Executive Office Update: Colorado voters show independence in split vote

Saturday, November 01, 2014 12:05 PM

Alfred Gilchrist, Chief Executive Officer
Colorado Medical Society

“Democracy,” as George Bernard Shaw once wrote, “is a device that insures that we shall be governed no better than we deserve.” Or put more cynically by satirist Andy Borowitz after this cycle’s near-historic low national voter turnouts, “voters who didn’t vote say America is headed in the wrong direction.”

Colorado voters continue to show remarkable discretion, even in relatively lower turnout years. We will have a split – some could argue balanced – state government with a Republican-led Senate by a one-vote margin, a Democratic-led House by a one or two vote margin (at press time one race was still up for grabs), and an executive branch that starts with a Democratic governor reelected with 49.2% of the vote. Our red or in recent past blue ‘waves’ are not of the same magnitude as many other states. These dynamics create a level of stability as we shift back and forth between election cycle and policy-making.

As our political leaders prepare for this next phase and their ultimate purpose, let’s take a look what might be on the horizon in terms of health care policy.

First, with all due respect to his worthy and thoughtful opponent, Gov. John Hickenlooper’s vision of a Healthy Colorado, which as we noted in our endorsement is virtually synonymous with ours, will stay on course.

The four years of collaboration with stakeholders like CMS and the General Assembly can pretty much pick back up where it was moving before sine die adjournment. Legislators can be expected to debate the balance between the market’s and government’s role in health care delivery, but many of the advocates in that space on both sides of the aisle we have talked to over the election cycle seem determined not to reverse directions.

For the third year in a row, Colorado’s unique, homegrown version of Medicaid managed care is producing award winning results and savings. Our nominee, Sue Birch, a Hickenlooper Cabinet member who leads this locally-run effort through the RCCOs, won the AMA’s prestigious Nathan Davis Award for her work earlier this year. Substantial federal grants called SIM, designed to align physical and behavioral health, are in the pipeline – and frankly Colorado’s application may have taken a giant step over other states in that queue post election.

Colorado has a Cost Commission created this year with prime, bipartisan sponsors in both chambers of the state legislature: Senator-physician Irene Aguilar MD, (D-Denver), Sen. Ellen Roberts (R-Durango), Rep. Amy Stephens (R-Monument) and Rep. Sue Schafer (D-Wheat Ridge). This blue ribbon panel of experts and influencers will make recommendations over the course of the next three years on how to improve the value of health care services and bend the cost curve to improve coverage, affordability and access.

As our longtime contract lobbyist Jerry Johnson observes in his guest column this month on page 10, the State House and Senate members-elect have spent quality time with CMS and the physicians in their communities long before they packed their bags for the Capitol.

As Yogi Berra observed, “I hate to make predictions, especially about the future.” Nonetheless, based on our conversations with them back in their districts, our decade-long defense of Colorado’s relatively stable tort environment just got stronger. Our perennial conflicts over the scope of practice with other health care professionals are also likely to remain within the possibilities of collaborative arrangements with physicians. Unless the U.S. Supreme Court detonates the subsidies to the thousands of new enrollees in states without homegrown exchanges and that decision negatively harms Colorado, we should expect the work of our exchange to expand coverage to continue. I urge you to read our friend and eminent law professor Ed Dauer’s take on the case just accepted for review by the Supreme Court in this issue.

Imbalances in political systems can be unfair to the minority voice, and potentially dangerous to society. Colorado seems to have a sixth sense about avoiding extremes, and has produced a new wave of legislators and leaders that are more likely to continue our long-held tradition of fixing problems instead of affixing blame.