2020 Legislative Summary

ABOUT USCCHI is a nonprofit, consumer-oriented, membership-based, health advocacy organization that serves Coloradans whose access to health care and financial security are compromised by structural barriers,affordability, poor benefits, or unfair businesspractices of the health care industry.

MISSIONCCHI advances the consumervoice to improve access tohealth care for all Coloradans byworking statewide for progresstoward equity, access,affordability, and quality.

VISIONAll Coloradans haveequitable access toaffordable, high-quality health care.

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On January 8, 2020, the second regular sessionof the 72nd General Assembly convened inColorado. Similar to past years, CCHI hadambitious goals to achieve greater access tohigh-quality, affordable, and equitable healthcare for all Coloradans. Unlike past years, the2020 legislative session was unprecedented,interrupting promising momentum on manyhealth care initiatives and requiring an abruptsuspension of activities in March due to theCOVID-19 pandemic. After resuming in lateMay, the legislature returned with a renewedfocus on consumer protections and publichealth. Likewise, CCHI set aside major prioritiesin an effort to focus our attention on efforts ofgreatest urgency and importance to the healthand financial stability of Colorado families.   When considering any legislation, CCHI’sprimary focus is on expanding access to care,improving consumer protections, increasing

2020 Legislative Overview

This CCHI priority bill wouldhave created a public healthinsurance option in Colorado.The plan would havecompeted on the individualmarket with othercommercial health insuranceproducts, and the savingswould have been realized bya reduction inreimbursement rates forhospital services. Planbenefits and qualityimprovement would havebeen contemplated by an 11-member advisory board.HB20-1349 was postponeddue to the COVID-19pandemic.

This CCHI priority bill wasprepared for introduction inMarch and aimed to create a5-member board that wouldhave had the authority toinvestigate and set upperpayment limits for the highpriced prescription drugs inColorado. Due to the publichealth crisis, the bill was notintroduced in the 2020legislative session.

This CCHI priority bill wouldhave ensured thatconsumers have theinformation they need whenbuying into health care cost-sharing arrangements (aka“health care sharingministries”) throughincreased transparencyrequirements, consumerdisclosures, and reportingrequirements. HB20-1008was postponed due to theCOVID-19 pandemic.

HB20-1349"Colorado Affordable

Health Care Option” Rep. Roberts | Sen. Donovan

HB20-XXXX"Prescription Drug

Affordability Board"(bill not introduced)

HB20-1008"Health Care Cost-sharing

Consumer Protections” Rep. Lontine | Sen. Fields

affordability in the health care system, andprotecting progress we have made in the pastsession. This year, our highest priority billswere aimed at increasing affordability throughthe establishment of a Colorado public healthinsurance option, addressing high prescriptiondrug prices by creating a Prescription DrugAffordability Board, and protecting consumersfrom misleading, non-traditional forms ofcoverage. Additionally, CCHI opposed bills thatwould have destabilized the health insurancemarketplace and misled consumers, includingHB20-1199, which would have lowered theminimum attachment point for stop lossinsurance for businesses, and SB20-145, which would have repealed the reinsurance program. CCHI also supported the work of our membersand partners on a variety of other bills relatedto health care. These included a number of billsaimed at lowering prescription drug prices and

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Pre-COVID Priorities

making the supply chain more transparent:HB20-1160, which improved drug pricetransparency; SB20-107, which focused ondrug production cost transparency; HB20-1198, which created more accountability forpharmacy benefit managers; and SB20-119,which expanded the drug importationprogram. We also supported the FAMLIinitiative to pass a bill establishing a paidfamily and medical leave program in Colorado.Additionally, CCHI supported efforts on SB20-033 “Allow Medicaid Buy-In Program AfterAge 65,” HB20-1236 “Health Care CoverageEasy Enrollment Program,” SB20-156“Protecting Preventive Health Care Coverage,”and HB20-1061 “HIV Prevention Medications.” Unfortunately, due to COVID-19, many billsdid not make it across the finish line during 

HB20-1236"Health Care Coverage Easy Enrollment

Program" Reps. Lontine & Will | Sens. Tate & Bridges

This CCHI-member priority allows Coloradansto more easily enroll in health coveragethrough their tax returns. When filing statetaxes, taxpayers will now have the option tobe assessed for eligibility to receive financialassistance through Connect for HealthColorado, the state’s health benefit exchange,in order to purchase affordable healthcoverage. HB20-1235 passed on June 4, 2020.

SB20-215"Health Insurance Affordability Enterprise" Sens. Donovan & Moreno | Reps. Kennedy &McCluskie

This bill captures an expiring federal fee onhealth insurance carriers in order to fund thestate’s reinsurance program, mitigate theunintended consequences of reinsurance, andprovide state-level financial assistance for glitchfamilies and those without properdocumentation. This bill will relieve pressure onthe budget by creating a funding source forreinsurance. SB20-215 passed on June 15, 2020.

SB20-205"Sick Leave for

Employees" Sens. Bridges & Fenberg |Reps. Becker & Caraveo

This bill requiresemployers to providepaid sick days, whichaccrue at one hour per 30hours worked, with anadditional amountduring a public healthemergency. SB20-205passed on June 15, 2020.

SB20-211"Limitations on Extraordinary

Collections Actions" Sens. Gonzales & Winter | Rep.Herod

This bill limits what actionscollections offices can take to collecton debt, including medical debt,during the pandemic. Theselimitations include bans on levies onproperty worth up to $4,000, wagegarnishment, and enforcingjudgments. SB20-211 passed on June12, 2020.

SB20-212"Reimbursement for

Telehealth Services"Sens. Tate & Winter |Reps. Lontine & Soper

This bill expands accessto telehealth by breakingdown barriers carriersoften impose on services;it also requires expandedaccess to telehealth inMedicaid. SB20-212passed on June 13, 2020.

the 2020 legislative session. In an effort to beresponsive to our community needs and theshortened timeline, CCHI supported thepostponement of all of our top legislativepriorities. The pandemic, and its economicimpacts, provided stark evidence for the needfor affordable, comprehensive health care forall people in Colorado. However, thecomplexity of the dynamics of our prioritylegislation—like the Colorado AffordableHealth Care Option and the Prescription DrugAffordability Board—would have commandedmore time than was available during theabbreviated post-recess session. Preparing thelegislation and adjusting to the subsequentpandemic provided important learningopportunities that can help inform both thepolicy and process in future years.

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Post-COVID Priorities

On March 14, 2020, the legislature recessed formore than 10 weeks in response to local publichealth orders. They reconvened on May 26,2020, for three fast and furious weeks. WhileCCHI remains committed to bringing forwardour initial priorities in future years, we tookthis opportunity to shift our focus to legislationthat was directly related to the experiences ofhealth care consumers during the pandemic.   CCHI’s biggest win in 2020, SB20-215, creates afunding mechanism for Colorado’s reinsuranceprogram and state-level financial assistance.Other bills that CCHI supported will alsosignificantly benefit Coloradans. SB20-211limits allowable debt collection practicesthroughout the public health crisis, includingprohibiting garnishments, levies, and executinga judgment on a debt. HB20-1420 closes taxloopholes that unfairly benefit the wealthiestColoradans, providing around $175 million tothe state’s education fund, while alsoexpanding the earned income tax credit thatreduces the tax burden on Colorado’s lowerand middle income families. SB20-205 requiresemployers to offer at least one week of earnedpaid sick leave, and SB20-212 expands access totelehealth services.  COVID-19 ResponseThe legislature also responded to communityneeds in light of the COVID-19 pandemic:HB20-1410, which uses CARES Act funding toprovide housing assistance to peopleexperiencing hardships because of COVID-19through direct financial assistance, funding theeviction defense fund, and providing housingdevelopment grants; SB20-222 and HB20-1413,which establish loan and grant programs forsmall businesses; SB20-213, which extendsGovernor Polis’s executive order allowingrestaurants to sell alcohol to-go, givingrestaurants another source of revenue; andHB20-1414, which creates consumerprotections around price gouging during adeclared disaster. Other Notable BillsSome other notable bills passed and made itinto the headlines: criminal justice reformsinclude SB20-100, which abolished the deathpenalty, and SB20-217, a police accountabilitymeasure that requires officers to wear bodycameras, limits violent police response toprotests, limits the use of deadly force, and 

SCORECARD Typically, CCHI issues a scorecard totrack each legislator’s votes on ourpriority bills to gauge their alignmentwith our priorities. The purpose of thescorecard is to inform the public andCCHI’s members about their legislators’stance on important health care issues.Because of the disruption caused byCOVID-19, CCHI decided not to issuesuch a scorecard in 2020. Instead, thislonger, more in-depth report serves asan accurate overview of the session. Inlieu of a scorecard, we have includedthe following comprehensive list of  billsCCHI took a position on and theoutcome.

HB20-1008 "Health Care Cost-sharingConsumer Protections"   HB20-1061"Human ImmunodeficiencyVirus Infection PreventionMedications"  HB20-1092'"Reimbursement to FederallyQualified Health Centers"  HB20-1160"Drug Price TransparencyInsurance PremiumReductions" HB20-1198"Pharmacy Benefits Carrierand Pharmacy BenefitManager Requirements"  HB20-1236"Health Care Coverage EasyEnrollment Program" SB20-022 "Increase Medical Providersfor Senior Citizens"  SB20-033"Allow Medicaid Buy-inProgram After Age 65"

Support

failed

PASSED

failed

failed

failed

PASSED

failed

PASSED

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SB20-043 "Out-of-network ProviderReimbursement Rate"   SB20-107"Drug Production CostsTransparency AnalysisReport"  SB20-119"Expand CanadianPrescription Drug ImportProgram"  SB20-156"Protecting Preventive HealthCare Coverage" HB20-1420"Adjust Tax Expenditures for State Education Fund"  HB20-1427"Cigarette Tobacco andNicotine Products Tax" SB20-205 "Sick Leave for Employees"  SB20-211"Limitations on Extra-ordinary Collection Actions" SB20-212"Reimbursement forTelehealth Services" SB20-215 "Health InsuranceAffordability Enterprise"

other measures designed to reduce policeviolence; SB20-163, which formalizes theprocess for non-medical vaccine exemptionsand requires schools to publish data on theirimmunization rates; and SB20-200, whichestablishes a secure savings program inColorado, which is a state-run retirementsavings plan. Despite the disruption caused by COVID-19,CCHI was able to support the passage of manylandmark bills, making 2020 a truly historicand unforgettable session. The legislature wastasked with tackling big issues in the face of apandemic, and did not back down; publichealth, the state’s dire budget, and Coloradans’financial security after the collapse of theeconomy were of chief concern to ourlawmakers. While legislators compromised onsome efforts, the legislature still passedsignificant legislation that will help Coloradostabilize and thrive during our road torecovery.

PASSED

failed

failed

failed

PASSED

PASSED

PASSED

PASSED

PASSED

PASSED

Neutral

SB20-005"Covered Person Cost-sharingCollected by Carriers"

failed Monitor

HB20-1078"Pharmacy BenefitManagement Firm ClaimsPayments" HB20-1086"Insurance Coverage MentalHealth Wellness Exam"

PASSED

failed

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Monitor (cont.)

HB20-1264 "Health Care Contract Hospital System Carriers Providers" SB20-127 "Committee Actuarial Review Health Care Plan Legislation"

HB20-1140 "Direct Primary Care Services for Medicaid Recipients" HB20-1199 "Lower Minimum for Employer Health Stop-loss Insurance" SB20-145 "Repeal Colorado Reinsurance Program"

Oppose

failed

failed

failed

failed

failed

Budget Summary CARES Act Funding In March, Congress passed the CoronavirusAid, Relief, and Economic Security Act todefray some of the economic hardships causedby COVID-19. Part of this funding goes to statesto help with their budget shortfalls, while themajority funds specific programs related topublic health. While Colorado received $1.6billion in CARES Act aid, the amount isn’tsufficient to resolve Colorado’s budget crisisand there are stipulations that significantlylimit how the funds can be spent. The moneymust be spent in calendar year 2020, meaningthat any expenses that the state incurs due tothe coronavirus after December will have to becovered by Colorado. The funds also must bespent on items that were not already includedin the budget – meaning that they can’t backfillexisting programs to prevent budget cuts.Instead, the funds must be spent, veryspecifically, on mitigating the effects of COVID-19. In May, Governor Polis announced that themajority of the aid will go toward education,both K-12 and higher education, which will beused to help them build additional resources fordealing with the disease when classes resumein the fall. Some of the aid will go to localgovernments and some to the state’s pandemicresponses, while other funds will go to the statelegislature to support their work on legislationresponding to the virus. Because of the economic crisis that the publichealth emergency created, Colorado faced asteep decline in revenue and a budget shortfall

of $3.3 billion for fiscal year 2020-2021.Additionally,  revenue lost for fiscal year 2019-2020 was estimated to be around $1 billion. TheJoint Budget Committee worked to balance thebudget in this new climate, despite havingalready completed a budget prior to thelegislative recess. The final product includeddebilitating cuts to many of the state’sdepartments and programs. The LongAppropriations Bill (the “long bill”) and theother bills that make up the state budget(“orbital” bills) were finalized on June 12th andsent to the Governor, only weeks before thebeginning of the new fiscal year. Colorado Department of Health Care

Policy and Financing While the CARES Act increased the federalfunding match rate for Medicaid, the federalfunds were not enough to protect theDepartment of Health Care Policy andFinancing (HCPF) from cuts. Medicaid’scommunity provider reimbursement rateswere reduced across the board by 1%. Inaddition to this broad cut, some providers sawtargeted rate reductions, including in-homedialysis and providers for the Program for All-Inclusive Care for the Elderly (PACE). Teachingand pediatric hospital supplements were scaledback, and some Medicaid benefits were alsopared back. Customer service improvementsand funding for various studies were delayed.The low-income senior dental program was cutby $1 million, and the adult dental benefit cap was reduced from $1,500 to $1,000 per person 

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annually. The screening, brief intervention,and referral to treatment (SBIRT) benefit wascut to just $500,000 from $1.5 million. Thecopay amount for Medicaid members alsoincreased, and a behavioral health programand a healthy community outreach programalso faced significant reductions. However, dueto enrollment increases in the Medicaidprogram, HCPF's budget will actually increaseby 11.3% in total funds for FY20-21. Colorado Department of Public Health

and EnvironmentCDPHE also saw deep cuts, including a 1%reduction in local public health provider rates.Many of the grant programs, like the Cancer,Cardiovascular, and Pulmonary Disease fund,which funds programs that reduce theprevalence of chronic disease in Colorado, willtransfer their funds to COVID-related uses,amounting to a $17.7 million reduction ingrants to those programs. Other CDPHEprograms also face significant cuts, includingthe Comprehensive Sexual Education program(half the program’s funding) and the CAREnetwork that provides health screenings forkids who have been abused or neglected (athird of the program’s funding). Otherprograms saw cuts up to 20%: the dentiststudent loan repayment program, TuberculosisControl and Treatment, the Child FatalityPrevention Program, the Office of SuicidePrevention, the Community Crime VictimsGrant Program, the Family Planning Purchaseof Services, and the Primary Care Office, whichprovides funding for addiction counselorscholarships and loan repayment for substanceuse professionals. However, CDPHE’s budgetalso saw increases in funding for immunizationoutreach and air quality resources amountingto around $3 million.

Colorado Department of Health and

Human Services CDHS saw many cuts related to mental healthand substance use disorder prevention andtreatment, and the community provider ratewill also be reduced by 1%. Substance usedisorder treatment programs and generalcapacity will be reduced by over $13 million,including cuts to treatment programs forpregnant women and people in jails.Community mental health centers and jail-based behavioral health programs will see cutsof around $3 million. The department’s welfareand assistance programs, which help peoplesecure food, housing, and other necessities thatare social determinants of health, will also seecuts. However, funding for child care and earlychildhood development programs increased byaround $8 million. Other departments also saw significant cuts:higher education funding was cut by 58%,though this is mostly compensated for byCARES Act funding, although it must be usedon COVID-related expenses. K-12 educationwill see a 7% cut, which will mostly occur bycutting grants to programs like the QualityTeacher Improvement and Behavioral HealthCare Professionals grants. While CARES Actfunding will also go to K-12 education, it isn’tallowed to be used to backfill these programsbecause it must be used only on COVIDexpenditures. Housing assistance programs arecrucial for maintaining health because housingis the most significant social determinant ofhealth. $30 million will be diverted from theHousing Development Grant Fund and grantsby the Eviction Legal Defense Fund will also bereduced. The mental health criminal justicediversion program will also be cut by $1.1million.

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2020 Health Care

Day of Action CCHI’s 12th annual Health Care Day of Actionevent corresponded with our organization’s20th anniversary, so the event on February20, 2020 had the festive feel of a celebrationof our work over the years. Additionally, theevent served to bring community membersinto activism  at the capitol.  This year, over 100 people attended the eventwhere they heard from Governor Jared Polison the importance of expanding access toaffordable health care and the key role ofcommunity activism in getting meaningfullegislation passed. Before heading to thecapitol, the attendees underwent a ‘lobbying101’ training and practiced crafting theirstories in order to connect with legislators togive a personal touch to the policy issues. Atthe capitol, groups of people met withlegislators in the lobbies of both chambers,after learning how to call their legislators offof the House and Senate floors. Many attendees said that this advocacy wasvery valuable, that their story was heard andwould be considered when they made policydecisions, and that it was exciting to meettheir legislators and hear them prioritizeaffordable health care. A panel of legislators,who answered questions and went into detailon policy issues, expanded on their ownlegislative priorities this session and what theimpact would be for health care consumers.Overwhelmingly, people valued meeting theirlegislators and hearing that their voicesmatter in the policy process.

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