A years-long effort to create a lower-cost, higher-quality option on Colorado’s health insurance exchange for individuals and small market groups is close to becoming law after passing the state Senate on Wednesday morning.

House Bill 1232, sponsored by Sen. Kerry Donovan, D-Vail, and Rep. Dylan Roberts, D-Avon, passed the Senate, 19-16, on its third reading. Democratic Sen. Rachel Zenzinger of Arvada joined all Senate Republicans in voting “no.”

The bill will now head back to the House, where it previously passed on a 40-23 party-line vote, for state representatives to concur on new amendments before heading to the desk of Gov. Jared Polis.

If approved and signed into law, the bill would direct Colorado’s insurance commissioner to work with stakeholders to develop a new standard health benefit plan by next January. Insurance carriers would have to offer the standard plan in counties where they operate, starting in 2023, and reduce premiums by a total of 15% over three years.

An amendment adopted Tuesday lowered the cost savings from 18% to 15%.

Donovan delivered a 13-minute speech on the Senate floor before the vote was taken to again make the case that the status quo isn’t working for Coloradans, especially those without employer-provided health insurance.

“No matter where you sit on this floor, no matter where you live in this state, no matter who your employer is, I think we would be hard-pressed to find someone who would say health care is going great,” she said.

In her outreach to the communities she serves, Donovan said she has repeatedly heard the same narrative from constituents.

“Whether you’re a raft guide in Steamboat or you’re a farmer in Bennett, or you’re a small business owner in Denver, more access means that you get the care they need closer to where they live,” she said. “Lower premiums means more dollars at the end of the month to put into a college savings account or your retirement plan. Improving health outcomes looks like providers living and working in and reflecting the communities they serve.”

‘A positive change in the right direction’

The standard plan — dubbed the Colorado option — would be offered for the individual and small group markets on the Colorado exchange, Connect for Health Colorado. The two markets together account for about 15% of the state’s health insurance market. The small group market includes small businesses with fewer than 100 employees.

The program supervisor of the Mobile Intercultural Resource Alliance, or MIRA, an RV that travels the Eagle Valley offering public health services and resources to predominately uninsured residents, called the bill’s passing “a positive change in the right direction.”

“It’s a good change to start with and hopefully things will continue to get better,” Virginia Lecea said. “Definitely MIRA will help with promoting this and explaining this on how to enroll … We get so many questions on health insurance.”

Lecea said she often hears from small business owners in Eagle County’s Latinx population who have chosen not to insure themselves because it is simply too expensive to do so.

Many of MIRA’s customers are uninsured because of their status as undocumented immigrants. Roberts, in a text Wednesday, clarified that the plan is available for anyone to purchase, though undocumented immigrants wouldn’t be eligible for subsidies.

Other supporters of the bill agree that the measure is needed to help more people and small businesses in Colorado afford quality health insurance coverage and medical care, something too many have been struggling to pay for or gone without, because of the cost.

‘Final grand compromise’

Opponents question where the premium reduction savings are supposed to come from and argue that the bill will have negative and unintended consequences for health care providers and patients, and make it harder to keep or recruit doctors in the state.

Other amendments to the bill considered Tuesday offered compromises on those concerns and, ultimately, multiple amendments were passed that weakened penalties for hospitals and medical providers that refuse to accept the Colorado option.

Donovan described one of the amendments as the “final grand compromise.”

In introducing the amendment, she acknowledged the influence that medical interest groups have had on the lengthy process of bringing the bill to where it is today.

“I believe that many of you have heard from the Colorado Medical Society asking you to support this amendment,” Donovan said.

The amendment, which passed Tuesday, removed the ability for Colorado’s insurance commissioner to issue warnings and fines to physicians that do not accept the new plan and instead directs the commissioner to monitor for “problem areas” of health care providers refusing to participate, she said.

Without the amendment, providers could have faced fines of up to $5,000 per year which Sen. Joann Ginal, a Democrat and a health care provider herself, said would have caused Colorado to “lose a lot of physicians.”

Another amendment passed Tuesday removed the ability to revoke the licenses of hospitals or health care centers that refuse to accept the Colorado option.

The rejection of a third amendment left fines for hospitals and health care centers in tact. Fines can be up to $10,000 per day for the first 30 days and $40,000 for each additional day past 30 days.

Tom Lotshaw and Nate Peterson contributed reporting.