Dear Orthopedic Colleagues,

A lot has changed in the past three years with COVID, new leadership and legislation at the Capitol and new leadership within the Colorado Orthopedic Society. We owe a debt of gratitude to Dean Holzkamp for leading us through the past many years and helping us navigate both the legislative challenges and enhancing our membership benefits.  Please join me in congratulating him as he was chosen to be the leader and CEO of the Colorado Medical Society (CMS). As such, he could no longer balance the time needed to dedicate to the Colorado Orthopedic Society. He was instrumental and very involved in our transition to our new leadership. It’s with great pleasure that I would like to introduce Suzanne Hamilton and Dan Jablan as the new administrative and legislative leadership of COS. Suzanne has more than 30 years’ experience in health care policy work and successfully advocating for physicians both at the Colorado Medical Society as well as with various physician specialty organizations. Dan brings COS an extensive background in advocacy accompanied by very close relationships with legislators on both sides of the isle as well as the administration. Suzanne and Dan have joined forces to blend their talents for the benefit of your COS. They are clearly experienced and have already established a clear vision for the future of the society and its membership.  

We are hard at work on the development of a new website that will be found at www.coortho.org. As soon as it goes live, it will have links to local legislative news as well as national legislative news. Additionally, it will have COS membership updates so that you can connect with colleagues either locally or in different parts of the state. Please watch for the launch and check your own personal information and make sure that it is correct and up to date. 

This past legislative session was a busy one and COS was very active with legislative issues.  We have positioned ourselves a balanced voice at the table and are strengthening that position with legislators as well as with outside agencies like DORA.  Please see the 2023 Legislative Wrap-up below and keep a lookout for regular communications regarding the implementation of these new laws as well as what issues we are already hard at work on over this interim.  

This newsletter will have a more regular cadence in the coming months as we strengthen our membership and start preparing for the annual meeting in October. Please contact me personally if you have any issues that the COS can help you or your practice.  We continue to grow as a society and appreciate your support!

With gratitude,

Gary

It is important to begin by thanking the dedicated members of the COS leadership and those members who came to the Capitol to testify. When a Colorado orthopedic physician comes to the Capitol, legislators pay attention. That said, Monday, May 8th could not have come soon enough. The Colorado Constitution grants the Colorado General Assembly 120 days each year to complete the State’s work. May 8th marked the 120th day.

Considering the political polarization of this General Assembly (more on that below) COS was able to carefully navigate the more than 700 bills introduced into this legislative session. Once again, health care policy was a primary theme, along with TABOR, taxes, housing, guns, abortion, and state versus local control of land use to name a few. Your COS Board identified at least 50 bills impactful to the practice and profession of orthopedics and your patients. 

Here are a few highlights from this session:

• Drove amendments ensuring appropriate collaboration between physicians and physician assistants allowing a PA to practice at the top of their education, training and experience while ensuring the collaborating physician determine those capabilities (SB23-083)
• Responded to the opioid crisis with appropriate treatment for patients with chronic pain while avoiding addition government intervention in to your practice (SB23-144)
• Protected physicians from unnecessary processing fees when being reimbursed for billed claims (HB23-1116)
• Beat back efforts from trial lawyers that would have increased rates, number of settlements and exposed physicians to personal liability (HB23-1192)
• Protected your ability to collect for care provided, assign collections to a third party both without unjust caps on interest rates (SB23-093)

Our focus has already shifted to preparation for the 2024 legislative session. As we look forward it is important to remember that the same 100 legislators and first floor participants (aka the Governor and his staff) will be coming back next year, therefore we can expect much of the same. The COS Board of Directors is actively involved in a coalition to preserve Colorado’s non-economic damages caps which are currently under threat of a 2024 ballot initiative or preemptive legislation as well as pursuing legislation to remove administrative roadblocks impeding your ability from providing the highest quality care to their patients.

I would like to take a quick moment to provide you with a general political scan of this 2023 Legislative Session to better understand what to expect in 2024. This first session of the 74th General Assembly came to a screeching halt about 10 pm on May 8 without adopting the Governor’s land use priority, as the Democrats were unable to secure the votes necessary for its passage. Day 120 also saw House Republicans walk out of the chambers in protest of the rules limiting debate. This session will be remembered for working weekends and nights, majority rules, and intra-party squabbles.

With Democrats holding a historically large majority, they came into the session knowing they would control the proceedings. Business groups looked towards the first floor and Governor Polis to moderate the coming progressive agenda. Republicans merely hoped to be part of the conversation. In his State of the State speech on January 17, Governor Polis highlighted affordability and housing as two of his top legislative priorities along with public safety, air quality, water conservation, lowering health care costs, and tax policy.

Coming into the gold dome, Democrats held a 23-12 advantage in the State Senate and a 46-19 supermajority in the House, the worst legislative disadvantage the party had seen in 85 years.

Republicans had little leverage to stop or amend measures they opposed, except to filibuster a bill and ask for the bill to be read at length. These tactics, along with mishandling of the calendar and excessive late bills, led to a logjam the last month of session.  

The pressure to get through a legislative backlog was intense during the final weeks, and the tight timeline even brought the Senate into session on a Sunday for the first time in more than 80 years. Meanwhile, working nights and weekends had become the norm in the lower chamber. Republicans successfully debated bills for hours on end – until Democrat leadership decided to limit debate until Rule 14.  Rarely ever invoked, Rule 14, only takes a simple majority to pass and can limit debate on a bill to as little as an hour. In recent weeks House Democrats turned to it several times to cut off Republican objections to bills about guns and abortion.

There were 143 bills pending in the legislature as of the Friday prior to adjournment, including last minute bills on property tax and TABOR refunds proposed by Governor Polis. With the rules suspended, it only takes three days to pass a bill.  As highlighted in Colorado Politics, with just a days to go before the end of the session, Colorado's House Democrats rushed to push through a last-minute proposal that seeks to equalize TABOR refunds to about $660 per person. The new proposal also ties its implementation to the passage of Gov. Jared Polis' plan that offers tax relief by using a portion of TABOR refunds to give to property tax owners. 

Going into the final day of session, the biggest items remaining on the calendar were the land use bill and the property tax plan. The House and Senate were on course for a showdown over land use. Each chamber had passed very different versions of the bill. Either one chamber would have to accept the other’s version, or hand it off to a conference committee to try to negotiate a compromise.

The last night, Republican representatives stormed out of the House chamber while their colleagues in the Senate requested full readings of lengthy bills, asked to add new amendments to legislation, and rambled long debates to run down the clock and prevent passage of the more contentious proposals coming out of the General Assembly. In the end, Senate Democrats were unable to come to agreement among their own caucus on the Land Use bill and the measure died. Also on Monday evening, in an informal House Democratic caucus, one of the most progressive members, Rep. Epps, confronted the Speaker for allowing Republicans to speak and for allowing last minute bills to pass. 

Governor Polis and Democratic leadership declared the legislative session a success, pointing to a record investment in education, support for wildfires, regulation of utilities, capping prescription costs, enacting additional penalties for auto theft, stricter gun control, and providing tax credits for electric vehicles, bikes, and lawn equipment among other accomplishments. But it was a victory lap tempered by the late-session failure of the governor's top priority for 2023 — affordable housing. House Republicans, who staged a walk-out on the last day, say Democrats abused their majority by using an obscure rule to limit debate and Senate Republicans accused the Democrats of overreaching to keep TABOR refunds. 

Next year’s session, expected to be very similar, starts January 10, 2024.