2009 Legislative Update Colorado State Association of Health Underwriters Presented by Cindy Sovine-Miller

1. 2009 Legislative Update Colorado State Association of Health Underwriters Presented by Cindy Sovine-Miller

2. Branches of Government • Executive Branch • The Governor heads the state's executive branch. • The Governor is elected statewide and may serve up to (2) four year terms. • Branch consists of all State Departments and Agencies which implement laws passed by the Legislative Branch. • Legislative Branch • The Colorado Constitution places the power to make laws with the state legislature, the Colorado General Assembly. • The General Assembly cannot delegate this power, and no other branch of state government can usurp it. • Judicial Branch • The Colorado Supreme Court, whose decisions can be overturned by Federal Courts, rule on the Constitutionality of laws passed. • State judges and justices are appointed by the Governor, then elected to ten-year terms. The current Chief Justice of the Colorado Supreme Court is Mary Mullarkey. • The Colorado Supreme Court is the highest court in the U.S. state of Colorado.

3. The Colorado Legislative Process • Laws Begin as Bills • Most Bills are drafted out of session (Interim) • Each Legislator can propose 5 bills (with some exceptions) • The Long Bill is the budget bill, developed by the Joint Budget Committee • Bills are ideas that come from constituents and advocacy groups (a.k.a special interest groups) • The "version" of a bill indicates where it is in the process. Source: “The Legislative Process”, Colorado Legislative Council

4. The Colorado Legislative Process • Bills have different names, or versions, depending on where they are in the process • (1)Printed bill- the bill as introduced before any amendments are added. • (2)Engrossed bill- the bill as passed on second reading in the house of introduction. It includes any amendments adopted by that house on second reading. • (3)Reengrossed bill- the bill as passed on third reading in the house of introduction.  It includes all amendments adopted by that house. The reengrossed bill is the version sent to the second house for introduction and consideration by a committee of reference. • (4)Revised bill- the bill passed on second reading in the second house. It includes any amendments made to the bill on second reading by the second house. • (5)Rerevised bill- the bill as passed on third reading in the second house. The rerevised bill is then sent back to the house of origin for enrollment and transmittal to the governor for his or her action. • (6)Enrolled bill- after passage of a bill by both houses, the bill is printed in the form in which it will appear in the session laws.  This enrolled bill is the version signed by the President of the Senate, the Speaker of the House, and the Governor. Source: “The Legislative Process”, Colorado Legislative Council

5. The Colorado Legislative Process

6. How a Bill Becomes a Law

7. Other Resources

8. Colorado State Budget Source: Colorado Legislative Council

9. Colorado State Budget Colorado is Constitutionally required to maintain a balanced budget • The March 2009 Colorado$800 Million Revenue Shortfall in Colorado • Program Cuts across the board • 1.82% Reduction in all State Agencies (roughly equivalent of 8 furlough days for state employees) • 2% cut to Medicaid Reimbursement Rates • $180 cut to Senior Property Homestead Exemption • Over $150 Million in cuts to Higher Education Desperate times for legislators: Pinnacle Assurance

10. 2009 Legislative Session Introduced Bills House              368 Senate             296 Total               664 CSAHU tracked 40 bills and active worked on 22 of them.

11. 2009 Legislative Session CSAHU Leg Committee Criteria for Evaluating Legislation: • Will the legislation if implemented increase the cost of insurance? • Will the legislation if implemented increase access to insurance • Will the legislation if implemented improve competition? • Will the legislation if implemented increase regulation? • What is the practical ability of CSAHU to influence this legislation? • How can this bill be made better? • Does this bill move us closer to a state run health insurance plan?

12. 2009 CSAHU Legislative Agenda

13. 2009 CSAHU Legislative Agenda

14. CSAHU Major Legislation • HB 1012 – Wellness and Prevention (Support) This bill allows insurance carriers that provide individual and group health insurance plans in Colorado, to offer incentives for participation in wellness and prevention programs. Carriers are given flexibility in determining the types of programs offered as long as: • program participation is not a condition of coverage; • participation in the program is voluntary; • participants are not required to achieve a specific outcome to receive the incentive; and • the incentive is not used as a marketing device for the insurance plan. The bill is effective July 1, 2009

15. CSAHU Major Legislation • HB 1143 – Limited Benefit Plans (Support) This bill allows health maintenance organizations (HMO) the option to offer basic health care services to enrollees through limited benefit plans. Basic health care services are considered services that an HMO policyholder might require to maintain good health such as doctor and hospital visits, laboratory, and x-ray services. Limited benefit plans are not defined in the legislation, but generally such plans are offered at low cost and limit the amount of payments on particular services and total coverage per person The bill is effective August 4, 2009

16. CSAHU Major Legislation • HB 1209 – Health Care Cooperatives (Opposed) This bill modifies statutory provisions governing health care coverage cooperatives, accordingly: • requires insurance carriers to offer rates for health benefit plans that are competitive with plans offered to employers of similar size that are not part of a cooperative; and requires insurance carriers to offer a basic and standard plan upon request of a cooperative. • requires employers to include at least 60 percent of their employees in coverage purchased through a cooperative; • requires cooperatives to offer the same premiums and any negotiated health care prices to all member classes; • exempts cooperatives from the requirement to offer standard and basic health benefit plans to small employers; Postponed Indefinitely 3.16.09

17. CSAHU Major Legislation • HB 1224 – Prohibit Gender Rating in Individual Market (Opposed) As introduced, this bill prohibited insurance companies from using gender as a factor in determining the rate for an individual health insurance policy. CSAHU worked to amend the bill into an Interim Study to determine the actuarial impact of such a move. Awaiting Governor Action • HB 1256 – Multi-State Purchasing Agreements (Support) The bill authorized the commissioner to enter into multi-state agreements to enable the purchase of out-of -state health insurance products. Postponed Indefinitely 4.03.09

18. CSAHU Major Legislation • HB 1273 – Single Payer Authority (Opposed) As introduced, the bill created a 23 member Health Care Authority charged with creating recommendations to the General Assembly on how to implement a single-payer health care system. The criteria included: • the establishment of regional systems to administer and pay for comprehensive medical coverage; • the impact of incorporating medical portions of liability insurance, workers’ compensation, and auto insurance; • a financing system that includes means-based fees or premiums from all Colorado residents who are eligible to participate and coordination with existing federal and state funding; and • other issues relevant to creating a new health care system. Laid Over to July 6th 2009 (Same as Postponed Indefinitely)

19. CSAHU Major Legislation • HB 1293 – Hospital Provider Fee (Support) Allows the Department of Health Care Policy and Financing (DHCPF) to collect hospital provider fees to obtain federal matching dollars for the state's Medicaid programs. The additional dollars will be used to: • Increase reimbursements to hospitals; • Increase the income eligibility limit for the Children's Basic Health Plan (CBHP) from 205 up to 250 percent of the federal poverty level (FPL) for both children and pregnant women; • Increase the income eligibility limit for Medicaid for parents from 60 up to 100 percent FPL; • providing for 12-month continuous eligibility for children in Medicaid; • create a new Medicaid buy-in program for disabled adults and children with income up to 450 percent FPL; and • Create a new medical assistance program for childless adults with income up to 100 percent FPL. Governor Signed on 4.21.09

20. CSAHU Major Legislation • HB 1349 – Concerning Continuation Coverage (Support) • This bill provides a special election period to certain individuals who were involuntarily terminated from employment between September 1, 2008, and February 16, 2009, to choose health insurance continuation coverage. • Employers are required to send a written notice to qualified individuals about the special election period. Coverage must be elected within 60 days of the date of the notice. • Health insurance coverage providers are required to give employers the information necessary to fulfill the notification requirements. In Process

21. CSAHU Major Legislation • HB 1358 – Creation of a Health Care Authority to Administer a Health Care System – South Metro Chamber of Commerce (Conditional Support) The bill establishes the Comprehensive Health Care Reform Act and the Colorado Health Care Authority. The authority is a statutory public entity, and is governed by a 17-member board of directors. It is considered a political subdivision of the state, but is not an agency of state government or subject to direction by any state agency. The authority is to recommend: • an individual mandate for coverage and an enforcement mechanism; • recommendations concerning the impact of incorporating medical portions of liability insurance, workers' compensation, and auto insurance; • use of information technology including personal health records, administration and evidence-based practices; • a financing system that includes coordination with existing federal, state, and private health care funding as well as vouchers issued on an income-based sliding scale; and • other issues the board deems necessary to design and implement a new health care system. Postponed Indefinitely 4.24.09

22. CSAHU Major Legislation • SB 159– Dependent Coverage Age (Oppose) The bill would have changed the age of a individual for which a health insurance carrier is required to offer dependent coverage from 25 to 30. It also prohibits insurance carriers from terminating coverage for dependents who take a medical leave of absence from an institution of higher education. Postponed Indefinitely 3.18.09 • SB 244 – Mandatory Private Health Insurance Coverage of Autism Spectrum Disorders (Opposed) Requires all health insurance policies, subject to state regulation, to provide coverage to assess, diagnose, and treat autism spectrum disorders (ASD). Failure to include this coverage is considered an unfair or deceptive practice in the business of insurance. The bill includes definitions of terms including: ASD, applied behavior analysis, autism services provider, and treatment for ASD. Insurance carriers cannot deny coverage for applied behavior analysis or for physical, speech or occupational therapy for the treatment of ASD on the grounds that it is not medically necessary, unless a treatment review has been completed in the prior 60 days. Still in Process

23. CSAHU Major Legislation • SB 159– Dependent Coverage Age (Oppose) The bill would have changed the age of a individual for which a health insurance carrier is required to offer dependent coverage from 25 to 30. It also prohibits insurance carriers from terminating coverage for dependents who take a medical leave of absence from an institution of higher education. Postponed Indefinitely 3.18.09 • SB 244 – Mandatory Private Health Insurance Coverage of Autism Spectrum Disorders (Opposed) Requires all health insurance policies, subject to state regulation, to provide coverage to assess, diagnose, and treat autism spectrum disorders (ASD). Failure to include this coverage is considered an unfair or deceptive practice in the business of insurance. The bill includes definitions of terms including: ASD, applied behavior analysis, autism services provider, and treatment for ASD. Insurance carriers cannot deny coverage for applied behavior analysis or for physical, speech or occupational therapy for the treatment of ASD on the grounds that it is not medically necessary, unless a treatment review has been completed in the prior 60 days. Still in Process

24. CSAHU Next Steps • Staying involved in the Dialogue • Public Option • Individual Mandate • Employer List Bill • Education and Advocacy Efforts • Continued focus on awareness of the value the broker brings to health care. • Work to achieve CSAHU policy goals and resist efforts that work against a healthy market place. • Strengthening Grass Roots Efforts • Accept the political landscape. Make an effort to get to know and establish a relationship with your Congressional and State elected officials. • Communicate what CSAHU is doing for your clients and keep them aware of what is happening. • Speaking with One Voice • Being consistent with CSAHU’s message is the most important thing any member can do for the organization. Take the time to understand what CSAHU is doing on your behalf. • Communicate with your chapter’s representative on the CSAHU Legislative Committee to communicate suggestions, questions or concerns. • Partnership for a Healthy Colorado • Multi-stakeholder group initiated by CSAHU who meets independent of Government to work on meaningful steps for health care reform.

25. Get Involved – Stay Involved • Visit www.nahu.org to locate your elected officials • Visit www.csahu.org to access copies of this presentation and access CSAHU’s entire bill matrix. • Contribute to the CSAHU PAC PAC Chair: Bill Killgore (970) 257-7700 bkillogore@qwest.net

26. CSAHU Legislative Committee CSAHU Rep Claudia Maciuk (303) 774-2614 cmaciuk@vbbenefits.com Dorothy Marshall, (303) 516-0522 dorothy@davidmarshall.com FRAHU Jim Sugden (720) 480-4937 jsugden@ebscolorado.com David Marshall (303) 516-0522 david@davidmarshall.com MDAHU Bea Green (720) 207-2321 Bea.green@gemingrp.com Sheryl Briles-Thompson (303) 831-2057 sheryl.r.thomson@kp.org NCAHU Cindy Guldy (970) 674-3556 cguldy@ft.newyorklife.com Scott Rankin Scott.rankin@wilbansecurities.com SCAHU Sharlene Yabe (719) 210-2160 sharlene@transbens.com Carlos Douglas (719) 578-5570 CAD1048@aol.com WRAHU Randy Pifer (970) 241-5542 rpifer@employeebenefits.cc Anita Pollock (970) 424-5107 apollock@ascecntbenefits.com

27. Cindy Sovine-Miller Political Consultant Sovine Miller & Co Cindy@SovineMiller.com 720-290-5327