HEALTHCARE BILLS

HB 1344 - the medical malpractice bill was introduced in the House on April 17th, went into committee and was amended on the 20th and two days later, died on a third reading vote on the House floor with the Republicans locked in opposition and the Democrat’s “dirty dozen” going with them for the kill. This bill sponsored, by Representative Christine Scanlon (D-Dillon) would have inflation adjusted the $300,000 non-economic cap for medical malpractice and required medical malpractice carriers to file their rates with the Division of Insurance. The bill, as amended in the House Judiciary committee, required COPIC and all other Medical Liability carriers to file their rate increases for approval and included a provision allowing any person to request a review hearing thereby forcing the carriers to defend their rate. The CSOM, CAFP, CMS, specialty medical lobby, and our business friends worked hard to make legislators understand, the bill even in its amended form, would have grave impacts to the practices of Colorado physicians. The calls and emails to Legislators from physicians were the key to killing the bill. Pat yourselves on the backs folks, this was a hard won fight and most likely a fight we will see again next session!

Other major issues battled this legislative session, have all been in the area of Scopes of Practice. The Naturopath registration bill, HB1175, sponsored by Representative Kathleen Curry (D- Gunnison) passed the House only to die in the Senate Health and Human Services Committee. This bill regulated the practice of naturopathic medicine and protected the title of Naturopathic Doctor only for those people who have a four-year post graduate degree. Naturopathic doctors would have been authorized to perform a limited set of treatments and therapies, prohibited from a myriad of “medical acts” and the performance of treatments and practices that were considered unsafe or ineffective. The bill contained a provision that would have authorized a multidisciplinary task force to determine future qualifications of naturopathic doctors and to have dialogued on their scope of practice, all of this was to be reviewed through a lens of evidence backed by quality and peer reviewed literature. Finally, naturopathic doctors would have been required to provide disclosures aimed at educating consumers on the qualifications of a naturopathic doctor, the differences between a naturopathic doctor and a physician, and those practices that naturopathic doctors are prohibited from performing. All this work only to start again at the same point next year! Let’s see what the Naturopaths do now since their battle is not with Medicine, but with the “other” naturopaths who do not have four-year ND degrees!

In response to our lobby and grassroots efforts, the chiropractors pulled down their amendment that would have granted them prescriptive authority. They have requested to meet with medical groups over the course of the summer to express their “want” and hear our concerns.

The Nurse Practice Act Sunset, SB239, sponsored by Senator Lois Tochtrop (D-Adams) has passed the Senate and the House and is on the Governor’s desk for signing. As a collective voice, medicine worked overtime to assure a definition of Advance Practice Nursing was included in the Nurse Practice Act Sunset legislation. Medicine’s position on the NPA sunset primarily focused on two things; defining Advanced Practice Nursing to include delegated medical functions and a mutually acceptable process for safe prescribing.

CSOM monitored several bills dealing with healthcare reform:  HB 1273, “Health Care for All”, known by most as the “Single Payer” bill sponsored by Representative John Kefalas (D-Fort Collins). CSOM & CAFP discussed the need for Patient Centered Medical Homes as the cornerstone of any reform to our health care system. The opportunity to sing this same tune arose again in the form of possible testimony and amendments to HB 1358, “Creating a Health Care System For Colorado” sponsored by Representative Joe Rice (D-Denver). This bill would have created a parallel public/private payer, three tiered system of health care. The first tier would have been publically sponsored primary and preventive services, the second tier would have been supported by mandated individual coverage for acute care services and the final tier covered catastrophic care as a public benefit. The bill was supported by the South Metro Denver Chamber of Commerce only to be postponed indefinitely at the sponsor’s request.

HB 1204, Priority Preventative Services, sponsored by Representative Tom Massey (R-Poncha Springs) has made it through the House and Senate and is on its way to the Governor’s desk. The bill requires health insurance carriers to allow a co-pay in front of the deductible for preventative services supported in the A and B recommendations of the United States Preventative Services Task Force (USPSTF) for breast and cervical cancer, colorectal screenings, alcohol and tobacco interventions, pneumococcal and flu vaccinations, and childhood immunizations. The bill passed the House with an amendment that will allow fluidity in statute to require these screenings even as the recommendations from the USPSTF change over time.

BUDGET

The Joint Budget Committee (JBC), having just finished preliminary “final” figure setting for the upcoming fiscal year, received news that the state had to find an additional $150 million to balance the current fiscal year and cut or fill a $786 million gap for the fiscal year starting July 1, 2009. In order to introduce a balanced budget, the Joint Budget Committee made a motion to cut Higher Education $300 million and use $500 million in cash funds from Pinnacol Insurance (Worker’s Compensation Funds). These were funds available above the statutory reserve Pinnacol is required to carry. This action set off a fire-storm, splitting the Higher Education and Business lobby, and culminating in the Senate sending the state’s budget bill SB 259 back to the Joint Budget Committee for reconsideration (which was procedurally impossible). The bill was sent back to the Senate for action as the JBC could not re-write the state’s budget bill known as the “Long Bill”.

At the crux of the crisis was the American Recovery and Reinvestment Act (ARRA) which required states to fulfill maintenance of effort funding requirements in order to receive over $700 million in education stimulus dollars. The $300 million hit to Higher Education did not meet this condition. Consequently the Senate removed the $300 million cut in Higher Education, sent the House an unbalanced budget, and left the Governor intervening in the struggle between Higher Education and Pinnacol Insurance.

Pinnocal promised a lawsuit if the state tried to take their cash reserves or change their statutory designation and Higher Education students threatened sit-ins and speak outs. The budget turned into a melee with the Governor, Republicans and Democrats going back to the “black list” of cuts leaving Medicaid physicians experiencing a 4.33% rate cut, tobacco cessation, cancer, cardiovascular and pulmonary prevention programs decimated and primary care funding for qualified centers down $15 million. The health care lobby launched into action and held a rally protesting the cuts. New revenues from federal stimulus dollars were found and the budget was sent to the Governor for signature with only a 2% cut for Medicaid physicians, sadly none of the money for prevention programs was restored. The state will wait with trepidation and fear as new revenue estimates are anticipated in June and September. Are more cuts on the horizon? Sad to say, but that possibility remains a reality.

The General Assembly must finish all their work by midnight on Wednesday May 6th, better known as “Sine Die”…

Thanks to all CSOM physicians who called their legislators about these critical bills!