If there’s one word to describe the so-called "public option" bill, it’s "confusing." The bill is confusing for businesses, confusing for lawmakers and even confusing for health care experts.
A big reason for why HB21-1232 is so confusing is because the bill keeps changing. Dozens of amendments have been proposed; some passed, while many others failed.
Sen. Kerry Donovan, D-Vail, one of the bill’s cosponsors, isn’t trying to make too much of all of the amendments that have been proposed, saying many had more to do with politics than policy.
Nevertheless, an amendment that did pass during the House debate was a complete rewrite. The change essentially took out the state-run option portion of the originally-introduced public option bill.
Instead of the government creating its own health insurance option to compete with other insurers to lower the cost, the new version would force insurers to offer the standardized plan developed by the state and to cut their insurance costs for consumers using the individual or small group marketplace.
Only a small fraction of Coloradans, roughly one in ten, would be affected by the changes if the bill passes.
“The original version would’ve said, ‘Hey, forget about insurance companies, we can do this by ourselves at the state. We can run our own insurance program,” said Joe Hanel, the communications director for the Colorado Health Institute. “Now, instead of the government doing that, it’s the government working through private insurance providers to do that.”
Hanel says the change makes the bill more complicated but less of a departure from the current health care system, which is complicated in and of itself.
The Colorado Health Institute doesn’t take positions on legislation, but Hanel says he believes even with the changes, the bill could result in some savings — particularly on the Western Slope and in the mountain communities — and might be the biggest change Colorado lawmakers could pass given the circumstances.
“It turned into something that was not classically a public option, but was still a really big, or one of the biggest, ideas that we’ve seen in lowering health care prices,” he said.
Still, he admits the bill is confusing — likely more confusing than it needs to be and could have loopholes.
Hanel considers the latest amendments to be more technical than anything, with cosponsors trying to decide what would happen to hospitals or doctors that don’t participate, what the fines would look like, who would levy them, whether they would be able to be appealed, and more.
“The fight right now is how much to basically try to stick it to companies in the health care industry, hospitals, doctors, insurance companies in order to lower prices for consumers — how much you can do that without hurting the services that are offered to consumers,” Hanel said.
The Colorado Health Institute hasn’t done a formal study on the measure's effects simply because of how quickly and how constantly the bill is changing; he equates it to capturing lightning in a bottle.
Others say all of these changes prove that the bill needs more work and is not ready to be signed into law.
The Denver Metro Chamber of Commerce, which opposes the bill, argues that this will cause a cost shift, saving some who use the individual marketplace money while putting an additional burden on others.
The bill does have language preventing a cost shift but does not go into details.
“With the amount of concerns we’ve seen, the number of changes in amendments, the strike-below that we saw that bill, I do think it sends a message that there’s more work to do,” said Laura Giocomo Rizzo, the senior vice president of external affairs for the chamber. “I think everybody has questions about what this bill will look like and what the intended and unintended consequences of this legislation will be and I think we should all be concerned about that.”
Rizzo also worries that there is too much ambiguity in the bill over premium target reductions and more. She says the ambiguity makes it seem like the private market will have room to figure out how to make this work, but she doesn’t believe that’s really the case.
Others say the latest version of the bill reads more like a rate-setting mandate for doctors and hospitals than a public option. Rep. Jim Smallwood, R-Parker, says the latest iteration treats them more like a utility to set caps on than anything. He says he's also concerned with the amount of power the bill provides for the insurance commissioner to figure out how things should work.
“I don’t know why there is ambiguity in the bill and I don’t know what the proponents would gain from having some language that’s that open-ended in this. At the end of the day, the bill provides a ton of authority to the Colorado commissioner of insurance to perform a lot of these tasks,” Smallwood said.
He believes this could end up causing the bill to face constitutional challenges.
Even fellow Democrats have expressed some concerns with the bill. During a committee hearing Wednesday, Sen. Janet Buckner, D-Aurora, found herself at a loss for words when voting, saying she finds the bill difficult to keep up with because of all the changes.
She eventually voted yes but said she believes there’s a lot more work to do. Buckner said she is trying to strike a balance between helping her constituents and the hospitals in her area that have had a rough year.
Meanwhile, Sen. Rhonda Fields, D-Aurora, said she appreciates the intent of the bill but believes it is sending the wrong message at the wrong time to a health care system still battling a pandemic. The current version of the bill still allows for penalties of up to $10,000 a day for hospitals or $40,000 a month as well as fines for doctors.
Fields went on to vote yes but said she’s doing so with the upcoming floor debate in mind and hoping to address more of her concerns.
Through the questions and confusion though, Donovan insists the bill will do what it’s intended to do, just in a different way.
“The Colorado Option will decrease costs by 18% on the individual and small group market over a three-year period while making sure that those counties that don’t have health care options that we put another insurance option out there for people to choose from,” she said.
She believes the bill is not ambiguous and will eventually pass through the legislature. Several more amendments are currently being discussed that could offer even more changes to a bill that is radically different from when it started. It’s now in the Senate Appropriations Committee awaiting a hearing.
