Marianne Goodland, Colorado Politics 

The battle over a public option bill for the 2021 session has started about the same way it left off in 2020: with both sides claiming the other isn’t acting in good faith.

Three groups that could be most affected by such a bill have gone public with claims that they have been left out of virtually every discussion of how that policy should look. That prompted a letter sent to the governor and legislative leaders on Wednesday from those three groups: the Colorado Medical Society, the Colorado Association of Health Plans and the Colorado Hospital Association. It came with a plea: talk to us, please!

The three organizations aren’t always on the same page on health care issues, so the collaboration that produced the letter is a bit unusual. While politely worded, it  conveys the frustration that has been building over the last several years, and more so in this pandemic era.

But those working on the bill say they have been talking to the three groups, and that the letter is similar to the political posturing the groups engaged in last year, in an effort to kill the 2020 version. That bill went down to defeat last June in the wake of the pandemic.

The letter points out the historic challenge facing the healthcare industry during a pandemic. It’s required health insurers to modify policies to meet both patient and provider needs, alongside nearly five dozen regulatory changes issued by the state’s Division of Insurance. At the same time, providers and hospitals have worked together, the letter said, to improve clinical care and increase telehealth as part of dealing with the pandemic.

Then there’s dealing with the changes that have come from more than 30 bills passed by the General Assembly in the past three years dealing with all aspects of health care: insurance, what’s covered by insurance, reinsurance, and hospital transparency on financial measures, for example.

But “there has been a lack of authentic and early engagement with our sector and we are concerned about this trend continuing in 2021,” the letter said. “While we may not always agree with policymakers or with each other on policies, we do agree that there should be transparent processes for providing feedback and space for collaborative improvement on access and affordability policies. We have serious concerns that ‘surprise’ policies in 2021 could destabilize the market and be harmful to Coloradans while the entire sector is focused on maintaining coverage and care for both COVID and non-COVID patients.”

That’s a reference to the public option bill currently being drafted by Democratic lawmakers.

“While policymakers may have the best intentions, our knowledge and expertise are essential to creating and implementing sound policies that do not have adverse effects on those we hope to help – especially when considering how current implementation will align (or not) with proposed policy,” the letter concluded.

A statement from hospital association CEO Chris Tholen said, “We have learned a lot over the last 10 months, and most important is the fact that when we work together, we create the most effective solutions. It is concerning that important healthcare policy development going into the 2021 legislative session is happening without any input from those that provide care to Colorado. Our industry has been collaborative and will continue to bring solutions to the table — both independently and voluntarily and also in partnership with the administration and legislators — to address access to care, ensuring capacity to care for all patients, health care costs and more. As ready and willing partners, we know that working toward specific shared goals will result in solutions that truly benefit all Coloradans.”

But state Sen. Dylan Roberts, D-Eagle, who will be one of the sponsors of a public option bill in the 2021 session, is frustrated by the letter. He said their claims are incorrect, and that it’s another example of political posturing, continuing a tactic they employed in 2020. He noted the letter wasn’t addressed to him or any of the other lawmakers who are working on the bill, which includes Sen. Kerry Donovan, D-Vail, and he said the groups do know who’s working on it.

“I’ve been in dozens of conversations with all of the stakeholders throughout the fall and winter, including [Wednesday] with the hospital association. I’m in constant contact with them, keeping them in the loop with every update. I was disappointed to see that letter, more of a political posturing letter than a genuine discussion of policy,” Roberts said.

He pointed out that the 2021 session doesn’t start for another six weeks at the earliest. “That bill isn’t going to be introduced next week and we’re still working on major details.” Roberts said he’s always approached the process in good faith and still hope they will join him in working on the bill, but that sending letters to the governor and press does not show a good faith effort.

Roberts also said he believes they will be opposed to the public option, no matter what it looks like. “This is a transformative change for health care, so we don’t expect them to be cheerleaders. “ But if they work with the bill sponsors, conversations will be more productive if they don’t go to the press or send out letters with false information, he said.

While the letter is addressed to legislative leaders as well as the governor, it appears the frustration may be more with the governor’s office.

Amanda Massey of the Colorado Association of Health Plans said they have no idea just what’s being proposed in the public option bill. “The letter was intended to encourage meaningful engagement on healthcare policies, yet we don’t know what the goals of the administration are with regard to the public option,” she told Colorado Politics Thursday. The three groups have reached out to the governor’s office for a discussion on goals and solutions and gotten no response whatsoever.

That lack of engagement has happened before, Massey said, most recently with Senate Bill 20-215, the law that levied millions of dollars in fees on health insurance providers in order to fund two more years of the state’s reinsurance program.

Adam Fox of the Colorado Consumer Health Initiative, one of the main stakeholders in the public option discussion told Colorado Politics that lawmakers are trying to determine the best formulation for the policy, and bringing in more stakeholders. “There’s an acknowledgement that this approach can’t be the same as last year,” Fox said. The state’s financial situation doesn’t allow for a true public option, such as a Medicaid/Medicare for all, he explained. “The ultimate goal is to achieve more affordable coverage, and in order to do that we have to control and reduce costs,” such as in deductibles or other out-of-pocket costs or premium costs.

But some of the blame also lies with the groups, Fox explained. Some of these groups didn’t create a lot of good feelings last session when they started blasting the idea of a public option before a policy was even introduced. “They’re out of hand dismissing the concept in its entirety, which doesn’t create goodwill with the bill sponsors,” Fox said. That included ads against the public option, including on Colorado Politics’ website, which have been running for almost a year.

“They’re not being excluded,” Fox said. “They’ve expressed their concerns to the bill sponsors, who aren’t developing this policy in a vacuum.”

Thursday evening, the governor’s office said in a statement to Colorado Politics that “For years, Coloradans have cried out for their elected officials to find solutions to the out-of-control costs of health care – people simply cannot afford their care. This is why one of Governor Polis’ top priorities is to save people money on healthcare. Before this global pandemic, nearly one in five Coloradans went without needed health care because it cost too much. One in three Coloradans couldn’t afford their prescription drugs. We know the pandemic and the associated economic challenges have worsened this reality for Colorado families. We have to save people money on health care and we will continue fighting to do so. We are always happy to talk to stakeholders and do talk to all three of these groups on a regular basis on a range of issues. We are pleased that these important stakeholders want to be part of the conversation about saving people money on health care and hope they will help in the development of, as well as support the passage of a meaningful proposal.”

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