John Scarffe, Black Hawk. During a town hall meeting at the Gilpin County Community Center on Sunday, March 26, 2017 Colorado House Majority Leader KC Becker covered a wide range of legislative issues. Concerns surrounding the loss of Medicaid coverage for a Nederland doctor dominated the meeting.
Becker represents Colorado’s House District 13, which extends from the Wyoming border on the north, to Mount Evans in the south – from Boulder to Kremmling. The district includes Jackson, Grand, Gilpin and Clear Creek counties, as well as the western portions of the City of Boulder and Boulder County.
“Aside from being extremely busy at the Capitol, I host several ‘town halls’ in my district. At past events, I have met many interesting and engaged constituents,” Becker wrote.
Gilpin County Democratic Chair Eric Douglas welcomed those in attendance at the meeting and said this is the biggest crowd he’s seen yet in Gilpin County. He introduced Becker, who explained her background.
Becker was first elected to the Colorado House in November 2013 by a vacancy committee after Rep. Claire Levy resigned, she said, and has now been elected twice. Her responsibility as House majority leader is to manage the bill process and House democrats. She will serve as majority leader for two years.
“One thing the legislature has to do is pass a balanced budget,” Becker said. A bill for the budget was introduced on Friday, March 24, 2017. It goes to the Senate and then the House. It is an intense process and involves much negotiating.
“Colorado has unique budget challenges, and health care is the main thing,” Becker said. The State receives $9 billion a year from the federal government for health care, mostly Medicare and Medicaid, and the state provides $3.5 million. A fee on hospital beds generates $800 million per year.
Becker expects the U.S. congress to block grant Medicaid in the future, which means far less money will be coming to Colorado. Of federal funding to the state, one third goes to health care, one third to education and one third to the Department of Corrections.
The Colorado Taxpayer Bill of Rights (Tabor) allows citizens to vote on taxes and has a cap over which state revenue can’t exceed, Becker said. Colorado has the largest revenue in the country right now but the State can’t exceed the cap.
“We have to come up with a whole lot of cuts to make refunds happen because of a State law passed years ago,” Becker said. For transportation, Colorado collects $200 million per year, but $100 million must be refunded to oil companies.
The Gallagher amendment creates a ratio of commercial vs. residential tax, Becker said. According to Wikipedia, the Gallagher Amendment was an amendment to the Colorado Constitution enacted in 1982 concerning property tax. It set forth the guidelines in the Colorado Constitution for determining the actual value of property and the valuation for assessment of such property The Gallagher Amendment was a legislative referendum drafted by Dennis J. Gallagher, then a state legislator.
Becker said that commercial property taxes can only be 45 percent of taxes. In 1983, the rate was 21 percent, and now it’s at 7.96 and will probably decrease to 6.5 percent state wide. Special districts like schools and fire districts won’t collect as much tax, so the State has to backfill every penny, which amounts to a $130 million hit.
Refunds this year will amount to $260 million, Becker said. The budget submitted asks, “How are we going to fill all these gaps?” State revenue is $300 million above Tabor, so the budget will cut hospitals by $265 million, and then the State will lose the Tabor match, amounting to a $530 million hit.
Rural hospitals will be cut, and they will have to cut education. Fortunately, the rate of incarceration is going way down because of the legalization of marijuana, Becker said. In the University of Colorado system, less than 5 percent of its funding comes from the State. Higher tuition and doing an incredible job attracting federal research funding has paid the bills, but a lot of the research funding is going away.
In the past, the legislature has cut K-12 funding, Becker said. The State used to be in the top quarter in the nation, but now Colorado is ranked 47th in the country. “We have a fantastic economy. We are constitutionally prohibited from keeping and using the taxes we collect. I think that’s a major problem.”
The State should take all of its investments where we come together collectively and say, “What kind of society do we want to live in?” Tabor creates a cap which includes the general fund and fees like drivers’ licenses, water quality permits and the hospital provider fee, Becker said.
These could be reclassified as a government enterprise and then a separate body collects and manages the funds, and it doesn’t come under Tabor taxes. Becker said. “Then we wouldn’t have to cut it.” Becker sponsored a bill to pass such a measure but it died in the Senate each time because rural hospitals said they are closing and putting together wind-down plans.
Two entities opposed the bill: The Independence Institute and Americans for Prosperity, the biggest funders for republican elections, Becker said. This would help keep more money to fund Medicaid.
Dr. Camarata and Medicaid.
Becker asked for a show of hands regarding how many meeting attendees were here to discuss Dr. Michael Camarata. About one quarter of the audience raised their hands. Becker made it clear she has nothing to do with the Medicaid decision, which is in the executive branch and not legislative.
“I’m not allowed to interfere, but I’m happy to take questions.” She did bring a hand out detailing what she looked into, including contacting the Department of Human services and looking into aging and disability resources. She said the Colorado Community Health Alliance is trying to find a Medicaid provider for this area.
Camarata was present at the meeting and said he was trying to understand things about the whole issue. “As a physician in the mountains, I sometimes make house calls, and it’s good to see you all here making a house call to see me. I will be able to stay open and would like this to be about my patients who need to find services.”
Yearly, since 2010, he has been a Medicaid provider, Camarata said, and then they gave him 24 hours to comply.
He doesn’t know who to talk to alleviate this, and he had to hire legal counsel to appeal. Medicaid is an insurance company and not a regulatory body, and he has now stopped providing care for 1,500 patients who will have to find care in another location.
Camarata said he doesn’t know the process. He received a letter from the Medicaid board on Feb. 12 and has no idea who that is. It has no address, and the telephone number listed doesn’t work.
“The whole process doesn’t correspond to anything that is reasonable,” Camarata said. He received an email on February 24 which stated that he could no longer receive Medicaid patients beginning March 1. He emailed the letter to Becker’s office. “I’m not upset with you or angry with you, we just need to get some help.”
“My attorney says my appeal has merit,” Camarata said. “My constituents are asking for help.”
According to a Denver Post article by Eric Gorski published on August 24, 2013, the Colorado Department of Regulatory Agencies oversees the Colorado Medical Board. In a May order, the board said Dr. Michael Camarata, of Columbine Family Care in Nederland, violated generally accepted medical standards by failing to properly evaluate medical marijuana patients.
“He also prescribed pain medication and a class of drugs used to treat conditions such as anxiety and insomnia to patients in large amounts,” it said.
Camarata received a letter of admonition and five years of probation after the medical marijuana investigation. At the town hall meeting, Becker said she could take another look and ask for a speedy resolution, but can’t intervene in a judicial process.
Every three to five years, Medicaid goes through a relicensing process and makes sure people are in compliance. They didn’t realize his license was suspended in these other cases, and said, “We can’t allow you to continue to do Medicaid.”
Weekly Register-Call Publisher Aaron Storm pointed out that the reasons Dr. Camarata originally got his license restrictions are no longer relevant. Becker said she will be mentioning that in his appeal.
Those asking for consideration of Camarata’s case and the community’s crisis regarding health care for Medicaid patients include the Nederland Board of Trustees. At its March 21, 2017 meeting, the Board approved sending a letter to the Colorado Department of Health Care Policy and Financing in Denver.
“The Town of Nederland’s Board of Trustees (BOT) is writing this letter to urge your agency to expedite the appeal process for Dr. Camarata’s prohibition on serving Medicaid patients, to the extent practical. As a Town Board, we are very concerned about the impact that the prohibition may have on the health and welfare of residents in Nederland as well as the greater Peak-to-Peak area.
“To our knowledge, Dr. Camarata is the only physician serving Medicaid patients in an area of more than 500 square miles, from roughly Allenspark to Idaho Springs,” states the letter. “Currently, Nederland’s only physician serves more than 1,000 Medicaid patients. Often these are among some of our area’s most vulnerable residents, particularly seniors and children.
“As your agency knows, transportation for Medicaid patients, particularly given the time it takes to travel from Nederland to any Medicaid providers, may serve to be one of the biggest challenges of this prohibition. In the short-term, any outreach and education efforts aimed at providing a list of Medicaid providers and possible transportation solutions would be greatly appreciated. In the longer term, our greatest hope is that Nederland will continue to have a practicing physician who can serve the broader community, which includes its Medicaid patients.”
Attendees at the town hall meeting said this is devastating to people in the community. One lady is disabled, and she and her daughter are on Medicaid. “This doctor is the only doctor she trusts. This man is more than qualified and knows everyone in the community.
“It’s not like he’s making millions of dollars. He’s in this for his heart and his character. You’re talking 50 plus miles, and I have to take her out of school for a whole day,” she said about finding another provider. It’s dangerous for a community this size not to have access to medical care.”
A man who lives in Colorado Sierra said he has six children in Gilpin County schools, so it’s not just an issue for seniors. All of his children are on Medicaid and have seen Dr. Camarata for three years.
Gilpin County Commissioner Linda Isenhart pointed out that the County has a good community transportation system. Gilpin Connect can be scheduled through human services, or the seniors have transportation to providers 30 to 45 minutes from Gilpin County.
Clear Creek County is getting ready to open a clinic, Isenart said. “We are a little county, so part of the county effort is to find demand. The County Commissioners are working on that.” She said they should contact the commissioners.
Board of County Commissioners Chair Gail Watson said this is a concern of ours. Most people in the county get health care out of county, and the clinic in Black Hawk closed because not enough of us went there.
“It’s the reality of living in a small mountain community.” The County put in more than half a million dollars for the Gilpin County Ambulance Authority,” Watson said. The County has three ambulances available all the time.
“I hate to say that is our health care, but it is. I had to call them myself and was down in Boulder in 35 minutes. We are trying for transportation to get people to health care.”
Becker added that Via is available for Boulder County, and it will help you get to appointments. “I know that’s not a satisfactory answer or the ideal situation. I completely understand and am sympathetic. I don’t have to drive 35 miles, and I would be really frustrated if I did.”
Another lady said she has four children, and Camarata has been their doctor. “If we don’t have him, I’m going to have to move out of this community. Gilpin Ambulance has taken an hour and a half to take us down to Boulder. In an emergency it’s not reliable.
“The doctor has come to my house. My anxiety is through the roof. This is a crisis situation for the community. We need to know you’re going to bat for us.”
Wes Isenhart, one of the doctor’s patients, suggested that people should be addressing their testimony to the doctor’s legal counsel. “In terms of we who live up here, you choose to live up here and you’re not going to have immediate services if you live up here. If these resources are not available, maybe this is not the place you have to live. We cannot fund a clinic, we’re such a small community. You need self-reliance to live up here.”
After answering questions on a wide variety of other issues, Becker said she will do her best to respond to the area’s Medicaid crisis.
You can reach KC Becker through her website at http://kcbecker.org/; phone number 303-866-2578; email: firstname.lastname@example.org; or write to her at Representative K.C. Becker – District 13, 200 East Colfax Ave, Room 307, Denver, CO 80203; or visit her in Room #246 of the Capitol off the South West Stairwell on the second floor.