After the third attempt in three years, the public option bill has passed through the state House. It is now known as the Colorado Option. The bill saw a complete overhaul after being introduced to committee because of opposition from Colorado health organizations, including the Colorado Hospital Association (CHA). After a marathon debate session last Thursday that ended around 2 a.m. Friday, the bill passed on Monday in the House along party lines.

While the CHA has moved from opposition to neutral on the bill, rural hospitals that are over 25 on bed count are left in no man’s land. District 54 Rep. Matt Soper posted his statement from the debate on his Facebook page.

“What we’ve learned from the committee is that 53% of hospitals are operating with a non sustainable budget. Meaning if you ask them to cut any level of a percent these hospitals would be failing. They might have to cut critical line items that are offering care to patients,” Soper, who also sits on the Delta Health Board, said.

“Public option has gone through so many changes that you probably wouldn’t recognize it. Other than the fact that it still won’t work.” District 58 Rep. Marc Catlin said during a recent video conference.

Leann Tobin, chief marketing officer for Montrose Memorial Hospital, said on the same conference call: “It’s been updated and updated and updated. We are still working to see how it’s going to affect our hospital. That’s the piece that’s been a moving target. With CHA going neutral on this, they have come out and said they are not going to fight it anymore. We have to go a different direction. We had a call with CHA. If you read this bill, you need a lot of data from CHA and from the data payer base and other data we don’t have access to figure out what the modeling looks like for Montrose hospital. We feel like we could have a better story to tell to say this is exactly how much money this hospital is going to lose or say what’s going to hurt us.”

Catlin then said he was surprised by CHA’s neutral stance on the bill.

“We’re not because their biggest group is the big system hospitals and the systems are going to be able to weather this better than the small independent rural hospitals because they’ve got a bigger pot. We don’t have it,” Tobin added.

The proponents of the bill cite that Colorado is among the country’s most profitable health care system. The problem is the data comes from a 2018 report and is a study of the larger systems. Of course, the pandemic throws any prior health care data out the window. Montrose and Delta hospitals are not a part of the top five healthy profit systems.

The idea of the bill is to reduce health care costs for the individually-insured sector. Some say it would be an opening to a single-payer model. Washington state so far is the only state to have passed public option insurance. Passed last year, the reviews are mixed, according to data used by the Common Sense Institute. The data shows the Affordable Care Act marketplace average premium has lowered 6% nationally, and 30% in Colorado, while Washington has a 15% increase since 2018.

While it’s unclear what the revenue cuts to the health care industry in Colorado would be under the new version of the bill, the prior version according to CSI would have been between $830 million and $1 billion. When revenues are cut expenses are soon to follow. Anyone who has created a budget for any business will tell you significant revenue cuts lead to payroll cuts. According to CSI that could be in the neighborhood of 5,000 health related jobs. Seemingly the impact would be greater on rural hospitals that aren’t protected under the version of the bill that passed through the House.

Matt Heyn, president and CEO Delta Health in an email statement to the Delta County Independent had this to say, “I believe the changes asked in reference to floor calculations and inclusions of “essential access hospital,” instead of Critical Access Hospital are not enough. HB 21-1232 will continue to challenge the already most vulnerable rural healthcare facilities, it will challenge their ability to keep their doors open and will impact the affordability and access to quality health care. My earnest hope is that the state legislature will continue to work closely with Colorado hospitals and the Colorado Hospital Association and will not continue to cripple healthcare. Healthcare is the life source for many Colorado rural communities in areas that are already underserved.”

The other impact would more than likely be increased premiums for those who received health insurance from their employers. This would impact both employers and employees. Colorado employers are already under expense pressure with higher salaries, taxes and other fees.

The bill is now in the hands of the Senate.

“Frankly the senate numbers are much more favorable than what Marc (Catlin) had to deal with, our situation is if we peel off three of the majority then we can change a lot of things. We’ve been able to do that and frankly it’s good to see they’re all fighting amongst themselves,” Sen. Don Coram said during the video conference.

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