A one-time bill to boost access to primary-care doctors that morphed significantly as it moved through the Colorado House died this week after its Senate sponsors offered little enthusiasm for what the bill had become.
Wednesday’s Senate Health and Human Services Committee hearing for House Bill 1005 was unusual in the lack of support that sponsoring Democratic Sens. Dylan Roberts of Frisco and Rhonda Fields of Aurora extolled for the legislation. Instead of asking the committee to pass the bill in her closing statement, for example, Fields simply said: “At this point we just ask that you consider the bill before you, which is a strike-below. And I would leave it there.”
Members promptly killed HB 1005 on an 8-1 tally, with Fields offering the only “yes” vote.
When introduced on the first day of the session, HB 1005 was a bold but still developing idea from Democratic Reps. Chris deGruy Kennedy of Lakewood and David Ortiz of Centennial to stabilize relationships between patients and primary-care providers. Too many people are forced to shuffle between primary-care doctors because of job or insurance changes, leading to sometimes insufficient treatment from people who don’t know them well, as well as unnecessary tests, Kennedy said.
Why House sponsors rewrote the bill
But business leaders assailed his proposed method for doing so — requiring health insurers to include in all networks any primary-care doctor who met a certain set of qualifications. Doing so would disrupt narrow networks into which insurers limit the number of providers to control reimbursements and hold down health-care expenses, and industry leaders warned it would boost premiums for all Colorado-regulated plans.
Colorado state Rep. Chris deGruy Kennedy speaks to the Colorado Chamber of Commerce’s Health Care Council in January.
At a March 19 committee meeting, deGruy Kennedy acknowledged there were too many obstacles to move forward with his original plan and removed all provisions related to mandatory inclusion of primary-care providers in networks. Instead, he substituted provisions to allow primary-care physicians who are not majority owners of their practices to leave for new jobs more easily without facing onerous financial penalties or obstacles to working elsewhere in Colorado under noncompete agreements.
DeGruy Kennedy defended the new version of the bill as one that still could aid continuity of care by ensuring that noncompetes don’t force doctors to move out state and that could improve the relationships between providers and their employers. Rural Republicans argued that making it easier to end employment contracts could hurt their area’s hospitals that already are struggling to retain personnel, but HB 1005 passed the House on a party-line vote.
Senate sponsors appeared gobsmacked
Roberts and Fields signaled from the start of Wednesday’s hearing, however, that they weren’t enthusiastic about the sweeping changes made to the bill. Roberts said they would let supporters of the bill explain to committee members — and he added, to sponsors — the need for the new bill, and Fields said in her opening statement: “It’s not what we intended to sign up for.”
Nina DiSalvo, policy director for worker-rights law firm Towards Justice, explained that existing noncompete agreements can deprive doctors of their ability to continue practicing in the state unless they pay hefty penalties to the practices they are exiting. The rewritten bill would have allowed primary-care physicians to leave employment contracts after their initial terms are complete, and it limited damages for breach of contract to no more than 50% of the doctor’s annual pay.
Towards Justice Policy Director Nina DiSalvo speaks during a public hearing on the state’s family-leave insurance plan in 2023.
“This bill would ensure that noncompete agreements don’t excessively constrain mobility for physicians in our state,” said DiSalvo, who spoke with another employment attorney and a representative of the American Academy of Family Physicians in favor of HB 1005.
Rural hospitals, business groups push back
But Colorado Hospital Association vice president Josh Ewing and Colorado Chamber of Commerce senior vice president Meghan Dollar argued that eliminating clauses that bind physicians to jobs would disadvantage rural networks that include them in contracts because they have trouble attracting and keeping doctors.
And Jennifer Riley, CEO of Memorial Regional Health in Craig, explained how her 25-bed critical-access hospital has spent two years trying to recruit an ear, nose and throat specialist, finding that even increasing pay is hard to sell to doctors.
“Retaining physicians is important in maintaining continuity of care for our community,” Riley said in arguing against the bill. “In an environment like Colorado with workforce shortages, this means patients are often left without specialists.”
Issue may not be dead
Roberts, whose district includes several small-town hospitals, said in his closing statement that he had “heard some arguments that I can’t argue with that noncompete agreements are an important part of this space, particularly in rural Colorado.” And Fields essentially told the committee to do whatever it would like with the bill.
Republicans and Democrats then joined together to postpone the bill indefinitely, ending the strange saga of a legislative proposal that changed so dramatically in mid-course that it left its original backers seemingly confused on how to deal with it.
Discussions on whether changes are needed to physicians’ noncompete contracts — which largely are exempted from a two-year-old law limiting the use of such agreements — may not be over, however. Both Roberts and Ewing indicated they are willing to discuss the concept further after the legislative session ends, particularly as federal regulators look to clamp down further on noncompetes.