The Temperature | Colorado’s $64,709,268 hospital price question
Happy Wednesday to you, Temp readers, and welcome to another edition of the little climate and health newsletter that could.
I don’t know if you’ve noticed — joking, of course you have — but man there has sure been a lot of news lately. Anybody feeling exhausted by it all? Having trouble keeping up? Wanting to just hide away for your own wellbeing?
Well, folks, SAME.
Sometimes we need help figuring out how to tell our stories, and this is one of those times. Drop us a line at newsletters@coloradosun.com and let us know how you think we should handle the onslaught of news.
Do you want stories that are longer and more in-depth? Or shorter and more to the point? Do you want fewer stories — but make ‘em count? Or do you want more stories? Personal stories of people impacted by changes or just-the-facts?
The water’s looking like it will be turbulent for a while, so let’s figure out a way we can all stay in the boat. Or something like that. I’m from Colorado — I’m not good at nautical metaphors.
Let’s sail this skiff (?) newsward ho, shall we?
HEALTH INSURANCE
How much could hospital price caps save? A whole bunch, according to one analysis.
The annual savings for the state employee health plan projected from House Bill 1174
Limiting how much hospitals can charge for taking care of state employees could save the state $65 million a year, according to a new analysis of a bill that seeks to impose just such a regulation.
The bill, House Bill 1174, is backed by legislative Democrats and Gov. Jared Polis. It is scheduled to face its first committee vote this afternoon.
The bill limits how much health insurers are allowed to pay hospitals for services and also limits what hospitals could charge patients. (The bill would also create a payment limit for primary care services that insurers couldn’t drop below.)
But these limitations apply only to two relatively small groups of people
The first group are the employees of small companies that buy health insurance plans in the state’s small group market. (This includes companies such as The Sun.) The second are state employees who are covered by the state employee health plan. The bill wouldn’t take effect until July 2026 for state employees and January 2027 for the small group market.
As we’ve reported before, these two groups make up about 230,000 people out of a state of 5.8 million. But the newly released fiscal note for the bill demonstrates one reason why hospitals are so adamantly opposed: Even for a small number of people, hospital price caps can add up to a lot of money.
The bill’s fiscal note, which calculates all the spending and savings that would result from the bill, looks only at the benefit to the state budget. In other words, just the savings to the state employee health plan, which covers about 30,000 people.
Drumroll: The analysis estimates the savings at $64,709,268 in the first year. That’s around $2,000 per person.
The analysis, prepared by nonpartisan legislative staff, relied on claims data examined by the two insurers currently providing plans to state employees — Cigna and Kaiser Permanente.
Now, this isn’t necessarily all gravy to a state budget in need of some wiggle room. The bill calls for some of the savings to be used to fund a study on whether this price-capping idea can be expanded and for some of the savings to be used to buy down health insurance premium prices for state employees. Most of the savings would go into a fund that the state uses to pay health care costs for uninsured or low-income individuals.
The bill is scheduled for 1:30 p.m. today before the House Health and Human Services Committee. The committee is meeting in House Committee Room 0112, which is in the basement. The bill is, as of this writing, scheduled last on the three-bill agenda.
You can also listen to the committee hearing online here.
LAB TESTING
Problems at the state health lab expand by a smidge
The Colorado Department of Public Health and Environment continues to re-evaluate the work done at its health lab — and it continues to find problems.
The latest findings, which the department announced last week, were discovered in past tests for lead and for various chemicals in drinking water, as well as in food-safety tests and tests on mercury levels in fish.
The problems were all related to quality control measures — i.e., how do you know the machine doing the test is working right? — and not in the testing of the actual samples being analyzed. And they represented a small percentage of the overall tests done in each area.
“It’s important to note that current findings still have not provided evidence of an imminent public health risk, but the investigation is ongoing,” Dr. Ned Calonge, CDPHE’s chief medical officer, said in a statement. “The internal review is an important first step to address any immediate issues and ensure transparency.”
The evidence of shoddy quality-control work adds to previous findings of problems in drinking water tests that caused CDPHE to suspend water testing at the lab. Since the initial discovery of the issues, CDPHE has been going through years’ worth of tests at the lab to find any additional problems.
The tests flagged in last week’s announcement date back as far as 2018. In some cases, subsequent tests that were performed correctly — and showed no problems — have negated the need for retesting. But the state has notified four child care centers and an elementary school that its water may need retesting to ensure that it does not have high levels of lead.
A list of those schools can be found on CDPHE’s website.
VACCINES
A Colorado doctor sits on an influential CDC vaccine committee — for now
A Colorado doctor who sits on an influential federal health committee could be among those targeted by Robert F. Kennedy Jr. in the coming months over purported conflicts of interest.
The doctor, Dr. Edwin Asturias, who is a professor at both the Colorado School of Public Health and the University of Colorado School of Medicine, sits on a committee called the Advisory Committee on Immunization Practices, or ACIP. The committee is part of the Centers for Disease Control and Prevention. It reviews data on the safety and efficacy of vaccines and makes recommendations about who should receive them and when.
Last week, after Kennedy, a noted vaccine skeptic, took over the nation’s top health job, ACIP’s February meeting was postponed indefinitely.
Officially the meeting was postposted “to accommodate public comment in advance of the meeting,” and the U.S. Department of Health and Human Services has vowed to reschedule. But the episode has renewed attention on Kennedy’s pledge to remove conflicts of interest from the agency’s advisory committees.
ACIP, whose members are appointed by the head of HHS, was especially prominent during the COVID pandemic, when its votes were a key part of the rollout of COVID vaccines. But the committee’s work also plays an important role in the Vaccines for Children program, which provides vaccines to kids whose parents can’t afford them.
ACIP members must file confidential financial disclosures and agree to forego participating in certain vaccine-related activities during their tenure. The committee also has other conflict-of-interest safeguards in place.
But, during his confirmation hearings, Kennedy claimed that 97% of ACIP’s members have conflicts of interest. That kind of broad interpretation of what constitutes a conflict could land Asturias in Kennedy’s sights.
Asturias — who began serving on ACIP this summer — is an infectious disease and global health expert. Much of his work focuses on health in Guatemala, where he was born and has undertaken numerous health care initiatives.
During the committee’s October meeting, Asturias declared no conflicts of interest, and his current CU research profile lists only studies funded by the federal government. A review of previous disclosures in the federal government’s Open Payments system, though, show that he has received money in the past from drugmakers.
Throughout the late 2010s and early 2020s, Asturias received a few hundred to a few thousand dollars a year for what appear to be consultation and speaking fees. He has received much more — nearly $4 million — in research support to study RSV, pneumonia and other diseases in Guatemala and the U.S., including more than $3 million from drugmaker Pfizer.
The studies don’t exactly reek with suspicion — “Determination of the utility of Pfizer’s pneumococcal urine antigen test in children 5 years of age or younger with community acquired pneumonia,” for instance. In a different environment, this would be exactly the kind of work that would qualify someone to sit on ACIP.
But whether Kennedy sees it that way now may be another matter.
GLOBAL HEALTH
How U.S. cutbacks in global health funding could affect health back home
The projected increase in HIV cases in South Africa over the next 10 years if PEPFAR funding were eliminated
I had been thinking a bit recently — in a foggy, indistinct sort of way — about how U.S. funding cuts to global health programs could affect life here in Colorado. And then an article from The Atlantic popped up this week that cut right through that fog.
The piece tackles one of the persistent puzzles of the COVID-19 pandemic. In a nutshell: Coronaviruses, the type of virus that causes COVID, are usually slow mutators, owing to a proofreading mechanism in their genetic code. But the COVID-19 virus, SARS-CoV-2, has evolved rapidly in just a few years, burning through multiple variants with the potential to infect even people with prior immunity. So, WTF?
The answer, the piece concludes, is what happens when the virus infects someone with a weakened immune system. Rather than getting tossed out the door quickly, the virus hangs around and churns through mutations, using the immunocompromised host as a sort of training gym for new variants.
When an ultimate variant champion emerges, it can then rocket through a population, like the COVID omicron variant did in late 2021 and early 2022.
So, let’s talk about omicron. It was first identified in South Africa with a staggering 50 new mutations. And there has been considerable speculation that it may have emerged from chronic COVID infections of people in southern Africa with untreated HIV.
Zip ahead to the present, and the U.S. government is potentially looking to slash funding for global health initiatives, including one called PEPFAR that helps fight HIV.
Researchers in the U.S. and South Africa this month published a paper modeling what would happen if PEPFAR funding were cut. They projected that new infections just in South Africa over the next 10 years would increase by 24% if PEPFAR funding were cut in half and would increase by 47% if PEPFAR funding were eliminated entirely. Deaths from HIV would increase, as well. Because South Africa has more people infected with HIV than any other country, we’re talking about hundreds of thousands of new infections and deaths.
Often, when thinking about the impact of funding cuts for global health programs, we look at more direct consequences — say, how cutting funds to stop mpox abroad could lead to mpox outbreaks in the U.S. But the HIV-COVID variant connection shows another way that failure to address disease in one part of the world could cause a wide variety of health threats across the globe.
Viruses, as they say, don’t respect borders.
MORE ENVIRONMENT AND HEALTH NEWS
If you ever feel like you may be in a one-sided relationship with the federal government come tax season, there’s a chance you’re right. It’s not you, it’s them.
The focus lately on federal spending cuts has highlighted the importance that massive amounts of federal money play in all 50 states. But there’s another perspective to this issue: For some states, the amount they receive back in federal funding is less than what they pay in taxes.
The map above pulls data from a Rockefeller Institute of Government analysis first released last year. It looks at all the tax revenue coming from a state — income, corporate, Social Security, Medicare, etc. And it also looks at all the funding coming back — federal grants, salaries to federal employees, Social Security and Medicare benefits, and on and on.
This particular map shows data from 2022, excluding one-time funding related to COVID pandemic relief. Adding those relief dollars changes this slightly, but Colorado was still a net contributor in 2022.
That’s not always the case, though. While Colorado was also a net contributor from 2015 through 2017, the state was a net recipient from 2018 through 2021, even when excluding COVID relief dollars in 2020 and 2021. (All states were net recipients in 2020 and 2021 when including COVID money.)
Watch for a story in the coming days on ColoradoSun.com where we expand on this a bit. In the meantime, you can read the Rockefeller Institute’s report on its website.
Just give me a minute while I double over and try to catch my breath after all that news.
One exciting note: tickets for Colorado SunFest 2025 just went on sale. We’ve moved the date up this year, to May 16, and we’re back on the lovely University of Denver campus. We have a great lineup of panels planned that I can’t wait to tell you more about. And, best of all, there will be people just like you wanting to connect with fellow Colorado nerds and learn more about the people, places and issues in our state.
You can buy your tickets at ColoradoSun.com/SunFest.
Hope to see you there!
— John & Parker
Corrections & Clarifications
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