“No good deed goes unpunished,” the American writer and diplomat Clare Boothe Luce once said.
It’s a classic political axiom, and sadly, it’s happening right now in the Colorado legislature to the health care heroes and vaccine miracle workers who have been fighting COVID-19 for more than a year.
The pandemic isn’t over, but already there are bills that treat doctors, nurses, hospital staff, pharmaceutical workers and many other health care professionals like they’re the villains of the piece.
It starts with House Bill 21-1232, which would create a state-controlled health plan – better known as the “public option” – in Colorado.
Health care providers and private health plans have worked with the state government to reduce premiums for individual insurance under the federal Affordable Care Act by almost 30% since 2019. But rather than build on that collaboration, the authors of HB21-1232 want the state government to take control.
According to the authors, HB21-1232 delivers an “ultimatum” to the health care sector: Reduce ACA and small-group premiums 20% from today’s levels or face even more aggressive action from the state.
According to the Common Sense Institute, where I’m a fellow, complying with this price mandate could trigger $1 billion in pay cuts for health care providers and the loss of up to 4,900 health care jobs.
If the health care sector doesn’t meet the mandate within two years, then a state-controlled health plan – the so-called public option – would be created to enforce the price mandate directly.
It doesn’t end there. Individual health care providers and medical facilities would be forced to participate in the public option and accept whatever payment the state decides their labor is worth. If they don’t, they risk disciplinary action and losing their right to practice at all.
That’s because HB21-1232 also amends several licensing and certification laws that govern health care professionals and facilities in Colorado. In sections of the law usually devoted to professional misconduct and other serious offenses, the authors of the public option bill have added a new offense: Failing to participate in the public option.
The list of threatened professions and facilities includes: Acupuncturists, chiropractors, midwives, massage therapists, medical practitioners, mental health professionals, nurses, occupational therapists, optometrists, physical therapists, podiatrists, hospitals, nursing care facilities, birthing centers and community clinics.
I’ve had the good fortune to work with many health care professionals in the course of my career, so I’ll admit my bias. But even so, in a state where we had a shortage of more than 250 primary health care providers before COVID-19, how does it make sense to treat our doctors, nurses and other health care professionals this way?
Next, there’s a related effort targeting pharmaceutical manufacturers, including Pfizer, Johnson & Johnson, and other firms that helped make COVID-19 vaccines a reality in less than a year. That’s nothing short of a scientific miracle.
Now, the price of prescription drugs is driven by a range of factors that will make your head spin. Besides the cost of scientific research, development, clinical trials, production and distribution of medications, there are many more layers of complexity, including the role of insurance contracts, pharmaceutical benefits managers, international price controls and foreign subsidies.
The existence of services like GoodRx and SingleCare – which work outside the traditional insurance model to provide lower consumer prices for some medications – shows the potential for serious and thoughtful improvements on a larger scale.
But unfortunately, the bill aimed at lowering prescription drug prices in Colorado – SB21-175 – uses the same playbook as the public option.
Specifically, the bill makes it unlawful “to purchase or reimburse a payer for a prescription drug … at an amount that exceeds the upper payment limit” established by a five-member board appointed by the governor.
During a recent hearing, pharmacists and medical professionals warned the real-world impact of upper payment limits would be fewer, rather than cheaper, medications for patients in Colorado. Prices for medications are determined nationally and mandating prices below that level would effectively keep some medications out of Colorado.
One witness, a pharmacist and board member of the Colorado Pharmacists Society, warned that SB21-175 “doesn’t appear to address the actual issue of drug cost and access.” Instead, it has the “unintended consequence … of decreasing access to potentially life-saving treatments across the state,” she said. “If you can’t buy it, you can’t sell it [to patients].”
Another witness, the medical director of an intensive care unit, told lawmakers she could tell “thousands of stories” of patients needing better access to medicines. But “this bill is not going to fix it,” she warned. “I am concerned that we’re going to make a bigger problem for our patients rather than helping them.”
In recent months, our leaders have offered words of thanks to the health care workers who are carrying us through the pandemic and the scientists creating vaccines to end the pandemic. But if our leaders now punish those same professionals in pursuit of their political goals, those thankful words will have meant nothing.