He was the only GOP lawmaker in Colorado to vote for Medicaid expansion. Now this.

Larry Crowder is a San Luis Valley farmer and rancher who represents a large rural swath of southeastern Colorado from Wolf Creek Pass to Kansas. The other day after a smoke break outside the Capitol he sat for an interview in his office across the street to talk about the hospital provider fee. That’s a complex subject that’s become a flashpoint for controversy under the gold dome in Denver, but one important to the people in Crowder’s district that includes nine hospitals and where 15 of the 16 counties he represents are under the federal poverty level. (We explain the whole hospital provider fee issue here and what Crowder means when he talks about it being reclassified as an enterprise. Doing so is a priority for Gov. John Hicknelooper this year and is opposed by GOP leadership.)

What follows are excerpts from our conversation edited for clarity.

The hospital provider fee is shaping up as Colorado’s biggest political fight of the year. I wanted to get your perspective as a Republican representing a poorer, rural area with several hospitals. Where are you on the issue, especially re-classifying it as an enterprise?

Where I’m at is still waiting to see what develops on it. We need to look at where we’re at and why we’re there.

The reality is when you’re talking about putting that in the enterprise zone we have roughly a thousand different governments within the state of Colorado — fire districts, ambulance districts — and virtually all of them have been placed in an enterprise zone. So it’s something that the hospital provider fee has done, it’s basically really helped your critical-access hospitals. And what I’m talking about is, it’s done more than help them. It’s helped them survive. Without it, it would be very difficult. But where we’re at now is, to be able to get that hospital user fee in the enterprise zone is the issue. The problem with it is right now you have the memo [from nonpartisan Office of Legislative Legal Services] that states that it is unconstitutional to do that.

Prior to that the governor’s office went to the attorney general and basically talked to the attorney general about this, and the attorney general indicated that it was doable.

My side of the aisle has on letterhead stating that it is illegal, and what the Democrats had from the attorney general is verbal. What you have is a difference of opinion. So the reality is we just need to see [whether] it is legal.

But I think what we need to do on the hospital user fee is compromise. I think we need to come up with a compromise on this.

What would a compromise look like?

Basically a certain portion of that be under TABOR, a refund, and I think some of that should be used for the intent of the hospital user fee which is to strengthen our critical-access hospitals as well as our other hospitals that need help. And I think a portion of that should go toward transportation and the very needs of the people that sent us here.

You’ve got to realize it was put together as a fee, not as a tax. The question on the table: Is there a difference.

There are other law firms that have looked at that and indicated — to be honest with you I can’t tell you their names — but there are other law firms that have looked at this and said it was doable. So where we’re at right now is that if it is deemed unconstitutional it’s a no brainer. But the question on the table is the constitutionality of it.

Where are you philosophically on the issue though?

I think there’s enough needs there to justify it right now. But I think also there’s enough issues there to say that we can give a partial refund, we can help medical, and we can help education. How? Because that money is not taken out of the general budget. The reality is education is 38 percent of the budget, so if you pull a billion dollars out you still have 38 percent. But you have less money to draw from.

The Joint Budget Committee indicated there is enough money to balance the budget, but I want to see some tangible proof of it.

We have a thousand different governments in the state of Colorado and they have been overturned and voted on by the public. So philosophically when you’re talking about state government, tell me what the difference is between a thousand state governments and the state. Philosophically it’s the same concept.

If it’s deemed constitutional to re-classify the hospital provider fee as an enterprise, would you consider it?

Yeah. But if the taxpayers felt they were entitled to a refund, I think we should compromise on that.

How do you find that out?

Guys like you. When you write the articles we’ll hear from ’em. There’s already a certain amount of money being refunded.

The conservative group Americans for Prosperity asked lawmakers to sign a pledge on this issue. Basically, don’t re-classify it.

I’m not big on pledges. Here’s the thing about it: When you sign a pledge, it’s just for that day. A lot of things can change. This is just my personal opinion, but I think it’s irresponsible to sign pledges because you don’t know what the future is going to bring.

I understand their concept, but the reality is today we know where we’re at. Tomorrow we don’t. So if anybody can give them a pledge and say regardless of what happens that pledge will stick, they can still sign it. You’ve got to realize I’m a Republican. I’m really not interested in raising taxes. And I consider myself a staunch Republican. But if we can work within our means, and since this is put together as a fee, and the question is, ‘Is it constitutional?’ that’s a question we’ll have to answer.

You don’t mind getting crosswise with a group like that?

I’m not a member of a lot of organizations. I’m not a member of NRA. I can tell you my membership — right now I’m with the American Legion, Disabled American Veterans, and Colorado Cattlemans. And I think that’s just about the extent of it. I’m up here to represent my district.

I have 16 counties and 15 of them are under the federal poverty level. And you have to realize, too, you understand Medicaid expansion? There’s only one Republican in the state of Colorado to vote for it and that’s me.

And you’re still here.

My vote has been vindicated because of the other states clamoring to get on it now.

What have hospitals in your district been saying to you?

I’ve been lobbied heavily by hospitals. They want it in the enterprise. They want the hospital user fund to be in place for their needs, whether it’s reclassified or whatever.

Do you actually see anything happening this year on that front?

I think Senator Cadman [a Republican from Colorado Springs and the president of the Senate] hit it pretty much on the head. He said he wanted to fund education. I think this could be one of the avenues to do that. By not taking the money out of the general fund and having that additional money. If you take it out of that general fund you have much less to draw from.

It’s a little bit early. Let’s just see what develops on it and let’s look at it in an optimistic way.

What are you hearing from leadership about this issue?

Nothing.

Anything else?

You’ve got to realize I have several critical-access hospitals in my region. They are vital to us. Here’s the difference: In your metro areas you don’t have this problem. The metro legislators don’t exactly understand what rural Colorado is like. So what I have to do is I have to look out for my district.

The only thing I know is I’m there to protect my district, I’m there to represent my district, and I don’t see any changes in that aspect.

When you start talking about your critical-access hospitals in rural Colorado, let’s take an example of Springfield. Let’s say you don’t have a critical access hospital in Lamar. You’re driving 150, 200 miles to La Junta.

I can tell you the critical-access hospitals rely on that hospital provider fee to stay afloat. So without the hospital, it’s going to put them in dire straits. Let me take it a step farther. Before Medicaid expansion — I have nine hospitals in my area — four of them were in dire enough straits that they were actually considering closing. Now, how can I allow that to happen? We rely on our hospitals just like we do our schools and everything else.

An example would be that one up in Leadville. The people in that town decided not to fund it with tax dollars so it shut its doors. So now they have to come to Denver. The whole thing is a serious issue, but it’s also serious that we do it right. And the question is: What is right?

Let’s talk about Medicaid expansion. Am I the only area that had such a problem with hospitals and Medicaid expansion? Well, why did the rest of them vote against it? I don’t know. I don’t, honestly.

What about the 2016 ballot measure for universal healthcare in Colorado?

I am not in favor of the single-payer. Man, that’s just over the top.

Thanks for the candid conversation, especially on this issue.

You’ve got to understand our job up here is to come up with solutions. And a lot of times solution takes compromise. And I understand the risk in talking to you. You’re probably gonna bury my ass.