DENVER — Colorado health-care advocates celebrated wins after the close of the 2019 legislative session, and now are working to ensure programs are implemented. Bills headed to Gov. Jared Polis' desk include the addition of a public insurance option, a measure allowing the state to buy medicine from Canada, and the creation of a reinsurance program designed to lower premiums.

The passage of House Bill 1174 should result in an end to surprise out-of-network medical bills. Adam Fox, director of strategic engagement at the Colorado Consumer Health Initiative, said bipartisan support for these protections has grown over the past several sessions.

"I think it's reached a threshold now with so many consumers being hit by these surprise bills, and so many legislators hearing about it - and some of them being hit by those bills themselves - that it really pushed this issue to the forefront,” Fox said.

HB 1174 protects people with state-regulated health plans. Fox said the measure also should act as a strong deterrent, but added the issue needs to be resolved federally to protect all consumers.

Some health measures did not advance. A proposal to increase drug-price transparency died over industry concerns about proprietary information. And a move to boost tobacco taxes to prevent addiction and fund education and health reinsurance was criticized as an unnecessary tax increase.

Fox noted while there were disagreements on some policies and on how others should be implemented, he saw bipartisan agreement on the need to address the underlying causes of rising health costs.

"There was less contention this session on health care in general,” he said. “There was a very high level of bipartisan agreement that health care was something they wanted to work on and could find some agreement."

Some measures need federal approval before moving forward, including the addition of a public health insurance option under the Affordable Care Act. Fox argued with premiums increasing every year, especially in western and rural areas with just one or two carriers, there aren't enough options for Coloradans to choose the health care they want.

"By creating a public option at the state level, we can sort of spur that innovation and competition and try to make the private insurance market a little bit more robust and competitive,” Fox said.

California is poised to become the first state in the nation to give health care to all income-eligible residents, regardless of their immigration status.

The Legislature is set to pass the final budget bills this week, which will be signed by Gov. Gavin Newsom shortly thereafter.

Cynthia Buiza, executive director of the California Immigrant Policy Center, said it is the fulfillment of an almost decadelong push by the Health4All campaign.

"This is very timely, but also long overdue," Buiza asserted. "Because for many, many years, many of our immigrant workers who have contributed tremendously to what makes California, California, have gone on without this very important safety net."

The budget deal represents a huge step toward universal health coverage and is expected to benefit about 700,000 people, starting in 2024. Opponents cite the cost: The budget includes $625 million to cover the first six months of 2024, and then allocates $2.1 billion per year.

Beatriz Hernandez, Central Valley organizer for the California Immigrant Policy Center, said it will make a huge difference in people's quality of life.

"This means that they will finally be able to get the health care that they need to care for the chronic illnesses that they've been suffering for many years," Hernandez pointed out. "And also be able to get the checkups that they need."

The deal marks the final push to expand Medi-Cal to all low-income Californians. In 2015, the state expanded Medi-Cal to include undocumented children. In 2020 the program grew to include young adults, up to 26 years old. And this year the program began to accept undocumented adults, age 50 and older.

The ruling on abortion by the U.S. Supreme Court has returned the issue to the states, fulfilling long-held goals of Republican lawmakers in Texas to ban and criminalize abortion.

With the 49-year-old Row v. Wade case overturned, a trigger law takes effect next month, banning abortions from the moment of fertilization - there is no exception for rape or incest.

Texas lawmakers were ahead of the high court, passing legislation last fall to prohibit abortions after six weeks. Aimee Arrambide, executive director of the Texas chapter of the abortion rights group Avow, said she expects half the states to follow Texas' lead.

"We've been ringing the alarm that what is happening in Texas, doesn't stay in Texas," said Arrambide. "And that the public health crisis Texans have been facing for nearly 10 months will be the reality in half the country. Our opponents are not going to stop until abortion is completely inaccessible in the country."

In his concurring opinion with the 6-3 vote, Supreme Court Justice Clarence Thomas said high court rulings that established a right to contraception, as well as gay rights should also be reconsidered.

Following the ruling, Texas GOP Gov. Greg Abbott said abolishing Roe v. Wade, "reinstated the right of states to protect innocent, unborn children."

New Mexico is now the closest state for many Texans seeking an abortion, but getting there may not be possible for low-income people who don't have the time, money or child care to travel out of state. Progress Texas Advocacy Director Diana Gomez said education is the next step.

"There are a lot of folks who don't know about the existence of abortion funds," said Gomez, "of infrastructures that are already in place to help people get abortions, and so we want to let people know about clinics in surrounding states."

In addition to Texas, 25 other states are expected to make abortion illegal, affecting the lives of 36 million people. University of Texas at Austin Associate Professor Kari White said entire regions of the country may soon be in the business of extreme criminalization.

"In a state like Texas," said White, "it's also going to criminalize a whole range of behaviors and practices for people who are trying to help someone get an abortion."

Prior to the court's ruling, a poll by Reuters showed about 71% of Americans - including majorities of Democrats and Republicans - believed pregnancy termination should be a patient-doctor decision.

Medical negligence cases in Washington and elsewhere have taken on a new shape during the pandemic, as hospital resources have been strained and the potential usefulness of certain treatments has ebbed and flowed.

Drugs like ivermectin, for instance, were touted online as a potential COVID-19 treatment but ultimately lacked scientific evidence to back up those claims.

Elizabeth Calora is a Tacoma lawyer who specializes in medical negligence cases. She said there are some legal requirements for determining if a health professional acted carelessly which have been affected by COVID.

"We need to figure out what a reasonably prudent provider should have been doing in that context," said Calora, "and it usually means talking to experts in the field and then determining if what the provider did in the moment or over the course of several visits violated that standard of care."

Calora said after that, the person has to prove that the breach is what caused the damages.

The Washington state Legislature modified evaluations of negligence cases in 2021 so that resources and staffing must be taken into account. For instance, hospitals have often lacked beds at the height of different COVID waves, a factor outside of doctors' or facilities' control.

Calora said the standard of care evolves over time. What was once an acceptable medical practice in the 1970s, for example, might not be anymore.

"But usually it happens in a much slower timeframe than what we experienced at the start of the pandemic," said Calora. "With COVID, you had physicians all over the world basically - it makes me think of throwing spaghetti on the wall to see what sticks. Everyone was trying everything they could."

Calora said the unforeseen nature of the pandemic has made it hard to bring medical negligence cases forward. However, she added that shouldn't discourage people from speaking with an attorney if they feel they or a loved one has been wronged.

"Even though things were bad," said Calora, "it doesn't give people license to practice beneath the standard of care."