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Anyone going to the central committee meeting this weekend I need to point out something very important. This comes from an extremely trusted source!!!!!

Initiative 146, “Transparency in Healthcare Billing” is virtually identical to HB18-1358, which pro-reproductive health care groups like Planned Parenthood, NARAL, COLOR, health care advocacy folks like the Association of Addiction Professionals, the American Academy of Pediatrics, the Colorado OB/GYNs, the Family Physicians, and safety net health care providers like Denver Health, Children’s Hospital, and the Vail Valley Medical Center all opposed because of the harmful effects it would have had on patients – particularly on women, low-income people, people of color, and LGBTQ people.

The bill died in the House Committee on Health, Insurance, and Environment 12-1, with every democrat on the committee voting no.

We believe that the initiative will make health care less accessible for low-income people, people of color, and LGBT people. We are further concerned by the very real risk of endangering the safety and wellbeing of domestic violence survivors, not to mention many other patients who want to keep their personal medical history private.

Our concerns are as follows:

Initiative 146 jeopardizes patient’s privacy and their safety.
Initiative 146 would require that health care providers send home “an itemized detail of each healthcare service provided, the charge for the service, and how the payment or adjustment by the patient’s carrier was applied to each line item.”

This initiative could endanger the wellbeing of our patients by requiring providers to send mail disclosing a patient’s visit, and what the visit was for, which could end up in someone else’s hands. For patients living with someone who disagrees with abortion, and for domestic violence survivors, and for patients being sexually abused by someone in their home, this is an unacceptable danger. Additionally, LGBTQ youth seeking access to health care, particularly trans youth seeking access to health care, are at a grave risk of being outed to unsupportive and potentially abusive family members. There is no ability to opt-out.

Initiative 146 will deter patients from seeking health care
The initiative requires all health care providers to publically post the maximum out-of-pocket cost for every service provided. As a transparency measure, this seems tempting – but the most recent data from the Colorado Health Institute shows that 93.7% of Coloradans have some form of insurance. That means that for 93.7% of Coloradans, the costs posted on provider websites will be wrong.

This initiative would require health care providers to post fee schedules which are misleading at best, and artificially inflated at worst. Providers would have to post the maximum out-of-pocket cost of every single service they provide without regard to private insurance, Medicaid, or financial assistance. These artificially inflated costs will deter Coloradans from seeking care.
This initiative puts the burden of cost transparency on patients, rather than health insurance companies. Requiring a patient to research the costs of CPT codes for chemotherapy for stomach cancer, or ulcer medication for a stomach ulcer, mean nothing for a patient who knows only that they have a stomach ache. Requiring patients to decode this information, which will likely tell them that their health care is going to be astronomically expensive, is wrong.
Initiative 146 will harm low-income people of color and LGBT people’s access to healthcare.
This bill will harm LGBTQ Coloradan’s access to care. One medication that LGBTQ folks are especially concerned about under this initiative is PrEP, which is 92-99% effective at preventing new HIV infections, but costs over $2000 per month. Insurance and Medicaid cover PrEP, and most patients pay $0 a month. But virtually any person quoted $2000 a month would opt not to start taking that medication.

The Women’s Wellness Connection (WWC) program provides thousands of low-income Coloradans with breast and cervical cancer screenings – particularly women of color, older women, those with disabilities, and women who have sex with women.

Most people who qualify for WWC do not know about the program until they call a provider are screened for eligibility. There is a very good chance that a patient seeking care who saw the m­aximum-out-of-pocket cost for a cancer screening would perceive it to be unaffordable, and would simply not call to make an appointment. We’re very concerned that this initiative will scare people – especially the most marginalized people who use safety-net health care providers -- away from going to the doctor.

Finally, and this is one of the things I’m about as a Democrat, Initiative 146 is not progressive, and is being funded by out-of-state conservative interests. This initiative does nothing to make health care more accessible or more affordable. It is a free-market solution to further capitalize health care, funded by conservatives and libertarians. Top donors include:

$95,070 from David Silverstein, donor to Republican State Representative Susan Beckman, and the Libertarian Party of Colorado. He’s the one spearheading this, and as far as disclosures show, was the only proponent of the bill when it was in the legislature.

$50,000. Patient Rights Advocate Inc, of Newton, MA. Conservative. Led by:
Kara Grasso, formerly of “business development in the pharmaceutical industry.”
Cynthia Fisher, “life sciences entrepreneur” and major republican donor. Over $1.7m to republican candidates and PACs, including over $750k to the Republican Congressional Committee, over $300k to the Republican Senatorial Committee, and over $166k to the Republican National Committee. She is also a Cory Gardner, Mitch McConnell, Mitt Romney, and Paul Ryan donor.

$50,000. Thomas W. Smith Foundation of Boca Raton, FL. Conservative. Dedicated to “supporting free markets.” Frequently partners with the Koch Family Foundation.
$50,000. Real estate developer Russ Landau.

Finally, studies have demonstrated that when health care providers post their fee schedules publicly, costs go up, not down, because for-profit health care corporations realize that they can make more money, and they know that patients are not able to shop around for providers. This conservative attempt to make health care more capitalist and more market-driven will not make health care more affordable or accessible. Follow the money. The people funding this measure are not our friends.

The initiative requires publication of the highest fee a health care provider charges for a given service – a number that may seem so unaffordable that patients forgo ever calling the provider to make an appointment. And what patient who wants to keep the health care they’re seeking private from other people in their household would feel safe knowing that a list of every test, diagnosis, and service will be sent to their home? This initiative would not provide patients with meaningful information – it will scare them into believing that their health care is unaffordable, and that is exactly what the republican and libertarian funders of this initiative want.

I hope this is helpful. I’m baffled as to why the platform committee is suggesting that people vote yes on this. I want health care to be more affordable and accessible – that’s why I do this work – but I don’t think this measure helps. I think it makes it a lot worse.

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