Questions from constituents for Irene
How long have you served?
I have served for 4 legislative sessions. I was selected in December of 2010 by a vacancy committee to fill Chris Romer's seat when he resigned to run for Denver Mayor.
I am the chair of the Senate Committee on Health and Human Services and the Assistant Majority Leader.
Where did you practice before that and for how long? What specialty?
I worked as a primary care internal medicine doctor at Denver Health's Westside Family Health Center from 1989 - 2012. I did my internal medicine residency at UCHSC and had my clinic at Denver Health so I have a long history with Denver Health. My husband, Dr. Tom Bost, Practices Pulmonary and Critical Care Medicine and I worked half time once our first child was born in 1993.
I am now on the Board of Directors for Denver Health and Hospital Authority. My area of passion is access to quality, affordable health care for the under-served.
When the legislature is not in session I practice about six days a month at Clinica Tepeyac, a clinic for the uninsured located in Denver's Globeville neighborhood.
Are you happy with Obama care? Is Colorado implementing it correctly?
Like most people, Obamacare is not everything I hoped for. I was very disappointed in the President until I came to politics and saw how difficult it is to pass groundbreaking legislation. Now I am grateful that this was passed as it gives Colorado a platform on which to improve. And I can say definitively that without the ACA Colorado would never have been able to offer Medicaid to childless adults living in poverty. Having worked at the safety net for so many years I saw the people who did not have "government" health care until their kidneys failed or they developed strokes or cancer. We pay for it anyway so we ought to find a way to pay upfront for proven prevention and primary care. The ACA helps us to start to do this.
Colorado is ahead of the curve in terms of implementing the ACA. We chose to expand Medicaid. We have a state based health exchange (Connect for Health Colorado). We have a large number of insurers and plans available on our exchange. Our prices held fairly steady for the second open enrollment. We have an Insurance Commissioner who is gearing up to ensure we have quality products for Coloradans. And the ACA mirrors the recommendations of Colorado's own 208 Commission on Health Care Reform, which is why it has been supported by our business community.
There are still many things we need to do to improve on the ACA but I am confident that the team we have working together on this will get this done in the next few years. I passed legislation creating a Commission on Affordable Health Care (CMS is represented by Dr. Jeff Cain) which should help us figure out how to increase quality and cut waste.
Should we expand Medicaid even more in Colorado?
I don't think we should expand Medicaid more for childless adults. I would consider ensuring that our children on CHIP (which goes to 225% of FPL) can stay on Medicaid. We need to find a way to create continuous eligibility for Medicaid to decrease people dropping off Medicaid and disrupting their doctor patient relationships. I would be open to allowing people to buy into a private insurer if that was an affordable option for them (and not a requirement).
The biggest problem with Medicaid is that it often covers the most difficult to treat population yet reimburses the least. This is a function of our state's limited budget but it creates a situation where those who need the best care are struggling to find people willing to deliver it at the inadequate reimbursement levels the state can afford. This runs the risk of increasing long term costs for certain populations of patients.
Do you think physicians should be employed by hospitals? or work independently of them?
I would prefer that physicians did not have to be employed by hospitals. I think it creates the potential for a conflict of interest. As a physician, our first duty must be to our patient and at times the hospital may have a competing need. I believe complexity of health care reimbursement and the requirement for electronic medical records has led to this unfortunate situation.
Can you maintain the tort reform that is so important to Colorado doctors?
I was pleased to sponsor the legislation which reauthorized professional review. I have had the opportunity to meet many times with COPIC and even participate in their Case Conferences and think that they are way ahead of the curve in terms of helping reduce malpractice claims and provide mechanisms for physicians to acknowledge and learn from errors. I have read the research which shows that successful malpractice suits are not indicative of medical neglect. I also served on the Colorado Board of Medical Examiners for eight years and have a clear sense of "community standard of care" versus book care. This is a long winded way of saying I do not support increasing malpractice caps but I do support changing the culture from fear to learning in order to increase patient safety and improve our clinical skills.