Rep Kathleen Curry (MBO; Flickr)

By holding back the start of the moratorium to next session, the two Western Slope lawmakers have effectively thrown the floor back open for mandate bills– like the one being drawn up by Denver Democrat K. Jerry Frangas’s that would require insurance companies to cover maternity and birth control.

Curry, a Gunnison Democrat recently turned Independent, and Roberts, a Durango Republican seeking a seat in the state Senate, were seeking to place a one-year moratorium on laws like Frangas’s while lawmakers attempt to overhaul the state’s mandate commission.

Curry drew heat for the proposed legislation, which political blog Colorado Pols called a “nasty bill” authored by the insurance industry and the reason Curry was effectively forced to change party affiliations. But Curry told the Colorado Independent that the bill’s intent was never to shut down any particular mandate being proposed for this legislative session.

“I thought we could just diffuse that whole debate by having the bill kick in after the session is over,” she said.

The Mandate Commission

Shortly before Curry formally announced she was leaving the Democratic party at the end of December, Colorado Pols opined that the move was precipitated by Curry’s co-sponsorship of the mandate moratorium bill. “Curry’s sponsorship was seen as improper bipartisan cover for Roberts on a bill with significant political import,” a Pols blogger wrote.

Curry said that kind of speculation had been “blown out of proportion.” She acknowledged, however, that reactions to the bill had “highlighted the difference in philosophy” she had with members of the Democratic party.

“There was a difference of opinion between me and other folks in the caucus who work a lot on insurance industry,” she said. “The difference really came about because of the thoughts that some people had that we should be actively working against, or [working] to penalize the health insurance industry.  That has come up more than once— that somehow it is an ‘us versus them’ situation. And I don’t believe that.“

In conversations about the bill, both Curry and Roberts emphasized that, for them, the bill is really more about overhauling the state’s Commission on Mandated Health Benefits than it is about the moratorium.

“The moratorium is a piece, but it is kind of the secondary piece,” said Roberts. She added that its purpose is to allow Colorado to wait for federal reform to pass.

The legislative mandate commission was instituted in 2003, according to Roberts, and is supposed to provide committees with a cost-benefit analysis of all proposed mandates.

Considering time and place

According to Roberts, however, Insurance Commissioner Marcy Morrison has argued in year-end reports that the commission is not working properly.  For example, said Roberts, one bill last session— a proposed mandate for preventative health services— never went through the mandate commission at all.

Another of Commissioner Morrison’s main complaints, according to Roberts, is the extremely short periods of time the commission is often given to review a bill.

So Curry and Roberts hope to establish a mandatory time period for the commission to work. They first proposed 30 days, but Roberts she now thinks that might be too long.

“We’re trying to figure out if there is something better than trying to have them produce it in 24 hours,” said Roberts. “But we don’t want it to be so cumbersome that people who have these bills can’t get through the process at all.”

Curry added that the bill will also ensure that the committee has time to review the reports before voting.

Curry and Roberts are also proposing moving the location of the mandate commission from the executive branch to the legislative branch.

Because members of the executive branch are appointed by the party in power, said Curry, there is always an inherent bias in the executive branch.  On the other hand, she argued that the Legislative Council is composed of nonpartisan employees already very familiar with the legislative process. The two will first have to determine if the Legislative Council can take on the additional work.

As for accusations that, in carrying the bill (which is being pushed by the Colorado State Association of Health Underwriters), she is acting as a pawn for the industry, Curry said such accusations are a way to dodge the conversation about the real cost of health care.

“I’m addressing an issue my constituents care a lot about—and that would be the control of cost associated  with health insurance…The real conversation has to do with escalating costs, the reasons for those costs, and what we can do as elected officials,” she said.

This story has been corrected to reflect the fact that Curry and Roberts are delaying the start of the proposed moratorium–not the proposal of the bill.

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Lt Gov. Barbara O'Brien

Colorado Independent: Can you talk at all about how the application is shaping up?

Barbara O’Brien: A lot of our proposal is about implementing, on a statewide basis, some of the policy changes that took place over the last three years, under Gov. Bill Ritter. So higher standards, creating a new CSAP test. Everyone hates the current test.

Any idea what that new CSAP test would look like?

We’re thinking that it will be a combination of online quizzes during the course of the year. So, instead of students just taking a drop-dead test in the spring, they’ll be able to take little informal assessments throughout the year to see where they are on a track. They’ll be able to actually re-take quizzes if they find they didn’t do well. So progress is encouraged.

We also want a test that is really going to be meaningful; it’s really going to fit in with what they’ve been studying. Right now the CSAP is out of sync with a lot of what students are taught. There are districts that teach chemistry in a different order, but the chemistry questions on CSAP, for example, don’t match up with what students learned in the first semester.

So higher standards and a new CSAP. What other proposals will be in the Race to the Top application?

We’re required to have a plan for greatly increasing student performance in the state’s worst 5 percent of schools—that’s about 95 schools in Colorado.

This is where district participation is really important. We really want districts that have some of these struggling schools to sign on to a plan for turning them around—because if we’re selected for Race to the Top, we can give them some new resources, some new tools: more teachers, more career counselors (to help students understand the connection between high school and a career or going on to college), longer school days (so they have more time to learn), and more tutoring.

And then if, after a couple of years, a school isn’t getting measurably better, the option is to take it over, and turn it over to some other group that has a track record of running excellent schools.

Probably the least exciting part of this application is the longitudinal data system. That’s actually something where Colorado has been a leader. But we have a number of small districts that can’t afford to upgrade their information systems. So part of this money would be used to help those smaller school districts modernize their computer systems so they can feed student data into the systems and the state can analyze what kind of algebra programs seem to be working best, what kind of reading programs, et cetera. It would create a real data system for education around the state.

Teacher evaluation is another part of the application. I understand there are some bills proposed for the next legislative session related to teacher evaluation. Is the governor’s office involved with those?

There are at least two senators pushing state legislation. We are not. We have been working with a large committee of people since July on this. We think they have a really strong plan for a teacher evaluation system. We don’t think we need legislation quite yet, because we’ve got to pilot the plan and see if it works first.

The legislature will do what it does, and they might push forward with something. But for our proposal, we’re just describing what our consensus is and hoping we get the funding to try it out.

Can you talk about what that new evaluation would look like?

Half of the evaluation system has to be based on student growth data. The problem is that a lot of teachers teach subjects not tested on CSAP. The teachers, and I think rightly so, feel that’s not fair— to have some teachers held accountable and others, well, their subject isn’t even tested.

So what we would have to do is to come up with some kind of quantifiable evaluation for all the teachers who teach subjects that aren’t on CSAP, like social studies.

Then we’ll add to that other measures that teachers feel are really important for knowing how kids are doing. I can’t tell you what those are. But we’d put together a committee that will include teachers and principals to take a look at what kind of fair components could be added to this evaluation.

Colorado recently won $250,000 in Gates Foundation money to solicit help to write the grant. Can you talk about why the proposal was successful?

We heard a couple of things about that proposal.

One was that we were taking this so seriously that we seemed like a state that, no matter what happens with Race to the Top, we’re going to try to implement a lot of this anyway. It would just be slower.

Part of it is that we are a local-control state— which is not like the majority of states. They were interested in helping us develop a proposal that just has to be different than other states’ because of our local control traditions.

And then we really needed help budgeting this thing. We’ve been through budget cuts, and we just weren’t in a position to have a whole lot of people with technical skill working on this. So they put us in touch with a consulting company that has great experience with education budgeting and human resources just to give us some technical expertise.

I hear there is some confusion around getting school districts on board with the state’s Race to the Top plan. Can you talk about that?

Part of the emphasis in the proposal requirements is that you have the participation of local districts. It’s voluntary, but the idea is to show that you have enough district participation to have a statewide impact. So we are asking school boards and local associations, if the district has one, to sign [a] Memorandum of Understanding [signifying its approval] as soon as possible.

The confusion has been that the latest possible date is January 6. But for budgeting purposes, getting those in sooner would have helped us know what number of districts we were dealing with.

How many districts have signed on?

We have 33 school districts, so we’re up to 18 percent of all school districts.

[Note:  by the end of the day on December 22, the count was up to 73 school districts that had either signed up or indicated that they will. That represents 906 schools and 53% of the K-12 student enrollment.]

That’s a pretty low number this late in the game. Do you think school districts don’t want to sign?

We’re very certain they want to sign because we did a survey and 90 percent were interested.

You know it’s the holidays and a lot of people aren’t working right now. So we think it’s just a matter of the fact that they’re kind of understaffed this time of year and there was a little confusion over the date.

Have you had any school districts say they just won’t sign?

There are some rural districts that are really afraid that they can’t meet the reporting requirements because they don’t have the personnel. So we think there’s going to be lighter participation out on the eastern plains, in all of those rural districts— but that the main ones, along the Front Range, will be signing up.

Have you been able to give districts any kind of preliminary draft of the application?

We haven’t had a proposal to show anyone. We’re planning on doing that in about a week.

So far, we’ve been trying to sort through all the ideas that came from input process. And then because the governor and commissioner have to approve content, we had to run everything past them before we could start writing. So our writing team really just started writing last week.

But we intend to make this available for people and put it on the website just as soon as we had a decent draft.

That doesn’t hurt your chances if you show your cards to other states?

You know, we’re assuming that by now, if other states aren’t pretty much committed to their own plan, it’s going to be hard to make mid-course corrections. But because we’re local control, and buy-in is so important, I think it’s more important to make sure that we continue to be transparent and inclusive.

The federal deadline has really made everyone work through the holidays, hasn’t it?

This is the one thing where I could wring [U.S. Secretary of Education] Arne Duncan’s neck [laughing] because the federal government missed every one of their own deadlines. They were supposed to have the guidelines to us in August— and they didn’t come out until November 18. So they’ve missed theirs, and now they’re done and every state in the nation has a team that’s going to have their Christmas ruined.

Do you have a hard deadline for when the federal government will announce the grants?

They’ve told us that they will pick the top five states and invite them to Washington to do a verbal presentation in March or early April. And then they plan to have a decision in late April. And then, if we’re selected, we have 90 days for participating districts to write their scope of work for implementing. That takes us to mid- to late-summer, so that’s when the money would start flowing.

Interview edited and condensed by Katie Redding.

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State Rep. Kathleen Curry, Independent

The moratorium is being proposed by the Colorado State Association of Health Underwriters (CSAHU), according to CSAHU lobbyist Cindy Sovine-Miller. Although the health insurance industry group is still working to land Senate sponsors, Sovine-Miller said she expects Ellen Roberts, a Durango Republican, and Kathleen Curry, a Western Slope Democrat-turned-Independent to carry the bill in the House.

In fact, insider blog Colorado Pols posted Tuesday that Curry had broken with her party over this very legislation, which it referred to as “a very nasty bill, crafted by the insurance industry.”

“Curry’s sponsorship was seen as improper bipartisan cover for Roberts on a bill with significant political import, and Roberts is likely to be a major front in the GOP’s strategy to recapture the state senate next year,” the poster wrote.

Sovine-Miller said she expected the bill to come early in the session, presumably to head off any mandate bills legislators intend to introduce.

“This bill is probably going to come right out of the gate. We really want to set the tone for the session,” she said.

According to Sovine-Miller, the bill aims to point out that requiring insurance companies to cover different health care needs unfairly puts “unfunded mandates” on small businesses instead of turning to other available resources to provide health services.

For example, she argued, a recently-passed mandate covering autism forces insurance companies to cover services that ought to be covered by school districts.

“Autism is not a physical body need,” she said. “It’s not even necessarily a mental-health need. It’s a whole range of things that require various physical therapies and health care therapies… Because the state education system can’t afford it, they’re pushing it off to the people who can.”

Sovine-Miller acknowledged that the proposed maternity mandate wouldn’t impact small businesses, since it only mandates maternity coverage on the individual market, but she argued that it would be an unfunded mandate on individuals.

The moratorium also aims to give insurers a chance to catch up with— and understand the implications of— any federal reform, she said. She acknowledged, however, that the moratorium would expire long before most federal health care reforms are expected to take effect in 2013.

In addition to a moratorium on mandates, the proposed bill would also provide at least 30 days to the Commission on Mandated Health Insurance Benefits to determine how much mandates should cost. Right now, argued Sovine-Miller, the amount of time the commission has to determine the cost of a mandate varies, and it’s often not long enough.

In the place of reliable information from the commission, she argued, supporters of various mandates and costs present their own information.

“I think we’re all tired of what both sides are saying because we all know they’re all biased in their information,” she said.

Rep. K. Jerry Frangas, D-Denver, sponsor of the proposed maternity and birth control mandate, said he’s not worried about the proposed moratorium killing his bill.

“I think that if people are talking to their constituents, they’ll know that blockading a discussion is not right,” he said. “And blockading [health care] based on someone being a woman or a man is not right. And that’s what this is about. So if legislators talk to their constituents, they’ll come to the legislature with the knowledge that we need to deal with this and we need to deal with this now,” he said.

He also didn’t accept the argument that Colorado should adopt a “wait and see” attitude to federal reform.

“My argument is how long do we have to wait?” he said. “And how long have we waited on an issue that essentially is discriminating against women in Colorado? How long do we have to put this off?”

Colorado, like all states, is subject to federal mandates that require employer-based health plans for companies larger than 15 to cover birth control and maternity. But the Centennial State has no coverage mandates for maternity or birth control on the remaining markets. This situation has led to significant gaps in maternity and contraceptive coverage for Colorado women– particularly for those buying plans on the individual market.

Frangas’s bill would require Colorado health insurance companies issuing plans on the individual market to cover maternity in the same manner that they currently cover sickness or accidents. The bill would also require both individual and group policies to cover pregnancy management, including contraceptive counseling, drugs and devices. But the bill explicitly excludes abortion procedures and services from the definition of pregnancy management. If the bill passes, the mandates would go into effect on Jan. 1, 2011.

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Colorado’s low-rating comes courtesy of a 2006 nonprofit Guttmacher Institute report, which ranked Colorado 40th in access to birth control. By contrast, Alabama–hardly considered a progressive state–ranked 4th.

Colorado, like all states, is subject to federal mandates that require employer-based health plans for companies larger than 15 to cover birth control and maternity. But Colorado has no coverage mandates for maternity or birth control on the remaining markets. The situation has led to significant gaps in maternity and contraceptive coverage for Colorado women– particularly women buying plans on the individual market.

The Colorado Independent investigated individual-market options in the state and found a tangle of plans women and families might cobble together that even the insurance agents paid to sell them couldn’t recommend. The options were expensive; the coverage was undependable.

On the issue of birth control, The Colorado Independent questioned the nine companies who offer coverage on the individual market through ehealthinsurance.com. Three companies said they offer birth control coverage on most of their plans; three don’t at all; one covers birth control devices, but not their implantation; one covers birth control for plans that include brand-name drugs (an option which requires the purchase of a rider for all the plans for sale at ehealthinsurance.com) — and one company still has not yet responded to inquiries. Moreover, whether a plan covers birth control is not always readily available information: it’s generally buried in the “exclusions and limitations” section.

But Rep. K. Jerry Frangas, a Democrat from Denver, recently proposed a bill that would force insurance companies to cover both maternity and birth control across all markets.

Whether or not the bill will pass remains to be seen. But if it did, passage would hardly earn Colorado a “pioneer” ranking. Many other states have already mandated insurance companies to cover birth control, and a number have full or partial maternity mandates, as well.

Birth control

Twenty-five states already have contraceptive mandates, according to a 2007 National Women’s Law Center (NWLC) study.  In general, those mandates require health insurance companies that cover prescription drugs to also cover any any prescription contraceptive drug or device that has been approved by the United States Food and Drug Administration

Nearly all of the laws were passed by the state legislature—except in Washington State, where the Insurance Commissioner issued an administrative rule mandating contraceptive equity.

The  NWLC argues that the exclusion of prescription contraceptives from health insurance coverage unfairly disadvantages women by singling out a health insurance need that only they have and giving it unfavorable treatment–requiring women to spend more of their income on this out-of-pocket cost.

But access to contraception is also critical in preventing unintended pregnancies—and enabling women to control the timing and spacing of their pregnancies, notes the report. This, in turn, reduces the incidence of maternal death, low birth weight babies, and infant mortality.

Maternity

A 2008 National Women’s Law Center study found that 21 states have an additional benefit mandate that relates to maternity care, some of which provide more access to maternity care than others.

For example, in New York, only HMOs and nonprofit insurance companies are required to cover maternity, leaving what Brigette Courtot, senior policy analyst with the National Women’s Law Center, called “a very small proportion” of plans without maternity. On the other hand, Maine and New Hampshire have mandates that require insurance companies to offer one or more plans that cover maternity. But such plans, according to the 2008 report, can come at a high and unaffordable cost.

According to Courtot,  five states mandate insurance companies to cover maternity across all markets: Massachusetts, Montana, New Jersey, Oregon, and Washington.

Courtot pointed out that it wouldn’t be accurate to suggest that a maternity mandate wouldn’t raise premiums. But she argued that the rise wouldn’t be as great as everyone fears–and that it would be outweighed by tremendous cost savings for women currently paying for pregnancy out-of-pocket.

For example, in 2008, noted Courtot, the California Health Benefits Review Program, which provides independent analysis of the impacts of proposed mandates, analyzed a bill that would have mandated maternity coverage in 40 percent of California’s individual market. (The other 60 percent of the market is already subject to a maternity mandate.)

The program estimated that the average health expenditure increase for all policyholder would be .32 percent.

“The cost issue is overblown,” said Courtot. “Most mandates raise premiums by less than 1 percent.”

Furthermore, she noted, when insurance companies don’t cover maternity, that cost is often picked up by state-sponsored aid.

According to Chaer Robert, a board member at the Women’s Lobby of Colorado, over one-third of the babies born in Colorado are born on public assistance. In an earlier interview, Robert speculated that the number might be lower if Colorado women had better access to maternity coverage through the insurance market.

“Whether it’s the state creating a special state-only program or if the fact that these plans don’t include maternity means that women are more likely to get covered through Medicaid, it is true that states are already covering a good portion of care that women are receiving,” said Courtot.

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This week, Lt. Gov. Barbara O’Brien announced a partnership with Hallmark Card, Inc., to send all Colorado parents a Hallmark card reminder to schedule their children for shots. The card will also include a growth chart and an immunization record with a list of all recommended vaccinations for children under the age of two.

According to the Lt. Governor’s press release, approximately 70,000 babies are born annually in Colorado. Roughly 55,580 of those children—or 79.4% are immunized, according to  National Immunization Survey data.

That’s above the national average of 76.1%. And it’s a number that has improved fairly significantly in the last decade—thanks to increased outreach and better tracking mechanisms. In 2002 and 2003, Colorado was ranked 50^th in the nation for childhood immunizations, with only a 68% immunization rate, according to O’Brien spokeswoman Ellen Dumm.

Dumm added that the Centers for Disease Control and Prevention goal is 80% by 2010. “So we’re close,” she pointed out.

The Lt. Governor’s press release noted that a June, 2009 study by Kaiser Permanente Colorado’s Institute of Health Research showed that children whose parents refuse vaccines are 23 times more likely to get whooping cough. Over half of the vaccine-preventable disease cases in Colorado occur in children less than two years of age, according to The Children’s Hospital in Denver.

Nonetheless, the number of parents refusing immunizations appears to be increasing in the United States, noted the researchers on the Kaiser study.

A 2008 New York Times story also noted a rise in refusals:

In 1991, less than 1 percent of children in the states with personal-belief exemptions went without vaccines based on the exemption; by 2004, the most recent year for which data are available, the percentage had increased to 2.54 percent, said Saad B. Omer, an assistant scientist at the Johns Hopkins Bloomberg School of Public Health.

Dumm is still confirming the cost of the program.

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Jon Caldara of the Independence Institute said Tuesday that he is still working on the language for his proposal, which would then need signatures from 76,047 voters to make the ballot. But he intends to find out in the fall whether voters want to stop the federal government from dictating insurance requirements to Coloradans….

Caldara’s proposal aims to bar the state from requiring its citizens to purchase health insurance, ensure Coloradans can pay out-of-pocket for health care expenses and allow them to purchase plans from other states.

He hopes to make a draft of the initiative public next month.

Meanwhile, freshman state Rep. Cindy Acree, R-Aurora, says she’ll also push the state legislature to opt out of federal reform.

A New York Times story published Sunday argued that about a dozen states are working on similar proposals. It also noted that such amendments would be largely symbolic—since any federal legislation would supersede a state amendment.

Moreover, the Times argued that the proposals were largely being floated in states in which the health care industry had spent heavily. It noted, for example, that nearly all of the 42 Florida state legislators backing such an amendment received particularly large campaign contributions from health care interests.

“The states are the next battle,” said Richard Kirsch, national campaign manager for the liberal advocacy group Health Care for America Now, “and the insurers and health care industry are primed up and ready to go. The industry has enormous power at the state level, and very few states have state-level consumer groups that are able to lobby effectively against them.”

The Denver Post reported that Colorado ranked second among the Rocky Mountain West states in campaign contributions accepted from the health care industry in the last three elections, according to the Institute on Money in State Politics

Democrats interviewed by The Denver Post cautioned opponents to wait and see what health care reform actually looks like before proposing constitutional amendments to opt out of it. They pointed out that the House and Senate bills still have to be reconciled.

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State Rep. Kathleen Cury

The move forces her to give up her positions as speaker pro tem—the number two position in the House–and chairwoman of the House Agriculture Committee.

Curry told reporter John Colson at the Glenwood Springs Post Independent that she no longer felt like a Democrat:

“I just don’t fit into either party,” she told the Post Independent late on Tuesday. “My votes are not consistently Democratic, they’re whatever I think is best for the district, and I know that has sometimes been kind of a disappointment” to party leaders…

Besides her feelings of not fitting well with either party, Curry declared, “I’m also not a very partisan person,” adding that partisan politics takes up too much of her time, time she feels would be better spent attending to the concerns of her district.

In an interview with Lynn Bartels at The Denver Post, however, Curry was clear that her decision wasn’t based on any particular issue—though she acknowledged her disappointment with this year’s budget discussions:

Curry, a rancher and water expert, said her decision was not based on any single bill, action or person.

“It’s just a matter of where I fit,” she said Tuesday. “But I’m not changing my personality overnight just because I filled out a form. I’m still going to vote my conscience, which the majority of time is with the Democrats.”

Curry said her biggest disagreement with her party came during budget discussions this year.

“The Democrats do have a big tent and have always been respectful, but I do feel in leadership you should march in line more than I have,” she said.

Curry pointed out to the Post Independent that there has never been an Independent in the House, and suggested the move could cause what she termed “procedural and administrati­ve hurdles”for the House leadership.

The Post Independent reported that observers in the district did not expect the move would endanger her re-election chances. Curry has run unopposed in the last two elections–2006 and 2008.

However, she registered too late to run as an Independent candidate in next year’s election, and will likely have to run as a write-in candidate–something she acknowledged won’t be an easy feat.

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Dr. Fisher's Office (Flickr; Bluegrass Annie)

The Colorado Rural Health Center (CRHC), the Colorado Community Health Network (CCHN) and the Governor’s office are jointly proposing the bill, according to Terri Hurst, policy analyst at CRHC. She expected it to be sponsored by Representative Sara Gagliardi, D-Arvada, and Senator John Morse D-Colorado Springs.

According to CRHC and CCHN, Colorado has a significant shortage of health care outside its metro regions. Fifty-seven of sixty-four Colorado counties are currently designated as primary-care shortage areas by the U.S. Secretary of Health and Human Services.

To meet its needs, the state would have to add at least 182 primary care physicians, 71 dentists, and 54 licensed mental health professionals, according to the federal Health Resources and Services Administration.

Of Colorado’s counties, said Clint Cresawn, program director for Colorado STRIDES (Sustainable Towns: Rural Innovation, Development, Expansion, and Success) eight have only one full-time primary-care physician, and four of those are not accepting new Medicaid patients.

Six additional counties lack even one full-time rural-care doctor, he said. One has none at all—Crowley County, on the eastern plains. Cresawn added that 14 rural counties have no dentist accepting Medicaid, and seven have no dentist at all.

“If you thought about a land mass as large as Rhode Island without one physician, that wouldn’t stand,” said Cresawn. “But we have counties bigger than that which are struggling to find a provider.”

Cresawn noted that a number of factors contribute to providers’ unwillingness to practice in rural areas. Among them, he counts professional and social isolation and the scary possibility that a provider may have to handle emergencies outside his or her specialty area. CCHN and CRHC add distance to major cities and low reimbursement rates as reasons that health professionals shy away from rural practice.

But Cresawn, CCHN and CRHC also argue that doctors choosing an area of practice are strongly influenced by a need to repay loans. According to the groups, graduating physicians in 2008 reported an average debt load of $142,000.

“High loan debt strongly influences health care professionals to opt out of primary care in favor of higher-paying sub-specialties that typically do not serve the uninsured and underinsured,” argues CCHN/CRHC. “Loan forgiveness significantly incentivizes primary care service in rural and medically underserved areas, increasing access to primary care for medically underserved populations.”

The new bill, said the CRHC’s Hurst, would raise or eliminate the annual repayment cap—currently set at $35,000. It would also include dentists and dental hygienists among those eligible for loan repayment. And among other administrative changes, it would rename the program as the Colorado Health Services Corps—to align its branding more closely with the federal loan repayment program, known as the National Health Services Corps.

Hurst said the bill is not expected to cost the state any more. She explained that the Primary Care Office at the Colorado Office of Health and the Environment, which administers the loan repayment program, received several grants this year to help fund the loan repayments, including American Reinvestment and Recovery Act funds.

“So they have a bigger pot of money than they usually do,” she said.

She also did not expect the bill to have any major opponents: “I’m not sure who would oppose it or why they would,” she said. “Then again, as soon as you say that, someone will come out of the woodwork.”

She did expect that providers not eligible for loan repayment might ask to be included in the loan repayment program. Currently the program covers doctors of allopathic and osteopathic medicine, primary care-certified nurse practitioners, certified nurse-midwives, primary care physician assistants, clinical or counseling psychologists, licensed clinical social workers, psychiatric nurse specialists, licensed professional counselors and marriage and family therapists, according to the website.

The loan repayment program began in the fall of 2007, a product of SB07-232 legislation, said Hurst. Last session, House Bill 09-1111 transferred administration of the loan repayment program to the Primary Care Office at the Colorado Office of Health and the Environment. It also adjusted the program requirements to attract private gifts, grants and donations.

The loan repayment program bill is the only rural health care bill that Hurst was aware of for Colorado’s next legislative session. However, U.S. Senator Mark Udall recently successfully introduced two rural health care amendments into the Senate health care bill passed on December 24.

Udall’s Rural Physicians Pipeline Amendment would establish a grant program to help expand rural training programs at medical schools.

Another Udall amendment would ensure that the Community Transformation Grants already in the Senate bill would be equally distributed between both rural and urban areas. The grants are designed to help prevent and reduce chronic disease in communities across the country by funding programs that combat obesity, tobacco use, diabetes and other health conditions or unhealthy lifestyle choices.

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The problem, according to the report, lies in the definition of “rural.”

(Flickr, cc; tipiro)

Congress defines what qualifies as rural. The rules vary from program to program, but most focus on an area’s population and how close it is to a large city. Small towns in metro areas can qualify for rural home loans if the Agriculture Department decides they are “rural in character”…

Still, the result is that money originally intended for rural areas is also streaming into major population centers. Metropolitan Phoenix has received $191 million so far, federal records show; greater Dallas has received $110 million. Counties around New York City received $32 million.

Queen Creek, a desert boomtown about 45 minutes from downtown Phoenix, typifies the paradox. The town’s population mushroomed from barely 3,700 at the start of the decade to more than 24,000 last year, making it the nation’s eighth-fastest-growing community. Yet Agriculture Department maps show much of the town remains eligible for rural loans, under which middle-income buyers can purchase houses with no money down.

The news follows an April report from the U.S. Department of Agriculture that found the Rural Utilities Service, charged with expanding broadband access in rural areas, was still giving money to urban areas. The Department noted they were particularly concerned because the Rural Utilities Service was scheduled to receive an additional $2.5 million from the stimulus package.

Wrote ProPublica:

The Rural Utilities Service’s broadband program faced heavy criticism in 2005 when auditors found irregularities [2] (PDF) with a quarter of the funds the program had received in its first four years of operation. In one case, the program loaned $45 million to wire affluent subdivisions in the Houston suburbs—including one that was built around a golf course and another outside one of the richest cities in Texas.

Monday’s report found that the Rural Utilities Service continues to grant loans to areas that already have broadband service and to communities near major cities…

More than 90 percent of the loan applications the agency has approved since the critical report in 2005 went to areas that already had broadband service, the report said. “OIG remains concerned because the overwhelming majority of communities…receiving service through the broadband program already have access to the technology,” [Assistant Inspector General Robert W. Young] wrote.

That matters for a state like Colorado—which has real gaps in broadband service.

At the recently-built, $21 million Weld Central High School, for example, students can’t download music or watch streaming video. They have to take turns going online to look at colleges. And for that, the district pays $8,000 a month, receiving only 7.5 Mbps of bandwidth, or 3.5 kilobits per student.

Maybe Weld should build a world-class golf course next to the school.

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The new $7,500 kiosks—near guest services and the food court—allow parents to check their children’s attendance, grades, and class assignments, among other information. Parents can also browse the Aurora Public Schools website—and, somewhat strangely, “browse mall shopping opportunities,” according to a story on the Aurora Public Schools website.

According to the Denver Post, the new kiosks will allow parents without computers access to the same information that more web-savvy parents already have:

Parents with children in the Aurora schools can already access information about their children online. But the free kiosks are a boon for parents who do not have a computer or Internet access at home…

“We know there is a significant portion of parents in APS who don’t have access to the Internet,” said Anthony Sturges, chief operating officer for the district.

And—it’s a convenient way for parents to decide whether or not Suzy deserves those new designer jeans!

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