Final
STAFF SUMMARY OF MEETING

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:03/12/2009
ATTENDANCE
Time:01:34 PM to 05:36 PM
Carroll M.
X
Lundberg
X
Place:SCR 356
Mitchell
X
Morse
*
This Meeting was called to order by
Newell
X
Senator Boyd
Schultheis
X
Tochtrop
X
This Report was prepared by
Boyd
X
Elizabeth Burger
X = Present, E = Excused, A = Absent, * = Present after roll call
Bills Addressed: Action Taken:
Conf 09-State Board of Nursing
HB09-1143
HB09-1061
Favorably Refer to the Full Senate
Amended, Referred to the Committee of the Whole
Amended, Referred to the Committee of the Whole


01:36 PM

Dr. Candace Berardinelli, Curtis Powells, Toni L. Gibbons, and Christopher Dopke, appointees to the State Board of Nursing, discussed their backgrounds and interest in serving on the board. Copies of their resumes and application letters were distributed to the committee (Attachment A). Dr. Berardinelli responded to questions from Senator Tochtrop regarding nursing education programs. The appointees responded to questions from Senator Mitchell regarding the role of the State Board of Nursing and the scope of nursing practice.

(Attachment A can be viewed at State Archives)



















BILL:Conf 09-State Board of Nursing
TIME: 01:48:08 PM
MOVED:Tochtrop
MOTION:Favorably refer the appointments of Candace Berardinelli, Curtis Powells, Toni L. Gibbons, and Christopher C. Dopke to the State Board of Nursing to the full Senate for confirmation. The motion passed on an 8-0 roll call vote.
SECONDED:
VOTE
Carroll M.
Yes
Lundberg
Yes
Mitchell
Yes
Morse
Yes
Newell
Yes
Schultheis
Yes
Tochtrop
Yes
Boyd
Yes
Final YES: 8 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS


01:50 PM -- House Bill 09-1143

Senator Schwartz introduced House Bill 09-1143 and distributed three handouts (Attachments B through D) and amendment L.002 (Attachment E) to the committee. The bill would permit health maintenance organizations (HMOs) to offer limited health benefit plans. Amendment L.002 limits the scope of the bill to counties with under 25,000 residents. In addition, amendment L.002 specifies that HMO limited health benefit plans would be required to cover all health services covered in the small employer group marketplace, but could put an annual cap on benefits. She noted that the limited benefit plans would be regulated by the Division of Insurance. The bill requires that certain disclosures regarding the limited benefit plans be provided to consumers who purchase the products. Senator Schwartz explained that amendment L.002 places a sunset date of two years on the bill's provisions. She stated that in rural areas, insurance options are limited and that the bill is an opportunity to provide basic health care to rural citizens. She stated that such individuals could be counseled into a more comprehensive product in the event that they eventually need more extensive coverage. Senator Schwartz responded to questions from Senator Tochtrop regarding why insurance coverage is less available in rural areas. Various committee member commented on amendment L.002, and its provision that limits benefit plans to counties with 25,000 or fewer residents.

09SenateHHS0312AttachB.pdf 09SenateHHS0312AttachC.pdf

09SenateHHS0312AttachD.pdf 09SenateHHS0312AttachE.pdf








02:13 PM --
Ed Kahn, representing the Colorado Center on Law and Policy, testified in opposition to the bill. He responded to questions from Senator Carroll regarding the premiums of lower benefit plans as compared to the value of the benefits offered through the plans. He responded to questions from Senator Morse regarding whether the coverage offered by limited benefit plans is better than no coverage at all. Mr. Kahn responded to questions from Senator Newell regarding whether possible amendments to the bill would garner his support for the bill.

02:28 PM --
Steve Bieringer, representing the American Diabetes Association, testified in opposition to the bill. He stated that he appreciates the amendments, but that there are fundamental problems with the bill. He stated that the plans will not be adequate for people who exceed the annual cap or for individuals with chronic illness, such as diabetes. He responded to questions from Senator Tochtrop regarding whether allowing HMOs to offer limited benefit plans would cause other insurers to offer less comprehensive plans.

02:36 PM --
Stephen Kopanos, representing Mental Health America, testified in opposition to the bill. He described the costs of untreated mental health illness. He responded to questions from Senator Newell regarding amendment L.002 and whether the coverage offered through limited benefit plans is better than having no coverage.

02:41 PM --
Dr. Bruce Madison, representing the Colorado Medical Society, testified in opposition to the bill. He stated that the fact that consumers must be given disclosures regarding the product indicates that it might not be the best approach. He stated that allowing limited benefit plans to be offered may cause healthy people to leave a group health insurance pool, increasing group rates. Dr. Madison responded to comments from Senator Mitchell regarding the bill's disclosure policies and whether the bill would lead employers to offer health insurance plans with less coverage. Dr. Madison responded to questions from Senator Carroll regarding the benefits offered through limited benefit plans in relation to their cost.

02:54 PM --
Jacqui Kilmer, representing the Colorado AIDS Project and Colorado Organizations Responding to AIDS, spoke in opposition to the bill and distributed a letter of opposition to the bill (Attachment F). She testified that plans that limit coverage for treatments for chronic illness may endanger safety. She stated that many consumers would not understand the disclosures and the extent to which benefits are limited.

09SenateHHS0312AttachF.pdf

03:01 PM --
Lacey Berumen, representing the National Alliance on Mental Illness, testified regarding her personal experience with a limited health benefit plan.

03:04 PM --
Dr. Kajsa Harris, representing the Colorado Academy of Family of Physicians, testified regarding a friend's experience with treatment in the intensive care unit. She described the medical bills that could result if a individual with a limited benefit plan were to require extensive hospitalization.

03:07 PM --
Greg Glischinski, representing AARP, testified in opposition to the bill. He stated that the bill could delay true health care reform in state.












03:10 PM --
Kelly Shanahan, representing the Colorado Consumer Health Insurance, testified that bare bones health insurance plans are a form of underinsurance and do not represent a solution to the lack of health insurance coverage. She distributed letter regarding limited health insurance benefits (Attachment G). She stated that uninsured individuals tend to be sicker than those with insurance, so limited benefit plans are an inadequate solution to access to coverage for those individuals. She asked the committee to postpone consideration of limited benefit plans until the final report on Senate Bill 08-217 is better understood. She responded to questions from Senator Newell regarding treatment available to individuals with cancer if they do not have health insurance and whether a person would be disqualified from charity care programs if he or she had a limited benefit health plan.

09SenateHHS0312AttachG.pdf

03:22 PM --
Donovan O'Dell, representing Handicaps Inc., testified that there is a desire for health care reform. He urged the committee to vote against the bill, and stated that he would not offer a limited benefit plan to his employees. He responded to questions from Senator Newell.

03:27 PM --
Robin Baker, representing the Bell Policy Center, testified that the Bell Policy Center has a neutral position on the bill. She distributed a copy of her testimony to the committee (Attachment H). She testified that the bill has the potential to improve access to health care for some workers, and that nationally, about half of the U.S. population spends very little on health care. She stated that there are substantial disadvantages to the bill, and that a single catastrophic event could be financially devastating to a person with a limited benefit plan.

09SenateHHS0312AttachH.pdf

03:30 PM --
Travis Berry, representing the Colorado Competitive Council, testified in support of the bill. He addressed comments made by previous witnesses that employers may provide less comprehensive coverage to their employees as a result of the bill. Mr. Berry stated the product may not be right for all employers, but that it provides assistance to rural areas of the state. Senator Morse and Mr. Berry discussed whether the limited coverage offered by the plans was better than not having coverage or having coverage through the public health care system. Mr. Berry responded to questions from Senator Carroll regarding which insurance companies are allowed to offer limited benefit plans currently.

03:45 PM --
Vanessa Hannemann, representing the Colorado Association of Health Plans, testified in support of the bill and in support of many of the provisions of amendment L.002. She testified that the bill will help cover more uninsured individuals in Colorado. She responded to questions from Senator Carroll regarding why more insurers are not currently offering limited benefit plans.

03:48 PM --
Jerry McElroy, representing Kaiser Permanente, testified that limited benefit plans are more affordable and are worth consideration. He responded to questions from Senator Carroll regarding why Kaiser Permanente is not available in more areas of the state.











03:54 PM --
Cindy Palmer, representing San Luis Valley HMO, described the impetus for the introduction of the bill and the specific health insurance needs of the San Luis Valley. She described her conversations with health care providers in the region and their support for the bill. She explained that limited benefit plans are available through insurers in the San Luis Valley already. She responded to questions from Senator Carroll regarding the level of reserves San Luis Valley HMO must maintain, the anticipated cost of premiums for the limited benefit plan proposed to be offered by San Luis Valley HMO, and the anticipated levels of coverage through the plan. Ms. Palmer responded that the plan sought to be offered by San Luis Valley HMO would offer all of the same benefits as their standard plan, but that the annual coverage would be limited to $35,000. She further noted that the cost of the plan was anticipated to be $200 a month. She responded to questions from Senator Morse regarding whether employees with more comprehensive plans would drop the coverage in exchange for the limited benefit plan. She stated that based on her information, less than 2 percent of the individuals covered under a limited benefit would incur expenses exceeding a $30,000 cap. She further responded to questions from Senator Carroll about the availability of supplemental coverage and disclosure materials for employers who purchase the plan. Ms. Palmer responded to questions from Senator Schultheis regarding amendment L.002's provision limiting the availability of the plan to counties with less than 25,000 residents.


04:43 PM

Senator Schwartz gave concluding remarks regarding the bill and amendment L.002. She explained the provisions of amendment L.002. Amendment L.002 specifies that the plan is only available to employer groups that have not offered insurance coverage in the past 12 months and individuals who have been uninsured for the past 12 months. The amendment also specifies that the plan may only be offered in counties with a population of not more than 25,000 residents. The committee discussed possible amendments to L.002.
BILL:HB09-1143
TIME: 04:57:41 PM
MOVED:Morse
MOTION:Amend prepared amendment L.002 (Attachment E), line 9, after "employees", add "or all classes of employees". The motion passed without objection.
SECONDED:
VOTE
Carroll M.
Lundberg
Mitchell
Morse
Newell
Schultheis
Tochtrop
Boyd
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection








BILL:HB09-1143
TIME: 04:58:26 PM
MOVED:Newell
MOTION:Adopt prepared amendment L.002 (Attachment E). The motion failed on a 4-4 roll call vote.
SECONDED:
VOTE
Carroll M.
Yes
Lundberg
No
Mitchell
No
Morse
Yes
Newell
Yes
Schultheis
No
Tochtrop
No
Boyd
Yes
Not Final YES: 4 NO: 4 EXC: 0 ABS: 0 FINAL ACTION: TIE


04:59 PM

Senator Carroll distributed amendment L.004 (Attachment I). The amendment specifies that a limited benefit plan must offer at least $30,000 in coverage annually. The amendment also limits the availability of a limited benefit plan to employers who have not offered coverage in the past 12 months.

09SenateHHS0312AttachI.pdf
BILL:HB09-1143
TIME: 04:59:38 PM
MOVED:Carroll M.
MOTION:Adopt prepared amendment L.004 (Attachment I). The motion passed without objection.
SECONDED:
VOTE
Carroll M.
Lundberg
Mitchell
Morse
Newell
Schultheis
Tochtrop
Boyd
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection




BILL:HB09-1143
TIME: 05:05:22 PM
MOVED:Mitchell
MOTION:Moved to reconsider the committee's action on amendment L.002 (Attachment E). The motion passed without objection.
SECONDED:
VOTE
Carroll M.
Lundberg
Mitchell
Morse
Newell
Schultheis
Tochtrop
Boyd
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:HB09-1143
TIME: 05:05:50 PM
MOVED:Newell
MOTION:Adopt prepared amendment L.002 (Attachment E). The motion passed on a 8-0 roll call vote.
SECONDED:
VOTE
Carroll M.
Yes
Lundberg
Yes
Mitchell
Yes
Morse
Yes
Newell
Yes
Schultheis
Yes
Tochtrop
Yes
Boyd
Yes
Not Final YES: 8 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS














05:06 PM

Senator Newell distributed prepared amendment L.007 (Attachment J). The amendment outlines a specific statement of understanding that must be provided to individuals who enroll in limited benefit plans. Senator Newell proposed several amendments to amendment L.007. The committee discussed authorizing the bill drafter to make technical changes to the amendments proposed to amendment L.007.

09SenateHHS0312AttachJ.pdf
BILL:HB09-1143
TIME: 05:06:33 PM
MOVED:Newell
MOTION:Amend prepared amendment L.007, page 1, line 10, after "services." add "That maximum is ____." Page 1, line 18, strike "I am" and substitute "I," and strike "dependent is" and substitute "dependent,". Page 2, after "may", insert "or may not". The motion passed without objection.
SECONDED:
VOTE
Carroll M.
Lundberg
Mitchell
Morse
Newell
Schultheis
Tochtrop
Boyd
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:HB09-1143
TIME: 05:09:03 PM
MOVED:Newell
MOTION:Adopt prepared amendment L.007 (Attachment J), as amended. The motion passed without objection.
SECONDED:
VOTE
Carroll M.
Lundberg
Mitchell
Morse
Newell
Schultheis
Tochtrop
Boyd
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection


05:10 PM

Senator Schultheis moved an amendment to strike the limitation on the offer of limited benefit plans to only those counties with 25,000 residents or less. The committee discussed the amendment.
BILL:HB09-1143
TIME: 05:14:53 PM
MOVED:Schultheis
MOTION:Amend prepared amendment L.002 (Attachment E), page 1, strike lines 15 through 17. The motion failed on a 3-5 roll call vote.
SECONDED:
VOTE
Carroll M.
No
Lundberg
Yes
Mitchell
Yes
Morse
No
Newell
No
Schultheis
Yes
Tochtrop
No
Boyd
No
Not Final YES: 3 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: FAIL








BILL:HB09-1143
TIME: 05:16:10 PM
MOVED:Schultheis
MOTION:Amend prepared amendment L.002, page 1, line 16, strike "twenty-five" and substitute "thirty". The motion failed on a 3-5 roll call vote.
SECONDED:
VOTE
Carroll M.
No
Lundberg
Yes
Mitchell
Yes
Morse
No
Newell
No
Schultheis
Yes
Tochtrop
No
Boyd
No
Not Final YES: 3 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: FAIL
BILL:HB09-1143
TIME: 05:19:54 PM
MOVED:Carroll M.
MOTION:Amend prepared amendment L.002, line 17, strike "people;" and "substitute "people, as of the effective date of this paragraph (h);". The motion passed without objection.
SECONDED:
VOTE
Carroll M.
Lundberg
Mitchell
Morse
Newell
Schultheis
Tochtrop
Boyd
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection













05:20 PM

Christy Chase, Office of Legislative Legal Services, requested that the committee grant her permission to harmonize the amendments that were adopted. The committee agreed to allow staff to make technical changes to the bill's committee report.
BILL:HB09-1143
TIME: 05:20:46 PM
MOVED:Newell
MOTION:Refer House Bill 09-1143, as amended, to the Committee of the Whole. The motion passed on a 6-2 roll call vote.
SECONDED:
VOTE
Carroll M.
No
Lundberg
Yes
Mitchell
Yes
Morse
Yes
Newell
Yes
Schultheis
Yes
Tochtrop
No
Boyd
Yes
Final YES: 6 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS






























05:23 PM -- House Bill 09-1061

Senator Tochtrop introduced House Bill 09-1061 and distributed amendment L.008 (Attachment K). The bill requires that intermediaries that contract with health insurers to comply with the same standards, guidelines, medical policies, and benefit terms as the insurers with whom they contract. In addition, payments to health care providers must indicate the name of the intermediary and the contracting insurance carrier. Violations of the bill are an unfair or deceptive act in the business of insurance.

09SenateHHS0312AttachK.pdf

05:25 PM --
Ellen Caruso, representing the Colorado Chapter of the American Physical Therapy Association, described a scenario in which an intermediary might limit care authorized under an insurance plan. She said the bill will allow consumers to receive more information about the entities limiting care in such situations.

05:27 PM --
Phil Plante, representing the Colorado Chapter of the American Physical Therapy Association, discussed problems that physical therapists encounter with intermediaries that limit care.

05:29 PM --
Jerry McElroy, Kaiser Permanente, stated that the bill, as introduced had a number of far reaching consequences, but that the amended bill is focused and represents the discussions of many parties.


05:30 PM

Senator Tochtrop gave concluding remarks regarding the bill. She described amendment L.008, which concerns access to prescription drugs.
BILL:HB09-1061
TIME: 05:33:23 PM
MOVED:Tochtrop
MOTION:Adopt prepared amendment L.008 (Attachment K). The motion passed on a 7-1 roll call vote.
SECONDED:
VOTE
Carroll M.
Yes
Lundberg
No
Mitchell
Yes
Morse
Yes
Newell
Yes
Schultheis
Yes
Tochtrop
Yes
Boyd
Yes
Not Final YES: 7 NO: 1 EXC: 0 ABS: 0 FINAL ACTION: PASS






BILL:HB09-1061
TIME: 05:34:57 PM
MOVED:Tochtrop
MOTION:Refer House Bill 09-1061, as amended, to the Committee of the Whole with a recommendation that it be placed on the consent calendar. The motion passed on an 8-0 roll call vote.
SECONDED:
VOTE
Carroll M.
Yes
Lundberg
Yes
Mitchell
Yes
Morse
Yes
Newell
Yes
Schultheis
Yes
Tochtrop
Yes
Boyd
Yes
Final YES: 8 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS


05:36 PM

The committee recessed.