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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The bill would allow Colorado to opt out of federal healthcare legislation by joining an interstate compact—an agreement Colorado would enter into with other states allowing for the opt-out if Congress approved the compact.

Republican House Majority LeaderAmy Stephens, of Monument, Majority Whip B.J. Nikkel, of Loveland, and Senate Republican Minority Leader Mike Kopp, of Littleton, say they are sponsoring this legislation to preserve Coloradans’ individual liberty and control over health-care decisions.

Small business employers who cannot afford health insurance for their employees under the group market but want to provide some money for their employees to purchase a health insurance plan on their own, can do so under a recent ruling by Colorado’s Division of Insurance. Sen. Keith King, R-Colorado Springs,  wants the ruling secured by law. His bill, Senate Bill 19, would do so.

“We need to find a way to insure more people,” said King. “This bill provides an alternative for small business employers to contribute toward an employee’s health insurance.”

Under the ruling, employers that don’t offer health plans and have fewer than 50 employees can contribute any amount of money, as long as it is distributed equally, into an employee’s Health Retirement Account. The HRA funds can then be used by an employee to purchase a health insurance premium or any other qualifying medical expenses.  The money stays with the employee from year to year, much like an IRA account.

Tony Gagliardi, speaking for the Colorado chapter of National Federation of Independent Business, said small businesses welcome the opportunity to be able to afford some coverage for their employees.

“It’s another alternative or option for both employers and employees to gain access to health insurance,” said Gagliardi. “We’ve been trying a long time to get more people covered. This bill is one mechanism to help them do so.”

Speaking in opposition to the measure, A.W. Schnellbacher, a volunteer with the AARP , said his organization was concerned that gravitation toward health insurance plans outside of the group market would prove detrimental.

“This could destroy the group market,” said Schnellbacher. “People will be shifted from the small group market to the individual market, where there will be cherry picking and lemon dropping.”

Voting against the measure was Sen. Morgan Carroll, D-Aurora who tried unsuccessfully to require a review in a few years to see if the HRA approach works.

“Any experimentation with a health insurance market that is volatile and changing without an evaluation process in place is not something I can support,” Carroll said.

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A coalition of organizations housed under the umbrella of the “All Kids Covered Initiative” organized the event in recognition of the 106,000 children who have been insured through Medicaid and CHP+ since Ritter took office in January of 2007.

Ritter said that acquiring health insurance for children should not be a difficult task.

“By strengthening health coverage for children, we are doing the right thing for our youngest citizens and for Colorado,” said Ritter. “We still have more work to do. We need to make it as easy for children in Colorado to get health insurance as it is for them to check out a library book.”

Joan Henneberry, the executive director of the Colorado Department of Health Care Policy and Financing, said that she agrees with Ritter that more can be done for the thousands of kids in Colorado that still lack health insurance.

“Unlike many health problems facing kids in our country today, a lack of coverage is something we can collectively solve,” said Henneberry. “We are making real progress. It’s time to finish the job.”

The GOP’s Rep. Cindy Acree, of Aurora, said that getting children covered is only half of the equation. Acree said inflexible government health insurance policies, such as prohibiting consumers from buying cheaper health plans across state lines, tie the hands of families that may otherwise be able to afford insurance on their own.

She also noted that just recently, the governor had to temporarily withhold payments to Medicaid providers due to unavoidable budget constraints.

“We have a huge problem with making sure that Medicaid is functional,” said Acree. “Providers weren’t getting paid. That doesn’t help us to get doctors to continue to take Medicaid patients. If we had a truly competitive market that allowed people to buy across state lines, some of those families wouldn’t need the safety net of Medicaid.”

Acree said that two bills that she sponsored this past legislative session, which the governor signed, were designed to help people enroll in Medicaid programs and to keep costs down. House Bill 1041 authorizes Henneberry’s department to create a universal application that makes it easier for families seeking waivers under Medicaid to allow home- and community-based services for their children. House Bill 1029 directs the department to negotiate low-cost agreements with suppliers of durable medical equipment and medical supplies for persons receiving public medical benefits.

However, Acree also said that despite the strides made in enrollment, bigger problems may lie ahead that are more formidable than delayed payments to providers.

“We’re moving in the right direction but it’s going to be counter-productive, particularly in light of the federal health-care reform, which is going to cost the state billions of dollars,” said Acree.  “We can get kids on the list, but if they can’t get services, we still haven’t solved the problem.”

The health insurance program is paid for both by premiums–which range from as little as $120 per month for a nonsmoker under 18, to $806 a month for a 64-year-old smoker–and by a $90 million subsidy from the federal government. The subsidy is intended to cover the difference between the premiums paid by individuals and the actual cost of coverage for those with pre-existing conditions.

To qualify for the program an individual must have a pre-existing medical condition, must have been denied coverage for that condition, and must have been uninsured for at least six months.  The federal subsidy is a portion of some $5 billion allocated nationally under the Patient Protection and Affordability Act of 2010. The program is intended to help bridge the gap until 2014, when private health insurance companies will be required to provide coverage to those with pre-existing conditions.

Ritter said that the program will provide much-needed relief for Coloradans who are currently deemed too costly to insure.

“Colorado is proud to announce this first and important step in national health care reform,” said Ritter. “This plan will offer tremendous relief to thousands of our citizens who have struggled to find affordable health insurance.”

House Republican Rep. Cindy Acree, of Aurora, said today that she applauds people being able to purchase health insurance  but has reservations about whether the program truly addresses the problem of hard-to-insure individuals. And she questioned the sustainability of the program given that it requires a federal subsidy to keep it afloat.

“My biggest concern with the state’s approach, while I do think it’s important that we address health care reform, is that we will eventually need state money to subsidize it,” said Acree.  “We need to stick with free-market solutions, such as allowing people to shop for plans across state lines that give people more options.  When the state option is the only option—a single-payer system—there are no options.”

The program, Getting US Covered, will be administered by Rocky Mountain Health Plans, a Colorado-based nonprofit headquartered in Grand Junction, and in partnership with Cover Colorado, under a contract with the federal Department of Health and Human Services.

“They (the doctors) want open discussion with the patient, but they’ve been told by lawyers, ‘Don’t you dare,’ which has created a culture of fear rather than openness,” said Riesberg.

Riesberg’s House Bill 1283, heard today in the House Judiciary Committee, would throw open the doors of communication; it first needs to get final approval next week when the committee votes on the measure. Still pending are  several amendments to the bill requested by the Colorado Trial Lawyers Association.  The bill has already been approved by the House Health and Human Services  Committee, which is chaired by Riesberg.

Colorado Medical Society President Mark Laitos told the panel that the medical profession wants the reform to enable it to explore other options in helping injured patients, to learn from human and systems errors, and to create a safer health-care system overall.  Litigation does little to foster these goals, according to Laitos.

“Medical liability litigation doesn’t bring about a safer system that reduces the potential for error or unanticipated outcomes. It doesn’t help us learn from mistakes,” said Laitos.

“You can’t fix what went wrong if you are afraid that even acknowledging it and acting to fix it can be used against you in court.”

Most of the House Judiciary panel members, themselves attorneys, expressed support for the intent of the bill, but some had reservations about its potential legal implications.  Committee Chair Rep. Claire Levy, D-Boulder, questioned why doctors should enjoy communication protections under the law that other professions don’t have.

“No other profession gets this kind of incentive in order to have this kind of relationship with their client,” said Levy.

Echoing Levy’s concerns, Natalie Brown, an attorney who spoke on behalf of the Colorado Trial Lawyers Association, said openness alone isn’t enough for evidence to be admissible in a court proceeding.

“Open communication means nothing without truthfulness,” said Brown.

Brown said while open communication could foster a better outcome for the patient and the medical professional, litigation should remain a viable option.

“It (communication) should be an option along with the judicial system. We don’t want it to be an alternative to the judicial system,” said Brown.

Yet, an attorney siding with the Colorado Medical Society, Kari Hershey, took issue with Brown’s insistence on including the “truthfulness” language, saying it would only shut the door on open communication because any discrepancy could be construed as “untruthful”.

“Fearful that they are going to be involved in years and years of litigation, doctors will be afraid to speak freely about what happened if their words are going to be used against them if new light is shed on the situation after the fact,” said Hershey.  “This language will encourage litigation, and you may be providing a road map for someone to sue you.”

Riesberg said nothing in the measure will negate the ability of anyone to pursue a lawsuit if warranted and that the same standards of care must be met by the medical profession but perhaps, with the passage of the bill, patients will be able to get something they desire more than litigation.

“Patients are asking, ‘Will someone just please tell me what happened?’ We wrote this bill to take some steps in the right direction,” said Riesberg.  “We are moving from nowhere to somewhere. I don’t speak doctor language and I don’t speak lawyer language, but I can speak for patients.”

House Bill 1160 expands current law to allow small-group and individual health-care markets to offer wellness incentive programs in exchange for a discount on insurance premiums that larger group markets, self-funded and government plans are already allowed to offer. Under the measure, an additional discount could also be allowed for individuals who actually participate in a wellness program.

Yet, Kelli Fritts, Colorado associate director for the American Association of Retired Persons, contended the bill is not about wellness programs but rather is another way for insurance companies to play gatekeeper. Fritts said the measure will exacerbate a market that needs more healthy people to join to stave off rising premiums.

“This bill is a way to segment the health insurance market—to cherry pick and lemon drop,” said Fritts.  “The goal that AARP is seeking is to bring everyone into the pool and this bill doesn’t bring everyone into the pool.”

House Sponsors of the bill, Rep. Joe Rice, D-Littleton, and Rep. Amy Stephens, R-Monument, say the proposal simply provides an incentive that creates a win-win for both the insured and the insurance company.

“We know that participation in an exercise program will reduce risk and reduce cost–which is where the self-interest of the insurance company comes in,” said Rice. “In order to induce people to (participate),  they are willing to give the discount.”

Wellness programs can include things such as smoking-cessation classes, gym memberships or nutrition programs that are voluntary for the insured, but the financial incentive, said Rice, is key.

“When you say, ‘Here’s an incentive,’ some people will participate that don’t now.  It’s good for their own health, but it kind of becomes a part of the office culture or in your own mind when participating in these programs,” said Rice

The market that the AARP is concerned about is the 50-to-65 year-olds who are too young for Medicare but old enough to have pre-existing conditions or emerging health needs.  The bottom line, said Fritts, is that financial incentives based on health outcomes should not be tied to premiums.

“We support community ratings where everyone is paying the same rate regardless of health status and claims history.  If the industry is given the ability to underwrite–or set the criteria—based on wellness programs the losers will be older people,” said Fritts.

The bill is scheduled for debate by the full House as early as Tuesday.

The proposal passed, but only after a lively discussion on whether men or women ultimately get the short end of the stick from the insurance industry.

“The disparity in the cost of health insurance between men and women is unacceptable, and correcting this inequity should be one of our top priorities,” said Sen. Gail Schwartz, D-Snowmass Village, who introduced House Bill 1008 in the Senate alongside Sen. Morgan Carroll, D-Aurora.

Flying in from Washington D.C. to testify for the bill before the Senate Health and Human Services Committee, Lisa Codispoti from the National Women’s Law Center said the bill is needed because of the tenuous status of  national health reform, a pending version of which also would ban gender-based rating for health coverage.

“Women and men of Colorado should not have to wait on Congress to remedy this harmful and discriminatory practice,” said Codispoti.

Skeptics of the legislation, however, have noted that women in key age groups simply are more expensive to insure given their health-care needs, and disparities in rates reflect that reality.

Under questioning by the committee’s Sen. Shawn Mitchell, R-Broomfield, Codispoti acknowledged that there is  indeed a statistical difference between men’s and women’s health-care needs. However, she said the statistics are not fair to the individual.

“It is true that women throughout their lifetime do use more health care services than men, but what we find troubling about gender rating is that it makes an assumption that because you belong to a particular group that you will use more health care services,” Codispoti said. She also said rates charged to women varied greatly from state to state and policy to policy.

Sen. David Schultheis, R-Colorado Springs, said that dynamic also reflects market realities.

“We should allow the free market to find the price based on it’s own criteria … this is not the Soviet Union here,” said Schultheis.

Schultheis contended the bill would discriminate in reverse.

“What you’re doing is discriminating against men, and that’s not fair.  Why should men have to pay a higher premium when on balance they require less health care  … over their lifetime?” asked Schultheis.

Carroll contered that in a truly merit-based system, being gender-blind is more fair because it leaves it up to claims history and health status and that to add anything beyond that is a gender surcharge.

“Under this bill anyone that uses more will pay more and anyone that uses less will pay less,” said Carroll.

Erin Benett, the Colorado organizer of 9 to 5, the National Organization of Working Women, said the status quo is flat unfair.

“No one should be able to charge a person more for a product simply because of gender. Being a woman is not a pre-existing condition,” said Bennett.

Mitchell pressed Benett on her premise that gender should not be a factor in determining the price of an insurance product.

“Should auto insurance companies be allowed to charge more for boys than girls?” asked Mitchell, in reference to the much higher rates that are applied to the policies of teen-age male drivers than to teen-age female drivers.

Mitchell nevertheless was the lone Republican joining the Democrats on the committee in voting for the bill, saying that he will now consider introducing a bill that prohibits gender discrimination for auto insurance and that he anticipates their support.  The other two men on the committee, both Republicans, voted against the bill.

Several state lawmakers and others spoke at the protest promoted by the Golden-based free-market think tank Independence Institute. Independence President Jon Caldara said he hopes the rally will send a clear message to Gov. Bill Ritter and to the legislature that Coloradans want the right to opt out of key provisions in the sweeping health-care bill currently making its way through Congress. It’s also a message that Caldara says he will take to the voters, in the form of a citizens initiative, if the governor and state legislators don’t act to preserve Coloado’s autonomy over health care.

“It is our goal to make Colorado a sanctuary state for health care,” said Caldara, who on Friday began the process of putting a proposal on the ballot in November that would let voters decide if they want to exempt Colorado from the mandates for health-care coverage proposed in the federal legislation.

The ballot initiative asks voters to approve a constitutional amendment that would give Coloradans the right to choose whether or not to purchase health insurance; protect their ability to purchase private insurance, and  allow people to purchase health insurance from another state.

While the gathering drew several Republican lawmakers who turned out in support, a Democratic member of the legislature reached for comment said Caldara is being disingenuous by framing the initiative as a right to choose when people who are being dropped from health coverage don’t have the freedom to choose anything.

“Call it for what it is. If you are opposing reform then just say so,” said Sen. Morgan Carroll, D-Aurora, who sits on the Senate Health and Human Services Committee. “Frankly, I think it’s a cynical name game to pretend that simply thwarting health care is somehow a freedom of choice.”

Another Democrat who said she supports even more far-reaching change than that under consideration in Congress also gave today’s rally and the initiative a thumbs-down.

“We need to do something in this country,  and I am in favor of single-payer national health care reform—so I would not support this initiative at all,”  said Rep. Sara Gagliardi, D-Arvada, who is vice chair of the House Health and Human Services Committee.

Yet, the Republicans who addressed the rally contended that the costly and heavy-handed reform that congressional Democrats and President Obama have in mind would do far more harm than good to patients as well as their providers.

Republican Rep. Cindy Acree, of Aurora, said Coloradans should be able to choose the healthcare they want, and she said health care decisions should be made at the local level.

“We cannot afford the kind of health care that Washington is trying to impose on this state,” Acree said. “We can do it so much better at the local level.”

Neurosurgeon Sanat Dixit told protesters that his fellow physicians are very concerned about their ability under the congressional health-care bill to practice the kind of medicine that produces the best outcome for their patients.

“What I think is paramount in all this is that the patient (must be) empowered and not the federal government,” Dixit said.  “The reform they’re proposing to enact is not patient-centric; its bureaucratic-centric, and that’s unacceptable.”

The GOP’s Sen. Shawn Mitchell, of Broomfield, exhorted the crowd to make their voices heard in Washington.

“We need to tell the federal government that enough is enough and too much is too much,” Mitchell said.

Acree agreed that reform is necessary but said the omnibus bill backed by the Obama administration would make a bad situation worse.

“We do need to fix a broken system, but we need to preserve our rights as a state to determine what’s best for our families in Colorado,” Acree said.

Caldara’s initiative still has several procedural hurdles to clear before it can be placed on the ballot in November.

(The Colorado News Agency is a nonpartisan, nonprofit project of the Independence Institute.)