Position in Brief

Support access to adequate health care with funding by state and federal monies where necessary. LWVCO supports access to affordable, quality in- and out-patient behavioral health care, including needed medications and supportive services, for all people. LWVCO supports access to behavioral health care that is integrated with, and achieves parity with, physical health care.

POSITION: (adopted 1987)

LWVCO believes:

• The state of Colorado should bear some financial responsibility for funding programs to guarantee access to health care.
• Additional state monies should be generated to fund health care from “sin” taxes (alcohol, tobacco, luxury items) and income tax increases.
• Physicians should be required to participate in state and federal health programs which serve the low-income and elderly population.
• Medicaid coverage should be expanded to cover children and pregnant women at, or below, 150% of the federal poverty level.
• LWVCO supports policies and programs to increase efficient use of our health care dollars by increasing reimbursement for wellness and preventive care, decreasing inappropriate medical services, and providing universal access to primary health care for all Colorado residents regardless of income level.

Behavioral Health: (Adopted 2015)

Support for:

• Behavioral Health as the nationally accepted term that includes both mental illness and substance use disorder.
• Access for all people to affordable, quality in- and out-patient behavioral health care, including needed medications and supportive services.
• Behavioral Health care that is integrated with, and achieves parity with, physical health care.
• Early and affordable behavioral health diagnosis and treatment for children and youth from early childhood through adolescence.
• Early and appropriate diagnosis and treatment for children and adolescents that is family-focused and community-based.
• Access to safe and stable housing for people with behavioral health challenges, including those who are chronically homeless.
• Effective re-entry planning and follow-up for people released from both behavioral health hospitalization and the criminal justice system.
• Problem solving or specialty courts, including mental health and drug courts, in all judicial districts to provide needed treatment and avoid inappropriate entry into the criminal justice system.
• Health education – from early childhood throughout life – that integrates all aspects of social, emotional and physical health and wellness.

History

Since 1990 LWVCO has supported legislation for the creation of a health insurance plan for people who could not get insurance. In 2001 League supported Cover Colorado which strengthened and updated state assistance to those denied insurance because of pre-existing conditions.

In 1994 an insurance reform bill to improve access to health insurance for small businesses was passed with League support.

In 1997 League supported several changes to the way Medicaid services were provided in Colorado. Recipients were encouraged to enroll in HMOs instead of more expensive fee-for-service systems. The state was able to participate in the national Children’s Health Insurance Program (CHIP) which provides insurance for children who would otherwise be uninsured. Because enrollment was lower than expected, legislation was passed in 2001 with League support to make paperwork easier, allow annual instead of monthly payments, lower family contributions, as well as set a higher income threshold at which families could qualify (185% of Federal Poverty Level (FPL) versus 150%).

Mental health parity was enacted in 1997 with League support. This law required health care policies to provide coverage for treatment of six major mental illnesses at least equal to coverage for physical illness.

League lobbied for several years on behalf of a bill strengthening protections against female genital mutilation. It passed in 1999.

In 2001 League supported legislation, which passed, aimed at providing greater protection for Colorado children whose families object to medical treatment, based on their religious convictions.

During the 2002-03 legislative sessions, the League worked on major bills related to health insurance, prescription drugs, increased access to health care and mandated health benefits. However, limits were placed on medical assistance services for Medicaid participants, mental health services were reduced, enrollment of pregnant women in health care programs was suspended and limits were put on children enrolled in the Child Health Plan+ program (CHP+). Private duty nursing services for persons in assistance programs were reduced. Health insurance bills, especially those relating to small businesses which reduced the mandated benefits which employers must provide to their employees, were not supported by the League.

In 2004 League supported a bill that increased the eligibility for health care for children and pregnant women from 185 to 200% of the FPL, funded medical assistance to legal immigrants and removed the asset test under the medical assistance program for children and families.

In 2007, supported by the League, bills passed to provide prescription drug benefits, and to establish the Colorado Cares Rx Drug Program to provide generic and non-patented drugs.

In 2008 a Blue Ribbon Commission for Health Care set up by the 2006 Legislature reported on alternative health delivery systems. Spearheaded by the Larimer County League, LWVCO was in the forefront of this effort, testifying throughout the state. One of the five final plans, the provision for universal health care coverage, was supported by the LWVCO. Also in 2008 the number of children covered by federal government programs was increased, by raising income eligibility for the Baby and Kids Care program under Medicaid to 133% of the FPL. For the CHP+ program for children not covered under Medicaid, the percentage of the FPL increased to 225%. This program also covered pregnant women.

In 2008 Governor Bill Ritter formed a Behavioral Health Cabinet. Its mission was “to strengthen the health, resiliency and recovery of Coloradans through quality and effective behavioral health prevention, intervention, treatment and recovery.” The economic crisis that began in 2008 caused such stringent spending reductions that many behavioral health programs were scaled back or were not funded.

In 2009 LWVCO supported the Colorado Healthcare Affordability Act, assessing a fee on hospitals to raise revenue to be used to obtain matching federal dollars. This successful act increased reimbursements to hospitals under the Medicaid and Colorado Indigent Care program, thus increasing the number of people covered by medical assistance. The League supported the Colorado Guaranteed Health Care Act which would have created single-payer health care coverage, but it was defeated. Recruitment of foreign-trained physicians for underserved areas was facilitated and assistance for student loan repayments for persons serving in these areas was approved.

During the 2010 session, LWVCO supported four bills to standardize and increase the efficiency of the health insurance claims process. Regulations for school districts to provide parents with up to date information on their children’s immunization requirements and status were put in place. Gender cannot be used to allow varied premiums for health insurance coverage. Mammography may be individualized for each patient.

In Colorado, behavioral health includes the areas of mental health and substance abuse. In 2010 four pieces of behavioral health legislation, all supported by the League and all signed into law, established infrastructure and planning to increase access to adequate behavioral health care. One expanded the system of family advocates to include family systems navigators to help families get through complex behavioral health benefits and related systems. Another authorized state agencies to enter into public/private agreements with nonprofits. The next one authorized the state Department of Human Services to review current behavioral health crisis services and formulate a plan to address the lack of coordinated crisis response services. The last authorized the Governor to create a Behavioral Health Transformation Council as an advisory body to study and recommend changes in statewide behavioral health care design and delivery.

In 2011 LWVCO opposed a bill adding monthly premiums for some families whose children are enrolled in the CHP+ program. The bill passed but was vetoed by the Governor. The Colorado Health Benefit Exchange, supported by LWVCO, sets up a marketplace where businesses and individuals band together to pool risks and achieve greater buying power for the purchase of mandated insurance coverage. The bill passed. LWVCO also supported the unsuccessful Colorado Health Care Cooperative bill which proposed creating an authority to design a health care cooperative for Colorado. The legislature passed, and the League supported, a first step toward integrating public behavioral health and physical health services. The bill requires the Department of Health Care Policy and Financing (HCPF) to report to the legislature issues that relate to the provision of both physical and mental health care services to a patient during the same appointment.

In 2012 League supported successful legislation to increase access to health care, requiring that bills to uninsured patients be capped at the lowest negotiated private payer rate and requiring screening for discount and charity eligibility. League also supported unsuccessful legislation requiring hospitals to provide notice of all services that the hospital refuses to provide because of religious beliefs.

Also in 2012, following the mass murders at a theater in Aurora, Governor Hickenlooper proposed and the legislature authorized the development of a statewide network of 24-hour crisis centers for people with mental health emergencies. Difficulties with the Request for Proposals and lawsuits delayed the implementation of these centers until late 2014.

In 2013 the LWVCO authorized a Behavioral Health Task Force to provide the League with information to more fully understand the state of behavioral health in Colorado, and the public policy needs. The Task Force decided on its scope of work, heard from 13 highly qualified experts in behavioral health, researched and read publications, and obtained information from other Colorado resources. Seventeen Task Force members – psychotherapists, medical professionals, a former state representative, a former chief/district judge, a county commissioner, director of a substance use prevention agency, parents of adults with mental illness, and volunteers on statewide and county boards and behavioral health organizations – represented 10 Colorado Leagues.

In its study published in May, 2014, the Task Force recommended that League advocacy positions should include Behavioral Health and health care should include parity between behavioral and physical health services. Everyone in Colorado with a behavioral health challenge should be able to access affordable, quality care and treatment, and Colorado must make available, from many points of entry, early and affordable behavioral health intervention and treatment for children and adolescents. Colorado needs to increase the number of beds available across the state for civil commitments, and behavioral health crisis centers across the state must be implemented as soon as possible. School curricula should be expanded to include units on behavioral health, and mental health screening should be provided in schools. Also, Colorado needs to provide strengthened, high quality services for people with behavioral health challenges who are re-entering communities after incarceration or civil commitment.

In 2013, supported by League, the keystone bill, Expand Medicaid Eligibility, was passed. This extends Medicaid coverage to incomes at approximately 138% of the federal poverty level and fills the lower income health insurance gap before eligibility for the subsidized state health insurance exchange kicks in. Four other bills that League supported will facilitate ongoing implementation of the federal Patient Protection and 2010 Affordable Care Act and Colorado’s own SB11-200 creating a state health benefit exchange. League opposed a failed attempt to repeal the exchange. League also supported legislation addressing inconsistencies or gaps in health care coverage, including required reporting of elder abuse.

In 2014, as the Affordable Care Act (ACA) was rolled out nationwide, Colorado opened the doors on its own health benefit exchange called Connect for Health Colorado. In the 2014 legislative session League supported successful supplementary health care bills that promoted access, quality and affordability. Financial Assistance in Colorado Hospitals furthered efforts begun in earlier years to promote transparency and accountability by hospitals on behalf of lower income clients; Family Medicine Residency Programs in Rural Areas supported rural training for primary care physicians, thereby enhancing provider accessibility in rural Colorado; and Colorado Commission on Affordable Health Care resulted in a commission to look at rising health care costs and find long-term statewide solutions for consumer and public affordability.

In 2014 and 2015 League continued to oppose bills that sought to weaken Colorado’s rollout of health care reform, including repealing the health benefit exchange. All failed.

In 2014 League supported three bills that became law. First, Use of Isolated Confinement for Mental Illness requires that “the DOC shall not place a person with serious mental illness in long term isolated confinement except when exigent circumstances are present.” It also requires the establishment of a work group made up of Corrections management and psychiatric personnel, inmate advocates, and independent mental health professionals to advise the Department on the proper care and treatment of severely mentally ill offenders in long term isolated confinement.

Next, a suicide prevention commission was established, made up of a cross section of public and private individuals, to examine the issue of suicides in the state and to address issues related to suicide prevention.

Finally, Mental Health Duty to Warn Target Entities was a response to the Aurora theater shooting in 2012. As the law stood, therapists had a duty to warn possible targets of their clients “where the patient has communicated to the mental health provider a serious threat of imminent physical violence against a specific person.” The scope was changed to include warning larger, though still specific, entities, such as theater owners, that a mentally ill person had voiced credible threats against them.

League also supported a bill that failed to pass. The Legislative Civil Commitment Task Force recommended combining the statutes regarding alcohol and substance abuse and mental illness commitments into one comprehensive law. Opposition came from 2nd amendment advocates, who objected to portions of the current statutes mandating the reporting of court-ordered commitments to the Colorado Bureau of Investigations for use in background checks for gun sales. A substitute bill was introduced that would have modified the definition of gravely disabled and eliminated “imminent” danger and added “recent threats or actions” indicating danger to self or others, as the Task Force had recommended. It was withdrawn by the sponsor, because it also was opposed by gun rights advocates.

In 2015 League supported three bills to make incremental changes benefitting those who need behavioral health services. A bill passed that includes autism spectrum disorders in the state’s mental health parity law. Another bill that passed expanded the definition of mental health professionals to allow more professionals to treat minors with only the minor’s consent. While the League supported an effort to create a pilot program for Alcohol and Substance Abuse Medical Detox Centers within the Dept. of Human Services, it was postponed indefinitely due to lack of funding.

In 2015 League supported two bills that passed that will aid patients to remain in their homes by requiring hospitals to provide enhanced transitions for patients and by studying caretaker respite needs. League continued its ongoing support of rural access options with a successful bill facilitating telehealth. League also supported bills that conserved resources and reduced waste such as Prescription Give-back for Institutions.