 738 Contraception and Abortion: 4 BILLS eHealth and Technology: 3 INTRODUCED 441 280 IN 2003 in the House in the Senate Environmental Health: 8 Firearms: 4 Freestanding EDs: 4 423 Bills became law Hospitals: 2 59 percent success rate Housing and Health: 3 Just short of the 2017 session’s success rate of 62 percent Insurance and Health Costs: 9 Licensing and Scope of Practice: 13 9 Vetoes 135 The most in Governor Bills killed in State Marijuana and Tobacco: 14 John Hickenlooper's Affairs committees Medicaid: 7 eight years in office (40 House, 95 Senate) Pharmaceuticals: 12 Health bills Health bills Public Health: 5 watched by 70 became law 146 CHI in 2018 (48 percent success rate ) Miscellaneous: 17 2 Legislators are used to 1. Opioid Bills Steal a Win Five of the six bills from a 2017 interim committee charged with bare-knuckled political fights, addressing the substance use epidemic made it to the governor’s desk. but this year was something else. Despite the failure of a bill to allow a supervised drug injection site, this was the biggest health policy success story of the session. For the first time in more than a century, the House of Representatives expelled one of its members. He had 2. Transparency Push Trips Up been accused of sexually harassing several women, Legislators finally found some consensus regarding greater price including a House colleague. A senator accused of transparency at freestanding emergency departments, but every sexual harassment survived an expulsion vote. Four other major pro-transparency bill related to health — from drug pricing other legislators faced harassment complaints. The to hospital financial reporting — failed this session. resulting tension strained the personal relationships 3. Still Struggling with Cost Control that lawmakers depend upon to do the state’s While we once again saw attempts to rein in insurance cost growth, business. every notable effort failed. But bills focused on reinsurance, premium Even so, legislators made headway on top-tier issues subsidies and geographic rating regions kept the conversation front that had vexed them in past sessions. They funded and center and may position the General Assembly to enact changes in construction of rural broadband lines, and they added the near future. money to the transportation budget — though it is short 4. Modest Progress on Mental Health of what’s needed to repair Colorado’s highways. Legislators considered many bills focused on mental health and worked Health bills did not fare as well. The exceptions were together to take some promising steps. But politics and philosophical measures that responded to the high-profile drug disagreements derailed several suicide prevention measures. overdose crisis. Some bills addressing mental health — 5. Heated Battles Over Environmental Health especially among jail inmates — also succeeded. But Environmental health, especially climate change and oil and gas multiple attempts to address the price of health care issues, is increasingly in the spotlight at the Capitol. With the exception and insurance were brushed back. of a measure updating the Governor’s Energy Office, no bills tackling Here are the five health policy themes the Colorado this topic passed in 2018, but the issue is sure to be back next year — Health Institute identified in the 2018 legislative session. and hotter than ever. 3 A CLOUD OVER THE CAPITOL In addition to election-year politics, legislators were dogged throughout the session by the distractions and tension resulting from sexual harassment allegations. Members of both parties and both chambers were accused, and independent investigations substantiated many of the accusers’ claims. Things came to a head with two votes on expelling legislators. One was successful, the other was not. Members of the House voted on March 2 to kick out Rep. Steve Lebsock (D-Thornton), who faced credible accusations of sexual harassment and retaliation against several women. A fellow lawmaker was one of CBS the accusers. Going into the floor debate, Democrats Former Rep. Steve Lebsock (D-Thornton) speaks during his March expulsion didn’t believe they had enough support to expel him. debate at the State Capitol. But after seven hours of emotional testimony, they were joined by 16 of the 25 Republicans present in her leadership position in March — cited frustration voting to remove him from office, easily clearing the throughout the session with the refusal of Senate 44-vote hurdle. President Kevin Grantham (R-Cañon City) to discipline Republican senators accused of sexual harassment, Democrats — including Senate Minority Leader especially Sen. Randy Baumgardner (R-Hot Sulphur Lucia Guzman of Denver, who abruptly resigned Springs). But Grantham surprised legislators on April 2 4 when he announced that the Senate would debate and vote on Baumgardner’s expulsion that evening. Twenty-four votes were needed to remove him, and the move failed 17-17. Baumgardner was later Sen. Randy stripped of his committee Baumgardner positions by leadership. The discomfort and frustration went beyond legislators. An outside review of the atmosphere at the Capitol found that one-third of the 500 Sonya Doctorian/Special to CHI or so people surveyed have seen or experienced harassment there, but only a small fraction Capitol Discord: The Toll of 2018 said they would feel comfortable reporting it. In response, a bipartisan committee of legislative Legislator leaves her party prior to session. leaders recommended that a summer working group look into the issue rather than making Legislator resigns her leadership position during session. changes before the session ended. Legislator expelled in House, Several lawmakers, including Reps. Jon Becker and switches parties moments before. (R-Fort Morgan) and Yeulin Willett (R-Grand Junction), have decided not to seek reelection 1 Legislator survives expulsion vote in Senate, this fall, with the negativity at the Capitol but is later stripped of committee assignments. seemingly a major driver of their decisions. Legislators formally accused of sexual harassment. 5 THE BUDGET Legislators enjoyed something in their 2018 budget they rarely get: options. The General Fund grew by $1.3 billion over the previous year’s level, the most robust growth in a decade. Health care, however, largely missed out on the windfall. an increase in the per capita cost of covering enrollees, The legislature followed Gov. John Hickenlooper’s wishes according to the legislature’s budget summary. The to spend most of the new money on three big items: projected growth in these two areas is responsible for most K-12 schools, transportation and the Public Employees of the cost increase. Retirement Association (PERA). For the second straight year, the culture war over public No one had proposed any major health care initiative health remained in a state of truce. There were no serious that required tax money, so health programs mostly attempts to defund immunizations, contraception maintained the status quo. One partial exception is the programs, health surveys or school-based health centers. approval of an inpatient substance use treatment benefit Conservative Republicans had targeted those topics as in Medicaid, but the biggest costs for that program won’t recently as 2017. arrive until at least two years from now. Legislators also set Two bills from the Joint Budget Committee are relevant to aside $6.5 million for other substance use legislation (see health policy: pages 10-11). • House Bill (HB) 1322: 2018-19 Long Appropriations The Department of Health Care Policy and Financing Act. This bill, coming in at more than 600 pages, sets the (HCPF), which runs Medicaid, will get a modest 2.5 percent budget for all state agencies through June 2019. increase, bringing its total budget to $10.1 billion and keeping it the state’s largest agency. • HB 1327: All Payer Claims Database. The bill gives an Despite a recent drop in Medicaid enrollment — down to important new revenue source to the insurance claims 1,278,000 in April — the department predicts enrollment will database by setting aside $1.5 million from the General grow to 1,350,000 for the 2018-19 budget year. Meanwhile, Fund and another $1 million in federal money. The database Medicaid members are getting older, which is driving had relied on grant funding that is about to expire. 6 Fiscal Year 2018-19 Budget FY 2018-19 Total Funds FY 2018-19 General Fund Total: $30.4 Billion Total: $11.4 Billion All Other Health Care All Other Health Care Departments* Policy and Departments* Policy and 20.0% Financing 23.1% Financing ($2.3B) 33.4% ($7.0B) 25.4% ($10.1B) ($2.9B) Public Health and Public Health and Environment Environment 0.4% 1.9% ($51M) ($581M) Human Services Human Services 8.5% 7.2% ($972M) ($2.2B) Higher Education 8.8% Education Higher Education Education ($999M) 19.4% 15.0% 36.9% ($5.9B) ($4.6B) ($4.2B) Source: FY 2018-19 Long Bill (House Bill 1322) and Long Bill Narrative. *Includes the following departments: Treasury, Public Safety, Local Affairs, Revenue, Natural Resources, Military and Veterans Affairs, Judicial, Corrections, Transportation, Governor, Personnel and Administration, Labor and Employment, Regulatory Agencies, Law, Agriculture, Legislature and State. 7 WAITING FOR 2019 The state Capitol’s three main power centers have existed in an uneasy balance over the past four years. Republicans hold a one-seat majority in the Senate, Democrats run the House, and Hickenlooper, a business-friendly Democrat, occupies the state’s top office. At least one of those power centers will change after the November election. Hickenlooper is term-limited A November victory by any and will leave after eight years.