Democratic House Minority Leader Mark Ferrandino, of Denver, is asking for bipartisan support for the proposal.

“Democrats are here to say we want to partner with Republicans, the administration and providers to find ways to deal with our Medicaid budget,” said Ferrandino.

Rep. Dave Young, D-Greeley, a sponsor of the proposed legislation, said the economy and a recent push toward allowing more people to qualify for the program are the driving forces behind the new payment method.

“Colorado families are still suffering from the aftereffects of the Great Recession and thus the Medicaid rolls continue to grow,” said Young. “Expanded access to care is simply unsustainable without changes in how states deliver and pay for care.”

The proposed bill asks health care providers to partner with the Colorado Department of Health and Environment in creating pilot programs restructuring the payment system. The goal, said Young, is to incentivize better outcomes for Medicaid patients and to save the state money.

Currently doctors are paid on a fee-for-service basis, with payments made to the provider for each medical procedure.  A global payment, by contrast, would make payments based on how many patients are seen and services rendered effectively.

“The fee-for-service model is outdated,” said, Young. “Moving toward a global-payment, integrated-delivery system will ensure that physicians are getting incentives to provide quality of care rather than quantity of care.”

Yet, Joint Budget Committee Chair Cheri Gerou, a Republican House member from Evergreen, said she’s more comfortable with a medical provider-initiated proposal rather than “another government mandate.”

“The stresses placed on our medical providers to care for Medicaid populations are quite complex,” said Gerou.

Rep. Jon Becker, R- Fort Morgan, also a member of the budget committee, said changes to the way providers are paid for Medicaid patients should be thoroughly examined before any decisions are made.

“These doctors treating these patients have been harmed enough already,” said Becker. “If we keep cutting back on payments, pretty soon, we’ll be losing providers and patients will suffer.”

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The Legislative Health Benefit Exchange Implementation Review Committee oversees the work of the Health Benefit Exchange Board, which is in the process of applying for federal grant money for the exchange.  A previous grant application was thwarted when the panel could not reach consensus on the terms of the application.

This go-around, the grant application lacks specificity projecting participation in the exchange because of  uncertainties hovering over key components of the reform act, such as the required buy-in by all Americans.

Gretchen Hammer, Executive Director of the Colorado Coalition for the Medically Underserved and Interim Chair of the Colorado Health Benefit Exchange Board, told the legislative panel that work on building the exchange can still remain very much in motion but that “specific pieces of how that functionality will work are in question.”

“How the exchange will function is to some extent in question because of the movement of the federal lawsuit through the United States Supreme Court,” said Hammer.

Despite federal uncertainties,  Rep. Beth McCann, D-Denver, said the grant application should incorporate eligibility scenarios as they are integral to the success of the exchange.

“The subsidies are a fundamental requirement of the success of the exchange whether it is part of the federal law or state law,” said McCann. “It seems to me that eligibility is tied up with subsidies because if they can’t get the subsidy, they may or may not be able to enroll.”

Yet, Rep. Bob Gardner, R-Colorado Springs said it’s imperative to maintain the ability of the exchange to move in either direction pending the decision of the Supreme Court.

“We don’t want this grant proposal to presuppose the outcome of that litigation,” said Gardner.

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Seven years ago, Colorado voters approved Amendment 35,  allowing for the taxation of  tobacco products to fund early detection and treatment of cancer, cardiovascular and pulmonary diseases; comprehensive primary care; children’s health care, and prevention and cessation programs.  A provision of the measure allowed the state to redirect those dollars when a fiscal emergency is declared. In each of the last several years, just such an emergency has been declared amid back-to-back budget woes.

This year, says McNulty, the tobacco dollars will be “off-the-table” when it comes to budget negotiations next year as far as the House Republicans are concerned.

“We all recognize that the state has struggled over the past few years,” said McNulty. “But the programs that receive Amendment 35 funding have paid more than their fair share to balance the budget.  It is time these funds go where our state constitution directs them to go—to advance the health and well-being of Coloradans.”

House Health and Environment Committee Chair Ken Summers, R-Lakewood, a cancer survivor, said he agrees wholeheartedly.

“Cancer is something that has touched everyone.  I’ve personally lost several family members and even recently a friend to cancer,” said Summers.

Yet, some lawmakers across the aisle say the Republicans’ pledge on tobacco taxes might turn out to be more than they can deliver. Directing the money toward its intended use—cancer treatment and prevention—rather than shoring up a sagging budget would be ideal, says Democratic Senate President Pro Tem Betty Boyd, of Lakewood, but as a practical matter, cannot always be done.

“Sometimes we get stuck between a rock and a hard place,” said Boyd. “When two good things are equally needed, it’s difficult to choose. Unfortunately, it’s a choice that we are forced to make. As painful as it is, we have to balance the budget.”

Boyd says she has seen up close the devastating blow to programs that would normally be receiving the money, but she has also seen the realities of balancing a budget with gaping holes.

“I hate the fact that the grant programs aren’t getting the funds they need—they’re losing a large amount of money—but when we get to the budget, it’s always a matter of negotiation,” said Boyd. “In a perfect world we would fund the cancer programs no matter what, but we’ve got to be pragmatic.”

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Senate Bill 200, sponsored by Senate President Pro Tem Betty Boyd D-Lakewood, and House Majority Leader Amy Stephens, R-Monument, creates a framework for health-benefit exchanges, to be formed as prescribed by the federal Health Care Reform Act.

Some vocal constituents of Stephens had charged that the measure plays into the hands of the federal health-care reform, which conservative and Republican critics have dubbed Obamacare. Some aspects of the federal laws are being challenged in the courts.

Yet, Stephens said it is crucial that, given the likelihood of the exchanges coming to fruition, they should reflect Colorado values.

“SB 200 gives Colorado the ability to focus on what is important to Colorado in the design and implementation of health-benefit exchanges,” said Stephens. “I applaud the business community, the health community and the consumer community for supporting this important legislation. Now the work of designing an exchange that works for Colorado begins.”

Among those attending the bill signing at St. Anthony’s Hospital in Lakewood were business groups and consumer advocates that supported the measure’s passage.  Hickenlooper said the support was well placed.

“This legislation moves Colorado forward with one voice,” said Hickenlooper. “The health exchange will allow individuals and small businesses to choose among easy-to-compare affordable health-care options. It will give Coloradans more control, quality choices and better protections when buying insurance.”

Sen. Nancy Spence, R-Centennial, who was not in attendance at Wednesday’s signing, said she did not support SB 200 because the larger context of  health-care reform is not yet a settled question.  The exchanges, said Spence, are a good idea but the time is not quite right.

“Our No. 1 priority right now is to do away with Obamacare, or look for ways to opt-out , and then design these exchanges in a way that is beneficial for Colorado,” said Spence.

Still, Boyd said she has been impressed with the overall cooperation of those involved in crafting the legislation.

“I have never seen such a broad-based coalition of support for a piece of health care legislation,” said Boyd. “I appreciate how business groups, consumer advocates, insurers and healthcare providers came together to support this uniquely Colorado solution to help individuals and small businesses purchase health coverage.”

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Republicans in both chambers overwhelmingly supported the proposal in the legislature, casting it as a necessary step in budget balancing. However, it has divided Democrats, who are hearing vocal opposition from key constituent groups.

The measure, Senate Bill 213, sponsored by Sens. Mary Hodge, D-Brighton, Pat Steadman, D-Denver, and Kent Lambert, R-Colorado Springs; and Reps. Cheri Gerou, R-Evergreen, Jon Becker, R-Fort Morgan, and Mark Ferrandino, D-Denver—all serving on the Joint Budget Committee—makes changes to the Colorado Children’s Health Plan, or CHP. The JBC members said they brought the bill forward as a reasonable cost-saving measure to help balance a beleaguered budget.

The $25 annual enrollment fee will continue to apply to families between 150 percent to 205 percent of the federal poverty level, but families with 205-250 percent of the poverty level—the maximum allowed for the program—will now pay a monthly fee. The proposed fee would be $20 for the first child and an additional $10 per month for each additional child up to a maximum of $50 per month. Annual income for an affected family of four is approximately $40-56 thousand.

The Colorado Children’s Campaign has been publicly asking for the governor to veto the measure, stating in a press release, “….fiscal analysis shows this policy will cost, not save, the state money.  Furthermore, we know cost sharing of this kind causes kids who need coverage to drop out of the program and will add to the administrative burden for the state.”

During Senate debate on the bill, Steadman told his Democratic colleagues—13 of 21 Democrats wound up voting against the bill—that the imposition of a fee would have minimal effect on those families participating in the program.

“This is not the entire universe of CHP enrollees,” said Steadman. “It’s families that are on the higher end of income thresholds.”

Sen. Irene Aguilar, D-Denver, argued that the fee increase would not bring the promised savings because of projections that an estimated 20 percent of families would drop out of the program given the added cost.

“We’ll end up with more children that are uninsured in our state. That means more children in emergency rooms,” said Aguilar. “This will end up costing us more than we would save.”

Similar arguments carried over to the House when the measure was considered there.

“I fear that it will not bring the returns that we would hope, and it could really harm a lot of our families who cannot afford to pay these premiums,” said Rep. Su Ryden, D-Aurora.

Rep. Daniel Pabon, D-Denver, said the bill’s added strain on household budgets could hurt children, whose health care needs are not only a priority in Colorado but nationally as well.

“As a public policy in the United States of America, we have decided that there are those amongst us who deserve protections….in this case it’s our children,” said Pabon. “This puts the onus of coverage for health care on them (the children) because their parents don’t have the ability to pay the premiums.”

The measure garnered the full support of Senate and House Republicans, who all voted in favor of the proposal. Sen. Greg Brophy, R-Wray, said supporting the bipartisan budget committee’s proposal was not difficult for him.

“This isn’t a hard decision to make,” said Brophy. “It’s time to move forward with the tough choices that we need to make to balance the budget.”

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Lawmaker moves to stop sale of state nursing home in Trinidad

HB-1038–Fail

Lawmaker aims to reconcile land conservation, condemnation

SB-50–Pass

Bill would mandate physical activity for schools kids

HB-1069–Pass

State regulation proposed for blow-up bounce houses

SB-75–Fail

Senators question cost, pace of march toward renewables

SB-71–Fail

Senator says contracting out services could save schools money

SB-79–Fail

Foreclosure assistance bill gets broad bipartisan support

HB-1023–Pass

Bill requiring proof of citizenship to vote dies in committee

SB-18–Fail

Bill to streamline school meds is sent to waiting room

SB-12–Pass

School-trust land to get greater transparency under pending bill

SB-29–Pass

Questions about ballot questions? This bill aims to answer ‘em

HB-1035–Pass

SW Colorado lawmaker says stop raiding severance-tax proceeds

SB-35–Fail

HB-1123–Fail

Liability shield for mountain-biking biz fails in committee

SB-36–Fail

Lawmaker pushes to close loophole in identity theft

HB-1049–Fail

Requiring photo ID to vote wins a round in the House

HB-1003–Fail

Bill lets small employers chip in for individual health coverage

SB-19–Pass

Funding equity proposed for students at private, public colleges

HB-1168–Fail

Panel axes bill rolling back state worksers’ ‘partnership agreements’

SB-38–Fail

Local bicycle bans could hit roadblock at the Capitol

HB-1092–Fail

Dems’ bill would’ ensure state never spends more money than it has

HB-1052–Fail

Most pending reforms to state retirement system likely to die early

SB-76–Pass

SB-74–Fail

HB-1008–Fail

SB-127–Fail

Proposal underscore the ‘public’ in public records

SB-25–Pass

Lawmakers want utility to give the medically impaired a break

SB-87–Pass

Business community shows renewed optimism, clout at legislature

HB-1005–Pass

HB-1109–Pass

HB-1129–Fail

HB-1127–Fail

Panel OK’s bills targeting marketplace fraud, workplace discrimination

SB-72–Fail

SB-68–Fail

Workers with state vehicles won’t have to reimburse for the commute

SB-23–Fail

Coloradans will continue to elect their coroners

HB-1108–Fail

Undocumented students take a step toward in-state tuition

SB-126–Fail

Lawmaker: Let’s take a break from unpopular business tax

HB-1141–Fail

Committee kills effort to cut ‘carbon tax’ from utility bills

HB-1240–Fail

Senate passes youth-concussion bill

SB-40–Pass

House gives nod to one-stop shop to help small business

HB-1209–Pass

Bill would curb new wave of bullies at school

HB-1254–Pass

Regs on naturopaths rejected in committee

HB-1173–Fail

Dems offer bill for tax amnesty, transparency

SB-184–Pass

GOP lawmakers nix mandate, say greener schools come naturally

HB-1204–Fail

Senate votes to give homeowners a hedge against insurers

SB-15–Fail

Small-town rep seeks to keep communities whole amid redistricting

HB-1276–Fail

GOP legislation aims for remake of oil and gas board

HB-1223–Fail

Lawmakers throw a lifeline to homeless youths

HB-1079–Pass

Pending proposal would dump Xcel’s tiered power rates

HB-1271–Fail

House GOP seeks to reinstate spending limit

HB-1280–Fail

Service animal bill approved by Senate

HB-1151–Pass

Bill targeting domestic violence would tag death certificates

HB-1183–Pass

Daylight saving time wins first round

SB-22–Fail

Bill giving ex-cons a second chance draws scrutiny

SB-44–Fail

Unborn-child bill pulled by sponsor

HB-1256–Fail

Panel halts push for ’smart grid’- says private sector is smarter

SB-131–Fail

PERA bill sent back for revisions

HB-1248–Fail

Plan advances to bar felons from school employment

HB-1121–Pass

Local governments still can ding accident victims

HB-1059–Fail

Bid to curb vehicle late fees halted in Senate committee

HB-1084–Fail

Tailpipe testing of vehicles to continue in Larimer, Weld

HB-1082–Fail

Panel says preservationists should yield to property owners

HB-1289–Pass

Dust-up over health-benefit exchanges: ‘good policy, toxic politics?’

SB-200–Pass

McKinley backs owners on conservation easements: ‘A deal’s a deal’

HB-1208–Fail

Boyd’s beer bill moves ahead

SB-194–Fail

Legislative panel: Double-check child-care workers

HB-1145–Pass

Senate OK’s ‘parental involvement policy’ for ailing schools

HB-1126–Pass

Panel OK’s bill giving oil and gas commission a makeover

HB-1223–Fail

Panel agrees to incentives for alt-energy parks

HB-1255–Fail

Committee OK’s measure making PUC more accountable

HB-1222–Fail

Software tax cut said to be a slam dunk for both parties

HB-1293–Pass

Fast-tracked clean-air plan challenged by rival legislation

HB-1291–Pass

SB-236–Fail

SB-237–Fail

Panel nixes municipal elections on local trash collection

HB-1116–Fail

Cab passenger pick-up bill passes Senate

SB-180–Pass

Senators check the couch cushions for spare school funding

SB-1–Fail

SB-109–Fail

Senate panel draws a bead on ag land ‘loophole’

HB-1146–Pass

Lawmakers seek to get unemployment fund back on track

HB-1288–Pass

Roofers say they’re reeling from bad rep – seek

regulation

SB-207–Fail

After a year on hold, ag tax exemption back on track

HB-1005–Pass

Conservation easements: Plan pending to let landowners out of limbo

HB-1300–Pass

Food-sales bill aims to help rural climes – and ‘abgriburia,’ too

SB-258–Fail

Panel throws book at those who spit – on those who help us

HB-1105–Pass

Ag land ‘loophole’ bill goes to Guv

HB-1146–Pass

Businesses would get an ear on the bench under pending bill

HB-1302–Fail

Health care compact proposal wins first round

HB-1273–Fail

Proposal pitches a more effective way to grapple with graffiti

SB-256–Pass

Lawmakers eye easier credit for energy-efficient upgrades

SB-32–Fail

Lawmakers aim to retool former guv’s signature energy agency

HB-1312–Fail

A bill for Jerry’s kids – and fundraising firefighters

SB-270–Fail

Senate updates redistricting map

SB-268–Fail

HB-1319–Fail

State as bail bondsman of last resort? ‘Dog’ says no way

SB-186–Fail

‘Amazon Tax’ on its way out the door?

HB-1318–Fail

Legislation would open roads to off-roaders

HB-1264–Fail

Guv signs budget bill

SB-209–Pass

As Mom’s Day looms, lawmakers eye online flower sales

SB-271–Pass

Funds tapped to help fight state’s wildfires

SB-238—Pass

Legislation lets fest goers stroll with drinks in hand

SB-273—Pass

Lawmakers snip red tape in an assist to business

SB235–Pass

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House Bill 1105, sponsored by Rep. Cindy Acree, R-Aurora, and Sen. Jean White, R-Hayden, would allow for enhanced penalties—doubling the sentence—for assaulting emergency medical care providers in hospitals. Current law already imposes the added penalty when the assault victim is a police officer, emergency medical technician or firefighter.

White said the addition of hospital personnel to the list is not only intuitive but also simply the right thing to do.

“These are the people who are there everyday for us. Why shouldn’t we give them the benefit of elevated protection?” asked White. “This tells people that if you do this, you’re going to jail.”

An amendment was tacked on during the bill’s hearing today in the Senate Judiciary Committee that would give judges discretion when handing out sentences for the assaults that would apply to current emergency responders along with the newly added hospital workers.

Sen. Keith King voted for the bill as amended but not without hesitation due to the amendment added in committee.  King said he was concerned the discretion given to the judge under the amendment would weaken the protection already afforded emergency responders.

“This law protects people who protect us,” said King. “This amendment weakens the protection. We should be sending a strong message that if you spit at someone and say, ‘I have HIV,’ you’re going to be punished more severely for this act of psychological terrorism.”

Jane Barnes of Centura Health told the Judiciary Committee that reports by nurses say that over the last three years, they have been assaulted more than twenty times with bodily fluids. Barnes said that for some public servants, the attacks are all too common.

“Unfortunately, it’s just the way society is moving,” said Barnes.

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“It got a life of its own and people blew it out of proportion,” said Boyd.

The measure, Senate Bill 200, creates a framework for health-benefit exchanges, to be formed as prescribed by the federal Health Care Reform Act.

Much of the outcry over the introduction of the measure came from constituents of its Republican House sponsor, Majority Leader Amy Stephens, of Monument.  Stephens stands by her sponsorship, saying the exchanges are not only a Republican-inspired concept but that they also should be designed by Coloradans.

“If you look at how the Post Office is running, I’m not sure we want the exchanges left up to the federal government,” said Stephens. “The exchanges are a free-market idea that, absent some of the provisions of the federal law, are a good idea.”

Boyd said that despite the firestorm that accompanied SB 200’s introduction, the measure has so far enjoyed considerable bipartisan cooperation.

“We have had incredible agreement and support for this bill,” said Boyd. “Not every provision is loved by everybody, but it was put together in a bipartisan way.”

Stephens concurs with Boyd and said that she is confident that with Coloradans at the helm, the federally required arrangement will ultimately reflect Colorado values.

“We have good health care minds here in Colorado,” said Stephens.

Stephens adds that the  exchanges are something that the business community, which is often the portal through which people get their health insurance, embraces and has been asking for.

“I did it for small businesses who have been asking for a way to provide coverage for their employees,” said Stephens. “Business pays for health insurance and wanted oversight, and they got it with the crafting of this bill.”

Prominent groups representing the business community issued a  prepared statement today addressing the Senate Health and Human Services Committee and the House Health and Environment Committee, expressing satisfaction with the measure.

“The business coalition worked with sponsors to create a bill that provides great access to affordable care while promoting a competitive marketplace that protects private industry jobs, and provides employers with additional affordable choices when considering health benefits for employers,” said the Colorado Association of Commerce and Industry, the Denver Metro Chamber of Commerce, the Colorado Competitive Council, Colorado Concern and the National Federation of Independent Business.

Also supportive of the exchanges is Sen. Irene Aguilar, D- Denver, a physician. Aguilar has a bill of her own, Senate Bill 168, that would create a Colorado health care cooperative, essentially creating a single Colorado health care group that self-administers.  Aguilar says her goal is to see all Coloradans insured.

“The exchanges have the potential to help make things easier for insurance reform,” said Aguilar. “Someone needs to pay for people who get sick, and we need to ask ourselves how we can do that. The exchange gives the small-group markets the same power as large group-markets, making it more affordable.”

Sen. Greg Brophy, R-Wray, says he understands the rhetoric swirling around the measure.

“I can sum it up in four words,” said Brophy. “Good policy, toxic politics.”

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The presentation, sponsored by the Colorado Children’s Immunization Coalition, was delivered to a joint meeting of the House Health and Environment Committee and the Senate Health and Human Services Committee. At the heart of the presentation was author Seth Mnookin, who wrote the book, “The Panic Virus: A story of Science, Medicine, and Fear.”

Mnookin said the book was a result of his own experience as a new parent looking for information on vaccinations.

“I wrote the book because there were two extreme views and not a lot of discourse—with little room for compromise,” said Mnookin.

His book delves into the debate over whether or not vaccinations are a contributing factor to autism along with ailments such as asthma.  Mnookin said science suggests there is no link.  He said in the absence of any conclusive studies showing a connection to autism or other maladies, parents should embrace the merits of inoculation against preventable diseases.

The questions that lawmakers posed to Mnookin were primarily concerning the public policy aspect of balancing the need for public safety and personal autonomy of parents in making decisions for their children based on their own conclusions.

Mnookin indicated that he understood the dilemma, acknowledging that, “people on both sides of the issue that are the most passionate about this are parents that care a lot about their children.”   However the bottom line for Mnookin is that the perils avoided by inoculation outweigh the risks of vaccinations.

Sen. Irene Aguilar, D- Denver, a doctor, said she can understand both sides of the issue but she is not quite ready to write off the skepticism and is hesitant to say vaccinations should be required.

“It’s always hard to try to find good ways to make people do things,” said Aguilar. “It’s still an open-ended question, and I respect that parents have a right to make these decisions, but exposing other people to dangers is not okay, either.”

Still, Sen. Kevin Lundberg, R-Berthoud, said that there is enough anecdotal evidence that may give some parents pause in inoculating their children and that their concerns must be respected.

“The bottom line is that parents still need to be the ultimate decision maker for their children,” said Lundberg.

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House Bill 1173 by Rep. Jim Riesberg, D-Greeley, failed on a party-line vote in the House Health and Environment Committee, with majority Republicans voting to kill the measure. HB1173 would have identified criteria specifying the definition, scope and registration procedure for those who under the title of doctor practice naturopathic medicine.

Currently, the industry is unregulated, with a spectrum of practitioners ranging from consultants to those with a degree from an accredited naturopathic medical school, where the title of doctor is conferred.

Testifying in support of the bill, witness Laura Flanagan shared with the committee what she said can go wrong when trust in a self-titled doctor is misplaced. Her 18-year-old son, a cancer patient, died after 10 days under the care of a self-proclaimed naturopathic doctor. The practitioner had given her son hydrogen peroxide in an IV to treat the cancer.

“We trusted him and believed he was a doctor that could help our son,” said Flanagan. “It helps for people to be held accountable for what they do and what they claim to be.”

Opposing the bill were members of the naturopathic community, many of whom practice without the title of doctor, who say the measure would shut them out.  Kim Green, of the Colorado Citizens for Health Freedom, a consumer group,said the measure would put the naturopathic practitioners they frequent out of business.

“Despite what the bill sponsor says, this would make it illegal for naturopathic practitioners to practice,” said Green. “People who seek out our services would not be able to get the care that they want and need.”

Countered Riesberg, “That’s just not true. Anyone that’s practicing now would be able to continue. They just can’t call themselves doctor.”

Riesberg said his bill could only benefit current practitioners and patients with the added clarity that registration would provide.

“When they use the term doctor, people should know that there is accountability behind the title,” said Riesberg. “Coloradans deserve a broad range of choices, and we should value the term doctor so that it’s only used in Colorado by those who meet the requirements.”

Rep. J. Paul Brown, R-Ignacio, said people should be able to choose naturopathy as an approach to their well-being, but he said he opposed the bill in part because its restrictions on the practice actually also served to legitimize it.

“It may be too soon to go down this path, formally authorizing a non-scientific practice,” Brown said.

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