1. 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

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

4. Decreased Revenues and Appropriations 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 5 (Projected)

5. Medicaid’s Increasing Share of State Budget Colorado General Fund Operating Appropriations, FY2003-04 to FY2012-13, As Percent of Total 6 (Projected) Source: Joint Budget Committee Appropriations Reports and the Governor's State Budget Request for FY2012-13 ARRA funding

6. Medicaid Caseload Growth 7 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

8. Emerging Health Policy Themes for 2012 Departmental efficiencies and alignmentProgram cost savings and improvementsHealth care workforce: A focus on qualityHealthier communitiesOther proposals: Essential Health Benefits 9

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

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

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

12. Health Care Workforce: A focus on quality 13 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 14 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

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

16. General Assembly: 2012 Key Dates Governor’s budget to JBC Determine available revenue JBC Long Bill Conference committee on Long Bill To Governor Convene Deadline to intro Senate Bills Deadline to Intro House Bills Appropriations Committee Complete Adjourn Budget Process Jan 11 May 9 May 3 Feb 1Jan 27 Nov 1 Feb 1 March 26 April 19 Legislation 17

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

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

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 20

20. Click to change chapter title Allison Summerton 720.382.7092 summertona@coloradohealthinstitute.org