Michele Lueck is the president of the Colorado Health Institute.
Editor's note: Portions of this blog appeared in "2012 Legislation in Review," published by CHI.
Colorado's 2012 legislative session wasn't filled with grand new health policy initiatives – or big setbacks, either. Instead, lawmakers on both sides of the aisle rolled up their sleeves and worked on improving the state's existing health care system while setting the stage for future innovation.
A breather in the budget battles allowed legislators to turn their attention from reductions in health spending to more fundamental systemic changes – focusing on adjustments designed to provide better care for Coloradans while chipping away at the inexorable rise in health care costs.
The legislature tackled payment reform, asked for creative solutions in the Medicaid program and built a foundation for bipartisan efforts aimed at solidifying Colorado's role as a leader in smart solutions for tough health problems. Lawmakers also worked to help ease the cost of hospital care for uninsured families. They relaxed some regulations that were adding costs without improving health outcomes. And they found $3 million to provide dental services for a good number of low-income seniors.
Notable as well was what didn't happen. Efforts to repeal the law that created the Colorado Health Benefit Exchange and to roll back state-mandated Medicaid expansions were defeated. School-based health centers retained their funding levels. And co-payment levels for Medicaid enrollees didn't head higher.
Heeding a call from Gov. John Hickenlooper to improve government legislators targeted governmental inefficiencies that had bogged down health care delivery.
The session played out in the shadow of the November elections, when all 65 House seats and 20 Senate seats will be up for grabs, as will control of both bodies and leadership of the House and Senate health committees. With an uptick in revenue, balancing the budget became less painful for lawmakers. As a result, they focused on experimenting with pilot projects to make current state health care programs work better and cost less.
The health policy work undertaken during the 2012 legislative session falls within the framework of the four "E"s:
Easing of the budget – A better-than-expected revenue projection in March pre-empted a partisan fight over a property tax break for older Coloradans. While Medicaid continued to be a source of scrutiny because of rising enrollments, lawmakers avoided a proposed 4.5 percent funding reduction for school-based health centers. Legislators also retained co-payment levels for Medicaid clients.
Experimentation with existing programs and services – Legislators approved a number of proposals to change how health care is paid for and delivered in Colorado. Among them: The legislature approved a recommendation from the Department of Health Care Policy and Financing to pay health care providers a share of any financial savings from improved care coordination. It also passed a three-year pilot project that moves individuals eligible for both Medicaid and Medicare from nursing homes to alternative care facilities in their communities.
Improving governmental Efficiency – Lawmakers approved a number of health-related bills supporting Hickenlooper's call to make Colorado government "more efficient, effective and elegant." For example, House Bill 1054 simplifies HCPF's process to sign up health care providers by reducing the number of contracts required to participate in Medicaid, Child Health Plan Plus (CHP+) , the Colorado Indigent Care Program and school-based health centers.
The looming Elections – Regardless of the November elections, health care leadership will change significantly during the next session. Sen. Betty Boyd, D-Lakewood, chair of the Senate Health and Human Services Committee, is term-limited and won't return to the Capitol in 2013. Meanwhile, Rep. Ken Summers, R-Lakewood, chair of the House of Representatives Health and Environment Committee, has opted to run for the Senate in the wake of redistricting.
Crafting sound health care policy is challenging at any time. The system is complicated, the problems can seem overwhelming and any changes affect real people – often in profound ways. But as the economic downturn continues to take its toll and the nation awaits a decision by the U.S. Supreme Court on the constitutionality of federal health reform, this work can be even more difficult.
The Colorado legislature showed during its 2012 session that, with determination and strong leadership, progress is possible.