DENVER - Lawmakers started their dissection Friday of the biggest health-care proposal Bill Ritter has made as governor.
Ritter's idea is to charge a fee to hospitals and use the money to get matching funds from the federal government. Some of the resulting $1.2 billion or more would be paid back to hospitals, and some would put an estimated 100,000 uninsured people into government programs.
The House Health and Human Services Committee approved the bill on a 5-4 party-line vote, with Republicans opposed.
House Bill 1293 does not say how much the hospital fee will be. Instead, it puts an oversight committee in charge of creating the fee after the bill passes.
That raised the hackles of the panel's Republicans, who wanted to know which hospitals would pay more than others.
"I feel like I'm voting for a pig in a poke here, because that's really the key: Who are going to be the winners, and who will be the losers?" said Rep. Spencer Swalm, R-Centennial.
Swalm also worried the bill relied on deficit spending by the federal government, a concern echoed by Rep. Cheri Gerou, R-Evergreen.
"I'm concerned that this program is not sustainable," Gerou said.
But hospital leaders strongly backed the idea.
"What we have now is not sustainable," said Russ Johnson, CEO of San Luis Valley Regional Medical Center.
Johnson's hospital constantly serves patients who either can't afford to pay or have state insurance that doesn't cover the hospital's costs. As a result, it has to charge more to patients with private insurance, he said.
About 800,000 Coloradans do not have health insurance.
"You cannot fix the health-care system in Colorado if 800,000 people are left out. It just won't work," said Joan Henneberry, executive director of Ritter's Department of Health Care Policy and Financing.
Specifically, the bill expands eligibility for the Child Health Plan Plus for kids and pregnant women to 250 percent of the federal poverty level, up from today's 205 percent. And for the first time in Colorado, it would make childless adults eligible for Medicaid. The federal poverty line is $10,830 for a single person and $22,050 for a family of four.
In exchange for paying the fee, hospitals would get better reimbursement from Colorado's government-run insurance programs. The state's current payments to hospitals don't cover their cost of caring for poor patients.
The fees have not been set, but the Legislature's fiscal experts estimated they would total $11 million a year for hospitals with 100 to 300 beds, once the program is ramped up four years from now.
Gerou called the fees a tax, which, under the Taxpayer's Bill of Rights, should be sent to the voters for approval.
The sponsor, though, said there's a difference between a fee and a tax under TABOR. A fee is allowed without a vote of the people if it is used for the benefit of the people who pay it, said Rep. Mark Ferrandino, D-Denver.
Ferrandino argued the federal money will be spent even if Colorado doesn't use it, so the Legislature should serve Coloradans by making sure more of their federal tax dollars come back to the state.
Twenty-three other states already have a similar program, Ferrandino said.
HB 1293's next stop is the House Appropriations Committee.