Colorado Medicaid Expansion Moves Forward With One Republican Vote



The only real surprise about Colorado’s bill to expand Medicaid, now that it’s been approved by both legislative chambers, is that it won a vote from a Republican legislator.

Sen. Larry Crowder from the San Luis Valley said he couldn’t vote against the bill when hospitals in his district are strained to the breaking point caring for the uninsured. Colorado hospitals strongly support the expansion, saying it will replace many of their unpaid bills with new Medicaid payments.

Both chambers of Colorado’s legislature passed bills late last week to expand Medicaid as called for in the Affordable Care Act. The next step is the state Senate is expected to approve amendments to the House version of the bill on Tuesday and send it to the desk of Gov. John Hickenlooper, a Democrat, who has said he will sign it.

“I have no choice but to support this,” said Crowder, whose rural district includes several of the state’s poorest counties.

“I was opposed to Obamacare,” he said, but added that four of the seven hospitals in his district are in “serious financial trouble” and he felt obligated to vote for the bill because it will give uninsured patients a way to pay their bills.

Over four committee hearings, Republican lawmakers were the only ones to speak against the bill. No individuals or groups testified that it should not be passed. Proponents, on the other hand, were numerous and vocal. In testimony, advocates for the poor praised the expansion plan, saying it will finally extend coverage to adults without dependent children and tens of thousands of working Coloradans who make too little to afford private health policies.

The state’s hospital association and largest physicians’ group testified in favor of the bill, as did the health insurance industry and the Colorado Competitive Council, a statewide association of chambers of commerce and business interests.

“This is a way where everybody in the community is paying for,” unpaid hospital bills racked up by the uninsured, said Travis Berry of the Council, “rather than just those employers that offer insurance to their employees.”

Republicans say the expansion will drain state coffers and pile more debt upon the already financially strained federal government. They say the generous payments the White House is promising to states that expand will run out, leaving states vulnerable to lawsuits if they try to rescind benefits to newly covered populations.

But Medicaid advocates counter that Colorado will be able to pay its share of new Medicaid costs without dipping into tax revenue. It’s tapping a four-year-old hospital provider fee that brings about $600 million in federal revenue to the state, and advocates say savings from Medicaid payment reforms will save $28 million a year.

An analysis by the pro-expansion Colorado Health Foundation says those revenue streams, plus the federal share of expansion means Colorado will actually spend $133.8 million dollars less in state tax money over 13 years, even as it adds 330,000 people to its Medicaid rolls. That analysis says the expansion will also create 22,388 new jobs and boost the state’s economy by $4.4 billion over the same period.

Colorado has already started extending Medicaid to new populations. Last year it held a lottery to choose 10,000 new recipients from among its poorest adults with no children. It also started offering Medicaid to some parents of Medicaid eligible children. Those programs will continue to ramp up until the Affordable Care Act Medicaid expansion starts in 2014.

Tish Barber, a stay-at-home mom of three young children testified that expanding the Medicaid program will offer her and her husband peace of mind. He makes $31,000 a year working at a tire store. Their kids are already on Medicaid, but she and her husband “haven’t been to the doctor for a physical since high school, and we’re not able to take the kinds of preventive health measures we probably should to keep ourselves healthy and strong.” Barber says, “Being uninsured feels irresponsible. We are gambling with our health … our financial security … and our children’s futures. We don’t like it, but on our budget private health insurance just is not an affordable, realistic option.”

This story is part of a partnership that includes Colorado Public Radio, NPR and Kaiser Health News.