A Bill for an Act
Page 1, Line 101Concerning the analysis of a statewide universal
Page 1, Line 102health-care payment system.
Bill Summary
(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)
The bill requires the Colorado school of public health to analyze draft model legislation for implementing a single-payer, nonprofit, publicly financed, and privately delivered universal health-care payment system for Colorado that directly compensates providers (analysis). The Colorado school of public health must submit a report detailing its findings to the general assembly by December 31, 2026.
The bill also creates the statewide health-care analysis collaborative (analysis collaborative) consisting of 20 members invited by the executive director of the department of health care policy and financing; 4 members of the general assembly appointed by the president of the senate, the minority leader of the senate, the speaker of the house of representatives, and the minority leader of the house of representatives; and the commissioner of insurance and the chief executive officer of the Colorado health benefit exchange or any designees of the commissioner and the chief executive officer. The analysis collaborative is created for the purpose of advising the Colorado school of public health during the analysis.
Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:
Page 2, Line 2SECTION 1. In Colorado Revised Statutes, add 23-20-146 as follows:
Page 2, Line 323-20-146. Universal health-care payment system - research
Page 2, Line 4and selection of draft model legislation - analysis - legislative
Page 2, Line 5declaration - report - definitions - repeal. (1) Legislative declaration.The general assembly finds and declares that:
Page 2, Line 6(a) The final report of the blue ribbon commission for
Page 2, Line 7health care reform, created in section 10-16-131 before its
Page 2, Line 8repeal, issued in January 2008 and the report of the health care
Page 2, Line 9cost analysis task force, created in section 25.5-11-103 before its
Page 2, Line 10repeal, issued on September 1, 2021, both clearly showed that a
Page 2, Line 11single, nonprofit system for health care can save money, cover everyone in the state, and support better health care;
Page 2, Line 12(b) To achieve better, more affordable, and fairer health
Page 2, Line 13care, the people of Colorado need answers to very important questions regarding universal health care; and
Page 2, Line 14(c) An analysis of draft model legislation for a universal
Page 2, Line 15health-care system is important in order to determine whether
Page 3, Line 1such a system would achieve the goals of better, more affordable, and fairer health care for all Coloradans.
Page 3, Line 2(2) Definitions.As used in this section:
Page 3, Line 3(a) "Federal act" means the federal "Patient Protection
Page 3, Line 4and Affordable Care Act", Pub.L. 111-148, as amended by the
Page 3, Line 5federal "Health Care and Education Reconciliation Act of 2010", Pub.L. 111-152.
Page 3, Line 6(b) (I) "Health-care provider" or "provider" means a
Page 3, Line 7person that is licensed, certified, registered, or otherwise
Page 3, Line 8permitted by state law to administer health care in the ordinary course of business or in the practice of a profession.
Page 3, Line 9(II) "Health-care provider" or "provider" includes a
Page 3, Line 10professional service corporation, limited liability company, or
Page 3, Line 11registered limited liability partnership organized pursuant to state law for the practice of a health-care profession.
Page 3, Line 12(c) "Medicaid" means the medical assistance programs
Page 3, Line 13established pursuant to the "Colorado Medical Assistance Act", articles 4 to 6 of title 25.5.
Page 3, Line 14(d) "Medicare" means federal insurance or assistance
Page 3, Line 15provided by the "Health Insurance for the Aged Act", Title XVIII of the federal "Social Security Act", 42 U.S.C. sec. 1395 et seq.
Page 3, Line 16(e) (I) "Reproductive health care" means health care and
Page 3, Line 17other medical services related to the reproductive processes, functions, and systems at all stages of life.
Page 3, Line 18(II) "Reproductive health care" includes family planning
Page 3, Line 19and contraceptive care; abortion care; prenatal, postnatal, and
Page 3, Line 20delivery care; fertility care; sterilization services; and
Page 4, Line 1prevention of and treatments for sexually transmitted infections and reproductive cancers.
Page 4, Line 2(f) (I) "Resident" means an individual who is living, other
Page 4, Line 3than temporarily, within the state and who intends to establish Colorado as the individual's primary state of residence.
Page 4, Line 4(II) "Resident" includes Colorado residents who are
Page 4, Line 5temporarily living in another state or who are traveling out of state.
Page 4, Line 6(g) "Universal health-care system" means a single-payer,
Page 4, Line 7nonprofit health-care payment system that is publicly financed
Page 4, Line 8and privately delivered, under which every resident of the state has access to adequate and affordable health care.
Page 4, Line 9(3) (a) (I) No later than July 1, 2025, the Colorado school
Page 4, Line 10of public health shall research and select draft model
Page 4, Line 11legislation that proposes a universal health-care system for Colorado that directly compensates providers.
Page 4, Line 12(II) The Colorado school of public health shall make the
Page 4, Line 13draft model legislation it selects publicly available on its
Page 4, Line 14website so that interested parties may evaluate and review the draft model legislation.
Page 4, Line 15(b) The draft model legislation selected must be created
Page 4, Line 16by a Colorado nonprofit organization that prioritizes a universal health-care system that:
Page 4, Line 17(I) Provides comprehensive benefits for medical care, including dental, hearing, vision, and mental health;
Page 4, Line 18(II) Provides long-term care and support services to all
Page 4, Line 19residents at least at the level of coverage available to those
Page 5, Line 1residents who are eligible to receive medical assistance, as defined in section 25.5-4-103 (13);
Page 5, Line 2(III) Requires health-care decisions to be made by patients and the patients' health-care providers;
Page 5, Line 3(IV) Allows patients to choose among all providers that participate in the universal health-care system;
Page 5, Line 4(V) Provides comprehensive health-care benefits to all Colorado residents;
Page 5, Line 5(VI) Is funded by premiums, which premiums are in amounts that are determined based on an individual's ability to pay;
Page 5, Line 6(VII) Prohibits deductibles and copayments;
Page 5, Line 7(VIII) Ensures fair drug and hospital prices, as well as fair payment to providers;
Page 5, Line 8(IX) Is delivered through a publicly administered
Page 5, Line 9nonprofit enterprise that is the sole agency paying for health-care costs in the state; and
Page 5, Line 10(X) Is designed to prioritize benefits and access to care
Page 5, Line 11for patients while preventing barriers to care that are imposed for the purpose of increasing profits.
Page 5, Line 12(4) The Colorado school of public health shall analyze
Page 5, Line 13the draft model legislation selected pursuant to subsection (3) of this section. The analysis may:
Page 5, Line 14(a) Include an estimate of the first-, second-, fifth-, and tenth-year costs for operating a universal health-care system;
Page 5, Line 15(b) Identify reimbursement rates for health-care
Page 5, Line 16providers at levels that result in net income that will attract
Page 5, Line 17and retain necessary health-care providers;
Page 6, Line 1(c) Consider a program to cover health-care benefits at
Page 6, Line 2one hundred twenty percent of medicare rates for residents and
Page 6, Line 3at other reimbursement levels as determined appropriate by the Colorado school of public health;
Page 6, Line 4(d) Consider whether the benefits outlined in the draft
Page 6, Line 5model legislation are the same as the benefits required by the federal act and by state law;
Page 6, Line 6(e) Identify health-care expenditures by payer;
(f) Identify costs based on an individual's ability to pay;
Page 6, Line 7(g) Describe incentives and financial implications for
Page 6, Line 8hospitals from a global-budgeting-based reimbursement system compared to a fee-for-service-based reimbursement system;
Page 6, Line 9(h) Describe how a universal health-care system provides the following:
Page 6, Line 10(I) Services required by the federal act and by state law;
(II) Services covered under medicare;
Page 6, Line 11(III) Medicaid services and benefits that meet or exceed
Page 6, Line 12current services and benefits with provider reimbursement rates
Page 6, Line 13that are equivalent to or higher than current medicaid reimbursement rates;
Page 6, Line 14(IV) Medicaid services and benefits for individuals with disabilities who do not otherwise qualify for medicaid;
Page 6, Line 15(V) Coverage for women's health-care services and
Page 6, Line 16comprehensive reproductive health care to the extent that those services are allowable by state law;
Page 6, Line 17(VI) Vision, hearing, and dental services;
Page 6, Line 18(VII) Access to primary and specialty health-care
Page 7, Line 1services in rural Colorado and other underserved areas or populations; and
Page 7, Line 2(VIII) Behavioral health, mental health, and substance use disorder services;
Page 7, Line 3(i) Consider other collateral costs as determined by the Colorado school of public health;
Page 7, Line 4(j) Provide a general cost estimate and suggest potential
Page 7, Line 5additional revenue sources to cover long-term care and support services for all residents;
Page 7, Line 6(k) Estimate the impact of implementing a universal
Page 7, Line 7health-care system on various socioeconomic groups, including a racial equity impact assessment;
Page 7, Line 8(l) Estimate the impact of implementing a universal
Page 7, Line 9health-care system on health-care facilities, private health
Page 7, Line 10insurance companies, and the Colorado option health insurance plan;
Page 7, Line 11(m) Estimate the impact of implementing a universal
Page 7, Line 12health-care system on health plans that are regulated by the
Page 7, Line 13federal "Employee Retirement Income Security Act of 1974", 29
Page 7, Line 14U.S.C. sec. 1001 et seq., including multiemployer Taft-Hartley health-care trust funds;
Page 7, Line 15(n) Evaluate the feasibility of implementing a universal
Page 7, Line 16health-care system by expanding or modifying the Colorado option health insurance plan;
Page 7, Line 17(o) Estimate the impact of a universal health-care system
Page 7, Line 18on the cost and development of specialty pharmaceuticals and
Page 7, Line 19treatment for rare diseases;
Page 8, Line 1(p) Estimate the impact of a universal health-care system on the price of pharmaceuticals; and
Page 8, Line 2(q) Provide any additional information the Colorado school of public health finds relevant.
Page 8, Line 3(5) The Colorado school of public health may utilize an
Page 8, Line 4actuarial consultant in conducting the analysis pursuant to subsection (4) of this section.
Page 8, Line 5(6) On or before December 31, 2026, the Colorado school
Page 8, Line 6of public health shall submit a report detailing its findings from
Page 8, Line 7the analysis completed pursuant to subsection (4) of this section
Page 8, Line 8to the house of representatives health and human services
Page 8, Line 9committee and the senate health and human services committee, or their successor committees.
Page 8, Line 10(7) (a) The Colorado school of public health shall submit
Page 8, Line 11an application to the all-payer health claims database
Page 8, Line 12scholarship grant program, established in section 25.5-1-204.5,
Page 8, Line 13to acquire funding to cover any data or software costs that
Page 8, Line 14may be incurred by the Colorado school of public health in
Page 8, Line 15conducting the analysis required pursuant to subsection (4) of this section.
Page 8, Line 16(b) The Colorado School of Public Health may seek,
Page 8, Line 17accept, and expend gifts, grants, and donations from private and public sources to access the all-payer claims database.
Page 8, Line 18(8) (a) The Colorado school of public health may seek,
Page 8, Line 19accept, and expend gifts, grants, or donations from private or
Page 8, Line 20public sources for the purpose of conducting the required
Page 8, Line 21research and analysis.
Page 9, Line 1(b) Unless the Colorado school of public health receives
Page 9, Line 2an amount of appropriations, gifts, grants, and donations or
Page 9, Line 3money from the grant program pursuant to subsection (7) of this
Page 9, Line 4section sufficient to cover the costs of the research and
Page 9, Line 5analysis, and the department of health care policy and
Page 9, Line 6financing receives enough money in gifts, grants, and donations
Page 9, Line 7to implement the statewide health-care analysis collaborative
Page 9, Line 8pursuant to section 25.5-1-135, the Colorado school of public health shall not implement this section.
Page 9, Line 9(9) This section is repealed, effective December 1, 2027.
Page 9, Line 10SECTION 2. In Colorado Revised Statutes, add 25.5-1-135 as follows:
Page 9, Line 1125.5-1-135. Statewide health-care analysis collaborative -
Page 9, Line 12creation - membership - duties - repeal. (1) (a) There is created in
Page 9, Line 13the state department the statewide health-care analysis
Page 9, Line 14collaborative, referred to in this section as the "analysis
Page 9, Line 15collaborative", for the purpose of advising the Colorado school
Page 9, Line 16of public health in completing the analysis required by section 23-20-146.
Page 9, Line 17(b) The analysis collaborative is merely advisory and the
Page 9, Line 18Colorado school of public health is the entity responsible for conducting the analysis pursuant to section 23-20-146.
Page 9, Line 20(2) (a) On or before August 1, 2025, the executive director
Page 9, Line 21shall invite the following representatives to participate in the analysis collaborative:
Page 9, Line 22(I) One member who represents a statewide hospital association;
Page 10, Line 1(II) One member who represents organized labor;
Page 10, Line 2(III) One member who represents an organization that advocates for communities with disabilities;
Page 10, Line 3(IV) One member who is a reproductive health-care advocate;
Page 10, Line 4(V) One member who represents a statewide association of physicians;
Page 10, Line 5(VI) One member who represents a statewide association of mental health-care providers;
Page 10, Line 6(VII) One member who is a state tax expert or an expert on section 20 of article X of the state constitution;
Page 10, Line 7(VIII) One member who is a rural health-care advocate;
Page 10, Line 8(IX) One member who is a registered nurse representing a statewide association of nurses;
Page 10, Line 9(X) One member who represents a Colorado advocacy organization for people experiencing homelessness;
Page 10, Line 10(XI) One member who represents an advocacy organization for health-care consumers;
Page 10, Line 11(XII) One member who represents a statewide association of dentists;
Page 10, Line 12(XIII) One member who represents an advocacy organization for historically marginalized communities;
Page 10, Line 13(XIV) One member who represents an advocacy
Page 10, Line 14organization for lesbian, gay, bisexual, transgender, and queer communities;
Page 10, Line 15(XV) One member who represents a statewide association of pharmacists;
Page 11, Line 1(XVI) One member who represents small employer interests;
Page 11, Line 2(XVII) One member who represents large employer interests;
Page 11, Line 3(XVIII) One member who represents a pharmacy benefit management firm, as defined in section 10-16-102 (49);
Page 11, Line 4(XIX) One member who represents a self-insured employer
Page 11, Line 5that provides health insurance to its employees under a health
Page 11, Line 6insurance plan covered by the federal "Employee Retirement Income Security Act of 1974", 29 U.S.C. sec. 1001 et seq.; and
Page 11, Line 7(XX) One member who represents management of
Page 11, Line 8organized labor that provides health insurance coverage for
Page 11, Line 9individuals who are insured under a health insurance plan
Page 11, Line 10covered by the federal "Employee Retirement Income Security Act of 1974", 29 U.S.C. sec. 1001 et seq.
Page 11, Line 11(b) In inviting representatives to participate in the
Page 11, Line 12analysis collaborative pursuant to subsection (3)(a) of this section, the executive director shall ensure that the invitees:
Page 11, Line 13(I) Have demonstrated an ability to represent the
Page 11, Line 14interests of all Coloradans and, regardless of the invitees'
Page 11, Line 15backgrounds or affiliations, are able to present objective,
Page 11, Line 16nonpartisan, factual, and evidence-based ideas and to
Page 11, Line 17objectively advise the Colorado school of public health
Page 11, Line 18concerning a single-payer, nonprofit, universal health-care system, as defined in section 23-20-146 (2); and
Page 11, Line 19(II) Reflect the social, demographic, and geographic
Page 12, Line 1diversity of the state, including historically marginalized communities.
Page 12, Line 2(c) If a vacancy occurs on the analysis collaborative, the
Page 12, Line 3executive director may invite a new representative to fill the vacancy.
Page 12, Line 4(3) The commissioner of insurance and the chief executive
Page 12, Line 5officer of the Colorado health benefit exchange created in
Page 12, Line 6article 22 of title 10, or the designee of the commissioner or the
Page 12, Line 7chief executive officer, shall serve on the analysis collaborative.
Page 12, Line 8(4) (a) The chief executive officer of the Colorado health
Page 12, Line 9benefit exchange shall call the first meeting of the analysis collaborative.
Page 12, Line 10(b) The analysis collaborative shall meet at least two
Page 12, Line 11times before October 1, 2026, and the chief executive officer of
Page 12, Line 12the Colorado health benefit exchange may convene additional
Page 12, Line 13meetings of the analysis collaborative as determined by
Page 12, Line 14consulting with the members of the analysis collaborative and the Colorado school of public health.
Page 12, Line 15(c) All meetings of the analysis collaborative must be
Page 12, Line 16open to the public, and the analysis collaborative shall post
Page 12, Line 17notice of a meeting at least one week in advance of the meeting
Page 12, Line 18on the Colorado school of public health's website and the state department's website.
Page 12, Line 19(d) All meetings of the analysis collaborative must be
Page 12, Line 20held virtually and allow for attendance and participation by
Page 12, Line 21members of the analysis collaborative and members of the public virtually.
Page 13, Line 1(e) The analysis collaborative may hold meetings without a quorum of the members present.
Page 13, Line 2(5) At the first meeting of the analysis collaborative, a
Page 13, Line 3representative from the entity providing the draft model
Page 13, Line 4legislation selected by the Colorado school of public health
Page 13, Line 5pursuant to section 23-20-146 (3) shall present the draft model legislation to the analysis collaborative for feedback.
Page 13, Line 6(6) Nonlegislative analysis collaborative members
Page 13, Line 7invited pursuant to subsection (3)(a) of this section are not
Page 13, Line 8entitled to receive per diem or other compensation for
Page 13, Line 9performance of services for the analysis collaborative but may
Page 13, Line 10be reimbursed for actual and necessary expenses incurred in the
Page 13, Line 11performance of official duties of the analysis collaborative.
Page 13, Line 12Legislators who serve on the analysis collaborative are reimbursed pursuant to section 2-2-307 (3).
Page 13, Line 13(7) (a) The state department may seek, accept, and expend
Page 13, Line 14gifts, grants, or donations from private or public sources for the purpose of establishing the analysis collaborative.
Page 13, Line 15(b) Unless the state department receives an amount of
Page 13, Line 16appropriations, gifts, grants, and donations sufficient to cover
Page 13, Line 17the costs of establishing the analysis collaborative, and the
Page 13, Line 18Colorado school of public health receives enough money
Page 13, Line 19pursuant to section 23-20-146 (8) to implement the costs of
Page 13, Line 20research and analysis to implement section 23-20-146, the state department shall not implement this section.
Page 13, Line 21(8) This section is repealed, effective December 1, 2027.
Page 14, Line 1SECTION 3. In Colorado Revised Statutes, 23-18-308, add (1)(o) as follows:
Page 14, Line 223-18-308. Fee-for-service contracts - grants to local district
Page 14, Line 3colleges - limited purpose - repeal. (1) Subject to available
Page 14, Line 4appropriations, the department shall enter into fee-for-service contracts for the following purposes:
Page 14, Line 5(o) (I) The Colorado school of public health's analysis of
Page 14, Line 6model legislation related to a statewide universal health-care system conducted pursuant to section 23-20-146.
Page 14, Line 7(II) This subsection (1)(o) is repealed, effective December 1, 2027.
Page 14, Line 8SECTION 4. Safety clause. The general assembly finds,
Page 14, Line 9determines, and declares that this act is necessary for the immediate
Page 14, Line 10preservation of the public peace, health, or safety or for appropriations for
Page 14, Line 11the support and maintenance of the departments of the state and state institutions.