Medicine and the 2013 legislative session
Packed COMPAC luncheon at annual meeting honors two Colorado legislators and looks ahead to next year
The Colorado General Assembly will consider several issues that will have a major impact on physicians, their patients and the state’s health care system when lawmakers reconvene at the Capitol in January, legislators and physician leaders told attendees at the 2012 Colorado Medical Society Annual Meeting.
Those issues – ranging from a major expansion of Medicaid to a pilot project that will test an alternative to medical malpractice litigation for children with cerebral palsy – make it even more critical that physicians get involved in the November election and stay involved in the political process.
“You may not be interested in politics, but politics is interested in you,” state Rep. Bob Gardner, R-Colorado Springs, told the crowd. “It is interested in your pocketbook, how you conduct your business, what roads you drive to work on, and on and on and on.”
Gardner was honored with the “Defensor del Paciente” (Defender of the Patient) award along with state Sen. Irene Aguilar, MD, D-Denver, for sponsoring peer review legislation this past session that was supported by CMS. Physician advocacy was key to getting that legislation – known as House Bill 1300 – signed into law, Gardner said, as he urged attendees to get involved in CMS’ political action committee, COMPAC.
“The prime way that you as physicians have to make your voices heard is through COMPAC,” Gardner added. “It made a difference in House Bill 1300, it’s going to make a difference in the November election, and it will make a difference on Medicaid expansion and other issues (next session).” Gardner and Aguilar joined COMPAC chairman Dave Ross, DO, and CMS’ longtime lobbyist, Jerry Johnson, for a discussion about the upcoming legislative session during the 2012 COMPAC luncheon in Keystone.
They also discussed the upcoming election, and how it could affect not just which party controls the two chambers of the state legislature but more importantly, how many “friends of medicine” – those who vote with CMS on key issues – will have seats in each. (Democrats currently have the majority in the state Senate, while Republicans control the House. (Colorado Medical Society endorses candidates in both parties). The presidential race between President Barack Obama and former Gov. Mitt Romney also will have an impact, most notably because Romney, a Republican, has pledged that if elected he will get rid of Obama’s signature health care law, the Affordable Care Act.
That act, among many other things, provides funding for states to expand eligibility for Medicaid. If states choose to participate, the additional federal funding will cover the full cost of expansion for the first two years (2014 to 2016). Starting in 2017, states that opt into the expansion would have to pay a portion of the cost. (For more specifics on the expansion and what Colorado Medical Society is doing around this issue, see page 24).
Aguilar, who worked closely with Gardner on the peer review bill and has partnered with him on other legislation, joked that Medicaid expansion is an issue “where maybe our friendship starts to break down.” She supports it; Gardner does not.
I see this as a huge opportunity for Colorado to expand its Medicaid population in a way it otherwise wouldn’t be able to (fiscally),” Aguilar said.
While she agreed with many physicians that provider fees paid by Medicaid are insufficient, Aguilar also said that the current work being done in Colorado around Regional Care Collaborative Organizations (RCCOs) is promising, and could provide a way for the state to address some of the problems with the Medicaid program.
Gardner, meanwhile, said the prevailing Republican view is that Colorado should not participate in the expansion because the state cannot afford it. Republicans don’t have any confidence that four to six years from now the funds from the federal government will continue, he said, and if that occurs the too-easy solution from the Joint Budget Committee would be to cut provider fees.
“It is not a function of what people would like to do, it’s a function of what we can afford and what the budget would allow,” Gardner said, adding that if Republicans keep control of the House and take over the Senate, he doesn’t see any chance that the Medicaid expansion will occur. Another perennial issue at the state legislature is tort reform/medical malpractice – an area that pits physicians against the very well funded trial lawyers’ lobby.
This session, lawmakers also will be asked to support legislation for a demonstration project developed by Cerebral Palsy of Colorado (CP Colorado) that would serve as an alternative to medical malpractice litigation. The project would create a “birth fund” that will cover the lifetime medical costs of children born with certain neurological impairments. The fund would give parents a fair and reliable mechanism to cover their care, and an alternative to rolling the dice by filing a lawsuit, when the vast majority of those children were likely not harmed through physician error.
Aguilar, who is a parent of a child with cerebral palsy, said she has some trouble with any system that takes away a parent’s right to sue. She would like to explore other options, such as a three-tier system used in Oregon. That system starts with disclosure then moves into mediation before the right to sue is invoked.
“I think I’d be interested in seeing if that’s something there’s an appetite for (in Colorado),” Aguilar said.
Gardner, an attorney who sits on the House Judiciary Committee, called the recent fights over raising the cap on noneconomic damages (which CMS successfully fended off) “some of the most memorable battles we had” on the committee. He also acknowledged physicians’ frustrations with the current medical liability system, but implored them not to give up.
“There are things that you just have to lobby and lobby and lobby, and eventually their time will come,” Gardner said.
To that end, Johnson announced CMS is starting a “Breakfast Club,” which will pair groups of physicians with lawmakers to discuss key issues in a casual but thoughtful way. The goal is to get every lawmaker to meet with a group of doctors and help them better understand medicine’s issues.
“Our issues do not lend themselves to sound bites,” Johnson said. “They are complex issues that require thoughtful discussion.”
CMS and the component medical societies will provide more information on the breakfast meetings in coming months.
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