Final
Introduction and Discussion of Bills

HEALTH INSURANCE

Votes:
Action Taken:
Adopt a conceptual amendment to draft Bill E expan
Adopt amendment L.001 (Attachment D) to draft Bill
Adopt amendment L.001 (Attachment R) to draft Bill
Adopt amendment L.001. The motion passed without
Adopt amendment L.002 (Attachment E) to draft Bill
Adopt amendment L.003 (Attachment F) to draft Bill
Adopt amendment L.004 (Attachment G) to draft Bill
Adopt amendment #1 (Attachment B) to draft Bill C.
Adopt draft Bill B (Attachment H), as amended. Th
Adopt draft bill Bill A (Attachment C), as amended
Adopt draft Bill C (Attachment A), as amended. Th
Adopt draft Bill D (Attachment K). The motion pas
Adopt draft Bill E (Attachment L), as amended. Th
Adopt draft Bill F (Attachment M). The motion fai
Adopt draft Bill G (Attachment P). The motion fai
Adopt draft Bill H (Attachment Q), as amended. Th
Adopt proposed amendment #1 (Attachment I). The m
Adopt proposed amendment #2 (Attachment J). The m
Reconsider the adoption of amendment L.001. The m		Pass Without Objection
PASS
Pass Without Objection
Pass Without Objection
PASS
Pass Without Objection
Pass Without Objection
Pass Without Objection
PASS
PASS
PASS
PASS
PASS
FAIL
FAIL
PASS
PASS
PASS
TIE



10:17 AM

Senator Hagedorn discussed how the meeting would operate, stating that the drafters of the bills would come to the table to explain the bill and then interested members of the public would be allowed to comment on the bills. After the conclusion of public testimony, the committee would go back through the bills to vote on amendments and to take final action on the drafts. After the drafts are approved, the sponsorship of the bills would be determined. Senator Hagedorn reminded the committee that legislators who were not members of the committee could sponsor bills. Senator Shaffer asked if members who are committee bill sponsors had a duty to carry the bill exactly as the bill emerged from the committee. Senator Hagedorn explained that the bill becomes the member's bill after it is approved by Legislative Council. Senator Hagedorn reminded committee members and the audience that this was the final meeting of the committee.


10:27 AM

Michele Hanigsberg, Office of Legislative Legal Services, came to the table to discuss draft bill C (Attachment A). She explained that the bill establishes the Colorado Primary Care Program to provide primary care services to specified low-income, uninsured adults through community health clinics. Participating individuals cannot be eligible for Medicaid or the Children's Basic Health Plan. Under the bill, the Department of Health Care Policy and Financing must report to the House and Senate Health and Human Services Committee regarding the options for incorporating the Primary Care Program into the state's Medicaid program. She responded to questions from the committee regarding the definition of qualified alien and qualifying medical condition. She discussed proposed amendment #1 to the draft bill (Attachment B), explaining that the amendment changes the definition of "primary care" to be consistent with other definitions of primary care within the statutes, strikes specific reference to the HEDIS measure as the measure of quality required to be used in the bill, requires the Department to develop a waiting list for the program, changes the reporting requirement for the program, and establishes a Health Care Services Fund to contain $15 million if Referendum C passes. Half of the money in the Health Care Services Fund would go to the program, and half of the money would go to fund Medicaid services for adults above 60 percent of the Federal Poverty Level (FPL). Senator Hagedorn stated that four of the proposed bills are predicated on the passage of Referendum C and if bill C passes, it could provide care to 85,000 individuals. Ms. Hanigsberg responded to questions from the committee regarding the portion of the amendment that would provide $7.5 million to Medicaid clients above 60 percent FPL, stating that the dollars could be matched by the federal government. Representative Riesberg asked the funding for several of the draft bills being proposed by the committee relied upon the same $15 million from Referendum C. Senator Hagedorn, stated that yes, all of the bills were proposing to use the same pot of money, but that the General Assembly should be allowed to determine which of the committee's proposals to fund. Representative Penry asked when the General Assembly set aside $15 million of the Referendum C dollars for new health care programs. Senator Keller stated that pursuant to HB 05-1194, one-third of the dollars that would be raised through the passage of Referendum C were prioritized for health care. She stated that if Referendum C passes, there will only be a limited amount of dollars for health care programs and the total amount may equal $15 million, but may not. Representative Penry stated that it was his understanding that growth in Medicaid would consume most of the Referendum C dollars. Senator Keller stated that the Joint Budget Committee is concerned with the growth in Medicaid and changes in the Medicaid at the federal level.

10:46 AM -- Carrie Curtiss, Colorado Consumer Health Initiative, testified in support of Bill C. She stated that the committee should consider proposals that maximize federal dollars and target individuals who do not have access to or cannot afford health insurance. She stated that the population targeted in the bill cannot afford health insurance, but do not currently qualify for Medicaid.

10:48 AM -- Deb DeBoutez, Colorado Coalition for the Homeless, testified in support of the bill. She stated that the program will provide health care to adults that do not qualify for Medicaid. She responded to Senator McElhany's questions as to why the targeted individuals do not qualify for Medicaid, stating that the targeted individuals receive Medicaid only if they qualify for SSI benefits, and qualifying is often a lengthy process.

10:51 AM -- Polly Anderson, Colorado Community Health Network, testified in support of the bill. She stated that the populations served under the bill have very high needs and low incomes. She testified in support of the proposed amendment #1. Ms. Anderson stated that to truly make an impact on the unmet health needs of the state, the members of the committee needed to make an effort to ensure that funding for the program continues past the first year of the program. Ms. Anderson responded to the questions from Senator Hagedorn regarding rural access to health care through the community health clinics.


10:56 AM

Kristen Forrestal, Office of Legislative Legal Services, came to the table to discuss Bill A (Attachment C). She explained that the bill creates the Healthy Business, Healthy People program under which eligible small employer plans may receive reimbursement for certain amounts of claims paid on behalf of eligible insured persons. In addition, the bill creates a subsidy program for CoverColorado participants. Ms. Forrestal responded to questions from Senator Mitchell regarding changes in the draft from a similar bill, SB 05-237, that was introduced in 2004. Ms. Forrestal discussed amendments L.001, L.002, L.003, L.004 (Attachments D through G). She explained that amendment L.001 specifies that the funding for the program will be from the general fund exempt account created if Referendum C passes, Amendment L.002 requires health insurers to offer basic and standard health plans to participants of the program, Amendment L.003 delineates the authority and responsibility of the boards that will administer the programs created in the bill, and Amendment L.004 establishes a process through which the boards will select a third party to collect data regarding the programs.

11:03 AM -- Janet Fox Stephens, Colorado Health and Hospital Association, stated that the hospital association supports any bill that expands health insurance coverage, but would like more information as to how the bill will be implemented.


11:04 AM

Nicole Hoffman, Office of Legislative Legal Services, described Bill B (Attachment H), which creates Health Assurance Districts and also described amendments #1 and #2 (Attachments I and J). She stated that amendment #1 removes the limitation that the sales tax authorized in the bill be limited to one-fourth of one percent and amendment #2 allows Health Assurance Districts to levy both a sales and a property tax. She requested that, if amendment #2 is adopted, she receive permission from the committee to make additional conforming changes as necessary. Ms. Hoffman responded to questions regarding rural health assurance districts. Senator Hagedorn responded to a question from Representative Penry regarding how many rural health assurance districts exist currently.


11:14 AM

Jery Payne, Office of Legislative Legal Services, described Bill D (Attachment K), which authorizes a study of the factors that drive health insurance in Pueblo, including cost and access factors. He stated that the bill is silent on the dates when the study should begin. Representative Riesberg asked whether the study could be completed without legislative authorization.

11:17 AM -- Janet Fox Stephens, Colorado Health and Hospital Association, testified regarding data that hospitals are required to report under the bill. She stated that the hospital association is willing to work to amend the bill.


11:19 AM

Christy Chase, Office of Legislative Legal Services, described bill E (Attachment L). She explained that the bill repeals the requirement that small group health insurers offer a standard health benefit plan and adds a fourth basic benefit design option. Senator Hagedorn stated that the title should be amended to accommodate future amendments that may be proposed to the bill. Senator Hagedorn responded to questions from the committee regarding the addition of a fourth basic benefit design. Senator Hagedorn responded to questions regarding whether the bill will eliminate the standard plan if the bill title is changed.

11:26 AM -- Janet Fox Stephens, Colorado Health and Hospital Association, stated her concerns with eliminating the standard plan.

11:28 AM -- Carrie Curtiss, Colorado Consumer Health Initiative, stated her support for the basic and standard plans. She stated that she supports the bill going forward, but that the committee should explore data regarding how many businesses choose the standard plan option.


11:30 AM

Kristen Forrestal, Office of Legislative Legal Services, discussed bill F (Attachment M). She explained that the bill requires hospitals to inform a consumer at the time of admission that they may be responsible for services not covered by the health plan. Further, for managed care plans, the bill requires a consumer who receives nonemergency services at an out-of-network health care facility to be responsible for the difference between a provider's billed charges and the out-of-network rate paid by the plan. Senator Keller asked what patients' current level of responsibility is for out-of-network costs incurred at an in-network facility. She further asked if there were current requirements to inform patients of additional costs they might incur if they receive out-of-network services at an in-network facility. Senator McElhany asked for further explanation of the provisions of the bill. Representative Green asked if there were limitations on how much providers may charge patients.

11:44 AM -- Steve Bieringer, Colorado Consumer Health Initiative, testified in opposition to the bill and distributed a handout to the committee (Attachment N). He testified that consumers are already responsible for a large portion of health care costs, and allowing patients to be balance billed creates an additional burden on a patient. He stated that the bill may discourage consumers from receiving appropriate care. He stated that there is no evidence that consumers are abusing health networks and that the issue is predicated on a contract dispute between carriers and providers. He stated that the requirement in the bill that hospitals attempt to schedule in-network providers is vague. Senator Hagedorn responded to Mr. Bieringer's comments. Senator McElhany asked if the problem was statewide or only in rural areas. Representative Penry asked for more information regarding the scope of the problem. Mr. Bieringer responded that more data is needed.

12:00 PM -- Penny Baldwin, representing herself, distributed a handout to the committee (Attachment O). She described a scenario under which a consumer would be permitted to be balance billed under the provisions of bill F. Ms. Baldwin stated that there are people who are paying more under the law than they are required to pay. Ms. Baldwin stated that hospitals don't know which providers have contracted with which health insurance companies.

12:05 PM -- Edie Busam, Colorado Society of Anesthesiologists and Colorado Association of Medical Equipment Services, testified in opposition of the bill. She stated that more data is necessary to determine the scope of the problem.

12:07 PM -- Carrie Curtiss, Colorado Consumer Health Initiative, testified that data collection is necessary before consumer protections are weakened.

12:07 PM -- Janet Fox Stephens, Colorado Health and Hospital Association, testified that most hospitals inform patients that they may be treated by an out-of-network provider. She testified regarding the portion of the bill that requires hospitals to schedule in-network providers, asking that the provision of the bill be removed.


12:11 PM

Christy Chase, Office of Legislative Legal Services, came to the table to discuss Bill G (Attachment P). She explained that the bill creates a reinsurance program to provide payments to health insurance companies that provide insurance to qualifying individuals. Individuals must have no insurance, a low income, limited access to insurance, and must enroll in a high deductible health insurance plan with a health savings account. The bill is funded with the $15 million dollars dependent upon the passage of Referendum C.


12:13 PM

Christy Chase, Office of Legislative Legal Services, discussed Bill H (Attachment Q). She explained that the bill creates a premium subsidy program for qualifying individuals who purchase a qualifying health insurance plan, either a high deductible plan with a health savings account or a managed care plan similar to the plan in which Medicaid clients are enrolled. The subsidy would be capped at a $100 a month or 50 percent of the premium. She discussed amendment L.001 (Attachment R). She explained that the amendment specifies that the subsidy goes to the health insurance plan rather than the participant.


12:17 PM

The committee recessed.


01:37 PM

The committee reconvened.


01:38 PM

.Senator Keller moved draft bill A (Attachment C) and amendments L.001, L.002, L.003, and L.004 (Attachments D through G).
BILL:Introduction and Discussion of Bills
TIME: 01:38:30 PM
MOVED:Keller
MOTION:Adopt amendment L.001 (Attachment D) to draft Bill A. The motion passed 6-2-2.
SECONDED:
VOTE
Green
Yes
Johnson
Excused
Keller
Yes
McCluskey
Excused
McElhany
No
Penry
No
Riesberg
Yes
Shaffer
Yes
Boyd
Yes
Hagedorn
Yes
Not Final YES: 6 NO: 2 EXC: 2 ABS: 0 FINAL ACTION: PASS
BILL:Introduction and Discussion of Bills
TIME: 01:39:32 PM
MOVED:Keller
MOTION:Adopt amendment L.002 (Attachment E) to draft Bill A. The motion passed 6-2-2.
SECONDED:
VOTE
Green
Yes
Johnson
Excused
Keller
Yes
McCluskey
Excused
McElhany
No
Penry
No
Riesberg
Yes
Shaffer
Yes
Boyd
Yes
Hagedorn
Yes
Not Final YES: 6 NO: 2 EXC: 2 ABS: 0 FINAL ACTION: PASS
BILL:Introduction and Discussion of Bills
TIME: 01:40:30 PM
MOVED:Keller
MOTION:Adopt amendment L.003 (Attachment F) to draft Bill A. The motion passed without objection.
SECONDED:
VOTE
Green
Johnson
Excused
Keller
McCluskey
Excused
McElhany
Penry
Riesberg
Shaffer
Boyd
Hagedorn
Not Final YES: 0 NO: 0 EXC: 2 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:Introduction and Discussion of Bills
TIME: 01:41:13 PM
MOVED:Keller
MOTION:Adopt amendment L.004 (Attachment G) to draft Bill A. The motion passed without objection.
SECONDED:
VOTE
Green
Johnson
Excused
Keller
McCluskey
Excused
McElhany
Penry
Riesberg
Shaffer
Boyd
Hagedorn
Not Final YES: 0 NO: 0 EXC: 2 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:Introduction and Discussion of Bills
TIME: 01:42:16 PM
MOVED:Hagedorn
MOTION:Adopt draft bill Bill A (Attachment C), as amended. The motion passed 6-2-2.
SECONDED:
VOTE
Green
Yes
Johnson
Excused
Keller
Yes
McCluskey
Excused
McElhany
No
Penry
No
Riesberg
Yes
Shaffer
Yes
Boyd
Yes
Hagedorn
Yes
Not Final YES: 6 NO: 2 EXC: 2 ABS: 0 FINAL ACTION: PASS


01:43 PM

Senator Keller agreed to serve as the Senate prime sponsor of the bill, and Representative Green agreed to carry the bill in the House. Senator Shaffer and Representative Boyd were added as cosponsors to the bill. The committee requested that the bill contain a safety clause.


01:44 PM

The committee discussed draft Bill B (Attachment H). Senator Hagedorn discussed proposed amendment #1 (Attachment I).
BILL:Introduction and Discussion of Bills
TIME: 01:47:22 PM
MOVED:Hagedorn
MOTION:Adopt amendment L.001. The motion passed without objection.
SECONDED:
VOTE
Green
Johnson
Excused
Keller
McCluskey
Excused
McElhany
Penry
Riesberg
Shaffer
Boyd
Hagedorn
Not Final YES: 0 NO: 0 EXC: 2 ABS: 0 FINAL ACTION: Pass Without Objection


01:48 PM

The Chairman noted that the committee had adopted the wrong amendment. He moved that the committee reconsider its vote on amendment L.001.
BILL:Introduction and Discussion of Bills
TIME: 01:48:20 PM
MOVED:Hagedorn
MOTION:Reconsider the adoption of amendment L.001. The motion passed without objection.
SECONDED:
VOTE
Green
Johnson
Excused
Keller
McCluskey
Excused
McElhany
Penry
Riesberg
Shaffer
Boyd
Hagedorn
Not Final YES: 0 NO: 0 EXC: 2 ABS: 0 FINAL ACTION: TIE
BILL:Introduction and Discussion of Bills
TIME: 01:49:06 PM
MOVED:Hagedorn
MOTION:Adopt proposed amendment #1 (Attachment I). The motion passed 6-2-2.
SECONDED:
VOTE
Green
Yes
Johnson
Excused
Keller
Yes
McCluskey
Excused
McElhany
No
Penry
No
Riesberg
Yes
Shaffer
Yes
Boyd
Yes
Hagedorn
Yes
Not Final YES: 6 NO: 2 EXC: 2 ABS: 0 FINAL ACTION: PASS
BILL:Introduction and Discussion of Bills
TIME: 01:50:16 PM
MOVED:Hagedorn
MOTION:Adopt proposed amendment #2 (Attachment J). The motion passed 6-2-2.
SECONDED:
VOTE
Green
Yes
Johnson
Excused
Keller
Yes
McCluskey
Excused
McElhany
No
Penry
No
Riesberg
Yes
Shaffer
Yes
Boyd
Yes
Hagedorn
Yes
Not Final YES: 6 NO: 2 EXC: 2 ABS: 0 FINAL ACTION: PASS
BILL:Introduction and Discussion of Bills
TIME: 01:51:01 PM
MOVED:Keller
MOTION:Adopt draft Bill B (Attachment H), as amended. The motion passed 6-2-2.
SECONDED:
VOTE
Green
Yes
Johnson
Excused
Keller
Yes
McCluskey
Excused
McElhany
No
Penry
No
Riesberg
Yes
Shaffer
Yes
Boyd
Yes
Hagedorn
Yes
Not Final YES: 6 NO: 2 EXC: 2 ABS: 0 FINAL ACTION: PASS


01:51 PM

Senator Hagedorn announced that Senator Hanna would carry draft Bill B in the Senate, and Representative Riesberg agreed to be the House prime sponsor. Senators Keller, Hagedorn, and Shaffer and Representatives Green and Boyd were added as cosponsors. The committee requested that bill contain a safety clause.


01:52 PM

The committee discussed draft Bill C (Attachment A). Senator Hagedorn moved amendment #1 (Attachment B).
BILL:Introduction and Discussion of Bills
TIME: 01:52:58 PM
MOVED:Hagedorn
MOTION:Adopt amendment #1 (Attachment B) to draft Bill C. The motion passed without objection.
SECONDED:
VOTE
Green
Johnson
Excused
Keller
McCluskey
Excused
McElhany
Penry
Riesberg
Shaffer
Boyd
Hagedorn
Not Final YES: 0 NO: 0 EXC: 2 ABS: 0 FINAL ACTION: Pass Without Objection


01:53 PM

The committee discussed draft Bill C.
BILL:Introduction and Discussion of Bills
TIME: 01:57:40 PM
MOVED:Hagedorn
MOTION:Adopt draft Bill C (Attachment A), as amended. The motion passed 6-2-2.
SECONDED:
VOTE
Green
Yes
Johnson
Excused
Keller
Yes
McCluskey
Excused
McElhany
No
Penry
No
Riesberg
Yes
Shaffer
Yes
Boyd
Yes
Hagedorn
Yes
Not Final YES: 6 NO: 2 EXC: 2 ABS: 0 FINAL ACTION: PASS


01:57 PM

Senator Hagedorn stated that he would be the Senate prime sponsor of the bill, and that Representative Boyd would carry the bill in the House. Senator Shaffer and Representative Green were added as cosponsors. The committee requested that the bill contain a safety clause.


01:58 PM

Senator Hagedorn moved draft Bill D (Attachment K).
BILL:Introduction and Discussion of Bills
TIME: 01:58:59 PM
MOVED:Hagedorn
MOTION:Adopt draft Bill D (Attachment K). The motion passed 8-0-2.
SECONDED:
VOTE
Green
Yes
Johnson
Excused
Keller
Yes
McCluskey
Excused
McElhany
Yes
Penry
Yes
Riesberg
Yes
Shaffer
Yes
Boyd
Yes
Hagedorn
Yes
Not Final YES: 8 NO: 0 EXC: 2 ABS: 0 FINAL ACTION: PASS


02:00 PM

Senator Hagedorn announced that Senator Tapia would carry Bill D in the Senate, and Representative Butcher would be the House Prime Sponsor of the bill. Senators Keller, Hagedorn, and Shaffer and Representatives Green and Boyd were added as cosponsors. The committee requested that the bill contain a safety clause.


02:03 PM

Jo Donlin, Colorado Health Institute, came to the table to discuss a policy forum on the Medicare Part D prescription drug benefit being held by the Colorado Health Institute in the second week of November.


02:04 PM

Senator Hagedorn moved draft bill E (Attachment L), and discussed a conceptual amendment to the bill's title.


02:04 PM

Christy Chase, Office of Legislative Legal Services, offered an amended title for the draft bill.
BILL:Introduction and Discussion of Bills
TIME: 02:06:18 PM
MOVED:Hagedorn
MOTION:Adopt a conceptual amendment to draft Bill E expanding the title. The motion passed without objection.
SECONDED:
VOTE
Green
Johnson
Excused
Keller
McCluskey
Excused
McElhany
Penry
Riesberg
Shaffer
Boyd
Hagedorn
Not Final YES: 0 NO: 0 EXC: 2 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:Introduction and Discussion of Bills
TIME: 02:11:31 PM
MOVED:Hagedorn
MOTION:Adopt draft Bill E (Attachment L), as amended. The motion passed 7-1-2.
SECONDED:
VOTE
Green
Yes
Johnson
Excused
Keller
Yes
McCluskey
Excused
McElhany
No
Penry
Yes
Riesberg
Yes
Shaffer
Yes
Boyd
Yes
Hagedorn
Yes
Not Final YES: 7 NO: 1 EXC: 2 ABS: 0 FINAL ACTION: PASS


02:12 PM

Senator Hagedorn stated that he would carry the bill in the Senate. No house sponsor for the bill was designated. The committee requested that the bill have a safety clause.


02:13 PM

Senator Hagedorn moved draft Bill F (Attachment M).
BILL:Introduction and Discussion of Bills
TIME: 02:14:28 PM
MOVED:Hagedorn
MOTION:Adopt draft Bill F (Attachment M). The motion failed 1-7-2.
SECONDED:
VOTE
Green
No
Johnson
Excused
Keller
No
McCluskey
Excused
McElhany
No
Penry
No
Riesberg
No
Shaffer
No
Boyd
No
Hagedorn
Yes
Not Final YES: 1 NO: 7 EXC: 2 ABS: 0 FINAL ACTION: FAIL


02:15 PM

Senator Hagedorn moved and discussed draft Bill G (Attachment P).
BILL:Introduction and Discussion of Bills
TIME: 02:17:13 PM
MOVED:Hagedorn
MOTION:Adopt draft Bill G (Attachment P). The motion failed 1-7-2.
SECONDED:
VOTE
Green
No
Johnson
Excused
Keller
No
McCluskey
Excused
McElhany
No
Penry
No
Riesberg
No
Shaffer
No
Boyd
No
Hagedorn
Yes
Not Final YES: 1 NO: 7 EXC: 2 ABS: 0 FINAL ACTION: FAIL


02:18 PM

Senator Hagedorn moved draft Bill H (Attachment Q) and amendment L.001 (Attachment R).
BILL:Introduction and Discussion of Bills
TIME: 02:19:24 PM
MOVED:Hagedorn
MOTION:Adopt amendment L.001 (Attachment R) to draft Bill H. The motion passed without objection.
SECONDED:
VOTE
Green
Johnson
Excused
Keller
McCluskey
Excused
McElhany
Penry
Riesberg
Shaffer
Boyd
Hagedorn
Not Final YES: 0 NO: 0 EXC: 2 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:Introduction and Discussion of Bills
TIME: 02:22:11 PM
MOVED:Hagedorn
MOTION:Adopt draft Bill H (Attachment Q), as amended. The motion passed 5-3-2.
SECONDED:
VOTE
Green
Yes
Johnson
Excused
Keller
Yes
McCluskey
Excused
McElhany
No
Penry
No
Riesberg
No
Shaffer
Yes
Boyd
Yes
Hagedorn
Yes
Not Final YES: 5 NO: 3 EXC: 2 ABS: 0 FINAL ACTION: PASS


02:22 PM

Senator Hagedorn stated that he would carry the bill in the Senate, and Representative Boyd would carry the bill in the House. The committee requested that the bill contain a safety clause.


02:23 PM

Senator Hagedorn thanked the committee for their work. The committee adjourned.