A Preview of the 2012 Colorado

Legislative Session

CO AHEC, Central CO AHEC and CHI Conversation Series

January 4, 2012

2

A Challenging Year for Health Policy in 2012

• Competing spending priorities

• Supreme Court ruling on the federal health reform law (ACA)

• Divided legislature and 2012 elections

3

Budget Challenges

State General Fund revenues projected to be $30 Million below

pre-recession levels

Medicaid enrollment increased 72%Children’s Health Plan (CHP+) 19%K-12 student enrollment 6.8%Higher education enrollment 20.5%Annual State Park visits 6.5%

4

Decreased Revenues and Appropriations

FY2003-04 FY20004-05

FY2005-06 FY2006-07 FY2007-08 FY2008-09 FY2009-10 FY2010-11 FY2011-12 FY2012-13 -

1,000,000,000

2,000,000,000

3,000,000,000

4,000,000,000

5,000,000,000

6,000,000,000

7,000,000,000

8,000,000,000

OtherHuman ServicesCorrectionsHigher EducationHCPFEducation

Colorado General Fund Operating Appropriations FY2003-04 to FY2012-13

Source: Joint Budget Committee Appropriations Reports and the Governor's State Budget Request for FY2012-2013

(Projected)

(Projected)

5

Medicaid’s Increasing Share of State Budget

FY2003-04 FY20004-05

FY2005-06 FY2006-07 FY2007-08 FY2008-09 FY2009-10 FY2010-11 FY2011-12 FY2012-13 0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

EducationHCPFHigher EducationCorrectionsHuman ServicesOther

Colorado General Fund Operating Appropriations, FY2003-04 to FY2012-13, As Percent of Total

(Projected)

(Projected)

Source: Joint Budget Committee Appropriations Reports and the Governor's State Budget Request for FY2012-13

ARRA funding

6

Medicaid Caseload Growth

Source: HCPF Budget Request for FY2012-13,American Community Survey and Colorado Department of Labor and Employment

7

Medicaid Options

• Reducing eligibility• Reducing benefits• Reducing payments

to providers• Payment and

delivery reform

8

Emerging Health Policy Themes for 2012

Departmental efficiencies and alignment

Program cost savings and improvements

Health care workforce: A focus on quality

Healthier communities

Other proposals: Essential Health Benefits

9

Hickenlooper administration initiatives to make delivery of services more effective and efficient:

Departmental Efficiencies and Alignment

• Redesign and align long-term care services and supports under one agency (HCPF)

• New Office of Early Childhood and Youth Development in Department of Human Services to consolidate early intervention

10

Program cost savings and improvements (1)

Gain-sharing incentive payments for providers who

reduce expenditures through improved care management

Rate and service adjustments to

foster use of most cost-effective

services

Co-payments to encourage personal

responsibility

Administration payment reform proposals

11

Expand oral health services to pregnant

women to reduce transmission of caries to young

children

Develop electronic filing

system for death certificates to

reduce overhead costs

Align state regulation of

health information with national HIPPA

laws

Program cost savings and improvements (2)

Expected legislation

12

Health Care Workforce: A focus on quality

• Require the Colorado Department of Regulatory Agencies (DORA) to collect health care workforce information.

• Continue the Colorado Professional Review Act and extend to advanced practice nurses and physician assistants.

13

Healthier Communities

• Prohibit sale of foods with trans-fatty acids in schools

• Limit youth access to dissolvable tobacco products

• Allow local governments to tax tobacco products without losing their local share of state tobacco tax

14

Implementing Health Reform

States are to choose essential health benefits for individual and small group insurance plans from one of 4 benchmark plans currently offered in state:

• One of the 3 largest small group plans in the state

• One of the 3 largest State employee health plans

• One of the 3 largest federal health plan options

• The largest HMO plan offered in state commercial market

15

The Supreme Court and the ACA

• Is the individual mandate constitutional?

• Severability: are other parts of law void without the mandate?

• Can states be required to expand Medicaid?

U.S. Supreme Court will hear arguments on the constitutionality of ACA in March. Decisions include:• Can legal claims can be made

before tax goes into effect in 2014?

16

General Assembly: 2012 Key Dates

Governor’s budget to JBC

Determine available revenue

JBC Long Bill

Conference committee on

Long BillTo Governor

ConveneDeadline to intro Senate

Bills

Deadline to Intro House

Bills

Appropriations Committee Complete

Adjourn

Budget Process

Jan 11 May 9May 3Feb 1Jan 27

Nov 1 Feb 1 March 26 April 19

Legislation

17

Summary

• No easy solutions• We’re likely to see many more proposals and

extended budget negotiations. However . . .• Unlikely to see new programs or spending• Continued efforts to improve efficiencies

of current programs• Groundwork for discussion of Colorado’s

structural budget constraints

18

Ongoing Colorado Debate

Concern about increasing public and private health care expenditures will focus debate on:

1. What are the most essential health services? And . . .

2. What is the most cost-effective way to deliver them?

19

CHI Resources

• Legislative Opportunities and Trends Report 2012

• Colorado Medicaid: Options for Cost Containment

• Long-term Services and Supports in Colorado• Legislation in Review: Advancing Health in

Uncertain Times• Legislative Opportunities and Trends Report

2011

Click to change chapter title

Allison Summerton • 720.382.7092 • summertona@coloradohealthinstitute.org