Colorado Governor John Hickenlooper on Bipartisanship, the Opioid Crisis, Community Health Centers, Lessons Learned from Legalized Marijuana, and Presidential Interest

John Hickenlooper

Mark Masselli: This is Conversations on Healthcare , I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret , we ’ re starting off the new year with an evo lving public
health issue ; flu season is in full swing ; as ma ny as 46 states are reporting widespread
cases of flu and we ’ re only just getting into the season.

Margaret Flinter: Aha that is rough and California has been hit especially hard
accordingly an analysis and Kaiser Health News , they ’re seeing a record hig h number
of hospitalizations with the flu , they’re having a hard time keeping up with the number of
cases that actually require hospital care . But we ’ re seeing that story played out all
across the country and state health officials are on notice and letti ng the public know .

Mark Masselli: And you know Margaret this year's flu strain is a particularly virulent one
and according to public health officials the vaccine for the flu proved to be only about
10% effective in preventing flu .

Margaret Flinter: But people are still far better off getting the flu shot , even if it doesn't
fully protect you from contracting the flu , the vaccine can diminish the severity of the
case of flu and that is so important moment to look at flu mortality da ta it's the public
health axiom that bears repeating the more people who are vaccinated the less likely it
is to spread through the population .

Mark Masselli: And speaking of public health our guest today is a state leader who is
quite committed to healt h and well - being of his constituents Gov. John H ickenlooper of
Colorado is joining us today talking about the state's commitment to improving public
health really looking forward to having him on our show today .

Margaret Flinter: He will also be talking about what they've learned from their grand
experiment as the first state in the nation that legalize d recreational marijuana and what
they think other states can learn from their experience .

Mark Masselli: We will also have Lori Robertson stop by, she is the Managing Editor of
FactCheck.org. But no matter what the topic, you can hear all of our shows by going to
chcradio.com.

Margaret Flinter: And as always if you have comments, please email us at
[email protected] or find us on Facebook or Twitter; we love hearing from you. We
will get to our interview with Gov. John Hickenlooper of Colorado in just a moment.

M ark Masselli: But first here ’s our producer Marianne O'Hare with this week's headline
news.

John Hickenlooper

(Music)

Marianne O'Hare: I am Marianne O'Hare with these healthcare headlines. Congress is
moving ahead with approval of the President's pick to run the Depart ment of Health and
Human Services replacing former HHS Sec. Tom Price who resigned last year former
insurance industry executive Alex Azar came before the Senate Finance Committee to
respond with number of questions about the healthcare industry including the high cost
of drug prices . He said he would be willing to look at ways to being prices under control
but that a new formulary would have to be required to do this effectively across the
board . He also noted it might be worth to look to see if Medicaid could be shifted from a
so - called entitlement program to a block grant system offering states more flexibility .

New Hampshire is moving closer to legalizing recreational marijuana , the State House
passed a measure that would allow people over 21 to grow up to three pot plants on
their own for personal use . It's follows on the heels of neighboring Vermont who just
passed a similar measure in that state with Republican Gov. Rick Scott expected to sign
it .

Meanwhile states are bracing for what might come next in the wake of the
announcement from the Justice Department that the feds would now begin cracking
down on states who defy federal marijuana laws from pot to nukes the CDC is holding
talks later this mo nth on how public health officials and individuals should prepare for
nuclear war . The CDC is saying that while the chance for a nuclear explosion is in
certain preparation and planning can “ less e n deaths and illness ” in the wake of such an
event others a re expressing deep concern . For mer VP Joe Biden stating he thinks the
US has never been closer to the threat of nuclear war . I am Marianne O'Hare with
these healthcare headlines.

(Music)

Mark Masselli: We are speaking today with Gov. John Hickenlooper the 42nd governor
of the state of Colorado serving since 2011, a geologist, entrepreneur, long time
advocate for Community Health Center Movement. Gov. John Hickenlooper previously
served as mayor of Denver and was chosen by Time Magazine as one of the top five
big city mayors in the country. Gov. John Hickenlooper chaired the National Governor’s
Association and had since led the bipartisan coalition of governors commite d to
preserving the Affordable Care Act. He was named as one of the Esquire magazines
Americans of the Year. Gov. John Hickenlooper earned his BA in literature his MS in
geology from Wesleyan University. Gov. John Hickenlooper, welcome to Conversations
on Healthcare.

John Hickenlooper

Gov. John Hickenlooper: Well it's so exciting to be on.

Mark Masselli: Well certainly Colorado is known as one of the healthiest states in the
nation and your work as governor played in an essential role in establishing policies that
promote health and well - being . You’ve served both as governor and the mayor
Colorado's largest city focusing on a full scope of determinants of health from
enrollment and health coverage to access to care en vironmental quality and you took on
the task of homelessness at the City of Denver , and I am wondering if you could share
with our listeners of what you think are the most important health issues that a state
leader needs to be focused in on right now ?

Go v. John Hickenlooper: Well I think the integration of how we make sure that
everybody ha s a medical home , and that medical home by its nature should include
mental health so people can -- really kind of one - stop shop where they know they’re get
care . And if they need specialty works they could get recommended one place or
another , that’s probably to me the highest priorities and basically that ’s way of
expanding coverage without letting your cost run wild and without compromising in any
way your qualit y . I mean expanded coverage at the same costs or minimal increase
cost maintaining and improving quality that ’s go t to be the Nor th star [PH] for everybody .

Margaret Flinter: Well Gov. John Hickenlooper we've all seen over long years in
healthcare that without coverage access to really good healthcare can be very
problematic for people . And it's been really remarkable under Affordable Care Act over
these recently years to see coverage expand to more than 20 million Americans who
were uninsured before , a nd I know that you have seen significant coverage gain s in
your state as well . What does those gain s and coverage meant to the people of your
state ?

Gov. John Hickenlooper: Well, we've always been the fittest state , I mean Colorado
with a highe st state – I am not talking about medical marijuana or recreation of
marijuana. But we have the most elevation so that lot of people are attracted here for
hiking and mountain biking , and skiing you know outdoor recreation , but we haven't
always been the healthies t state. I think a lot of that is we had never test ourselves to
say , how do we expand coverage , because that’s a big part of that. I think that through
the Affordable Care Act we ended up expanding coverage to about 600,000 people in
the state with five half - million residents . We really went for about 50% of people that
were not covered down to less than 5% that's when you can really begin talking of
becoming one of the healthiest state s.

John Hickenlooper

Mark Masselli: Governor a s you were talking about how you'd exp anded coverage , I
was thinking about the funding of health programs like CHIP in Medicaid the major
challenges for state executives and funding for programs like Community Health
Centers in the National Health Service Corps all vital to the delivery system that you
have in Colorado , a nd in Washington there's this ongoing battle over how to fund these
programs that impact state budgets v e ry significantly . So how are you and other
governors dealing with this uncertainty ?

Gov. John Hickenlooper: You know th ere’s a bunch of us ; Republicans and Democrats
have been working on everything from trying to protect the Affordable Care Act to C HIP
is the more recent political bargaining CHIP , a gain CHIP should never – it's always
been bipartisan and it should have nothing to do with politics . I think that having clinic
where everyone is received and you have some sort of sliding scale that is the , only
future that I can see foreseeable that is going to allow us to really ultimately get
eventually 100% coverage and yet still make sure that we ’ re not taking a way too much
of our public resources from higher Ed , K - 12 education all the other pressing needs .

Margaret Flinter: Well you know Gov. John Hickenlooper among the many provisions of
the Affordable Care Act one of the important chapters was on innovation and how to
foster innovation at the state level . And that’s something that you and your team in
Colorado seem to have really excelled at, you have got your Colorado's State
Innovation Model or SIM as it's kn own with a number of pilots to improve care , improve
outcomes , really transform healthcare . You talked about integrating behavior health
into primary care which is so critical but also making payment reforms based on the
outcome s that patient experience , we would love for you to share with us what's some
of the SIM innovations are that you have developed . Share with us some of those
lessons.

Gov. John Hickenlooper: When we first applied for a federal grant the focus was how
do we really integrate mental health into people's existing medical homes , and that SIM
program has been remarkably successful . I was just down in a clinic in Southern
Colorado and it has change d the way they approach delivering healthcare of not just
mental health but everythi ng . So they will have a team approach and in one group
meeting they'll have you know four or five or six different professionals who will go down
the list of all the se different patients who are -- each one is unique and yet they can find
the generalities and the opportunit ies to catch undetected threats and make sure that
they’re address ed very early on . When I talk ed to every single professional in this clinic ,
everyone , they couldn't stop rating [PH] about it and most of the person they said they
were working longer hours but loving it more , they were totally enthusiastic . And I think
we've really worked hard to try and g ive people taking care of their own health and for

John Hickenlooper

all our state employees we have a incentive program so that if someone smoking we
make sure that there’s dollars and cents involved in their quitting because we know that
ultimately that going to make them better employee , better i nvestment but it's also going
to save the healthcare system cost.

Mark Masselli: We are speaking today with Colorado Gov. John Hickenlooper he has
served as chairman of the National Governor ’ s Association and before that was mayor
of Denver . Gov. John H ickenlooper , I think it's almost axiomatic when we hear your
name to think of sort of a bipartisan approach including in the area of health policy and
you and Republican Gov. John Kasich had notably launched several bipartisan efforts
on a variety of topic s urging lawmakers in Washington to improve the Affordable Care
Act rather than repeal it. And you have also both recently demanded the
reauthorization as you just mentioned of the CHIP funding that Congress has held up
for months and what have you learn e d from the collaboration with the Gov. Kasich and
also other governors around the country from your shared experience of fostering
bipartisanship ?

Gov. John Hickenlooper: We didn't know each other well until just about a year ago and
I was getting very worried about what -- the Trump Administration was just coming into
office then there were a lot of threats about the Affordable Care Act being dismantled .
And I thought it would be meaningful to have a Republican g overnor and a Democratic
governor both stand side - by - side say, hey wait a second , we agree that you got to
control costs , we agree that things should change , it can be improved , but we don't want
to roll back coverage and we don't want to roll back the par tnership with federal
government . And Kasich is a remarkable person in his own right , we don't agree on
number of things , but finding those core values where we can find the appropriate
compromises has been a real I think a powerful motivator for a lot of people in states all
around the country you know states are the laboratories of democracy . So we ’ re the
one s who is got to be doing experiments and coming up with the innovation s and then
finding out whether they work or not . And one of the real byprodu cts of -- for CHIP letter
that we just sent out before Christmas , we had 12 bipartisan g overnors , governors from
Louisiana and Alaska , Massachusetts and Montana and all of us unanimously agreed
the CHIP should continue and be extended as is . In this day and age you get
conservative Republicans like John Kasich and liberal Democrats , all recognizing that
these are core values that we need to embrace , that ’s a valuable message. Of all the
things I have worked on , I can't think of anything I hav e got more feedback from in a
p ositive w ay, Republicans and Democrats then the work with Kasich.

Margaret Flinter: You know governor sometimes it's adversity that pulls us together or
huge threats , and I think threat to the nation the opioid crisis is re ally unlike anything

John Hickenlooper

that we had seen in our lifetimes it's overwhelming challenge in states and in cities
areas rural and urban . We are really curious how you are grappling with the opioid
crisis in Colorado within the National Governor ’ s Association . I s there a sense of a best
practice emerging at the state level to address this crisis ?

Gov. John Hickenlooper: I had chaired along with Gov. Bentley who is from Alabama
and was an MD , we chaired committee within the National Governor ’ s Association
around opioid abuse . Since then we set up a Prescription Drug Monitoring Program in
Colorado , I think that’s now in about 12 states to make sure that somebody doesn’t take
a prescription and go from pharmacy to pharmacy to pharmacy . And we are seeing in
New England that now neighboring states are providing that interoperability so that
pharmacies can collaborate across state lines and make sure that people aren't -- the y
caught hiding prescriptions , getting people go through their medicine c abinets . You
know every time I go to a dentist to get a crown I am of that age and they had finished
procedure and then he’d say, alright here’s a prescription , call me if you still have pain
after three days and then he would give me a prescription for 3 0 days , that's crazy . And
so we start ed big effort promoted heavily , places where people could safely get rid of
their excess opioids .

And now in terms of our Medicaid patients unless they had got continuing chronic pain
we ’ re limiting the opioid prescri ptions to seven days, you know I am pushing very hard
for five days because somebody showed me a study that just five days of continuous
opioid use for certain people that will -- they will become addicted in that short a time .
There’s a study that came out in the American Journal of Public Health , they did a study
on – and we legalize d recreational marijuana -- we saw a benefit in terms of the opioid
abuse . We normalize d all our efforts around drug monitoring programs and reducing
that kind of usag e but they still found 6% or 7% reduction in opioid abuse from the
legalization recreational marijuana . And the moment my phone came off the hook
because all – lot of people who were very much opposed of recreational marijuana
be ing legal had lots of nega tive things to say about the study .

Mark Masselli: Gov. John Hickenlooper, I know you’ve just mentioned the issue of
Colorado legalizing marijuana number of years ago you were initially against it
California became another state , you ’ve realize d some benefits and some negative
concerns about the whole issue . And I am wondering if you could just share with the
larger American population what you see as the benefits around this grand social
experiment that Colorado was front and center on .

Gov. J ohn Hickenlooper: Yeah. I think everyone has to recognize that the old system
was badly broken , we sent millions of young people to prison for felonies largely

John Hickenlooper

Latino s, African - American , children of color for nonviolent crimes . As we legalize it --
I'm not sure we perfected the system yet and we had some initial unintended
consequence s. We had a lot of toddlers admitted to emergency rooms that the kids had
just gotten into the edibles so we change d the law and made it so that whenever you
sell edible s it has to be in an tamper proof containers . You know I went out to California
and I talked to the Gen eral Assembly , I talk ed to Gov. Brown and they are learning from
all the states that have gone ahead of them . I think they’re going to learn from our
mis takes they’re going to create their new innovations and we’re going to try and learn
from them as well . Certainly we are see ing less drug dealers , people that have like day
labor companies that workers would come and work for day, get paid in cash , they
d escribe always having 2 or 3 drug dealers around so when these guys would get off
work and have a pocket full of cash they try to selling mostly pot . Now , t w o specific –
companies specific ally said, you know we don’t see drug dealers around anymore , and
we had to actually lower the taxes that we were charging to recreational marijuana to
make sure that we really did push the black market so far on the ground that it's not
worth the risk to continue operating . So I think we ’ re getting close to gettin g it right .
Margaret Flinter: Well Gov. John Hickenlooper, you are in office until 2019 and certainly
your name is mentioned as a possible contender in the 2020 presidential race , we'd
love to have you – maybe share with us how your hopes and aspirations fit into this
shifting political landscape .

Gov. John Hickenlooper: Sure. What's going on right now across the country , the
divides we are see ing between rural and urban America issues around access to
healthcare is some of the basics that this country has always really been a leader in
investment infrastructure somehow all that has been turned upside down . And I think I
have in my little handheld calendar count down every day and that's true for all my
cabinet and our goal is to finish strong . And one of the things we have talked about
repeatedly is to make Colorado not just the fittest state but the healthiest state, I hope it
as this year goes forward , people begin to tamper some of the I call them crude political
approaches to making decisions where people will oppose something that really
benefit s their constituents but they will oppose it just because it might give political
advantage to a candidate in a year and a half . We ’ re trying to figure out how to draw
new alliances where people come together not around what party are you in but what
are your core beliefs . And healthcare is an excellent example there where pretty much
everyone doesn't want to roll back cover age pretty much everyone believes we got to
find way s to control costs . I thi nk clean air and clean water are big common values for
most Americans and belief in public land so we have been talking to outdoor recreation
industry about getting more politically e volved . But in those basic values about cleaner
air , cleaner water , acce ss to public lands , I think those kinds of alliances that are
outside the political order I hope are going to be the future and as people see more

John Hickenlooper

examples it would be nice to have some really loud voices that weren’t quite so strident
about one party or the other .

Mark Masselli: We have been speaking today with Colorado Gov. John Hickenlooper,
you can learn more about his work by going to Colorado.gov or you can follow him on
Twitter at @ Govof CO. Gov. John Hickenloo per, happy new year and thank you so
much for joining us on Conversations of Healthcare .

Gov. John Hickenlooper: Happy new year to you guys and keep doing your great work .

(Music)

Mark Masselli: At Conversations on Healthcare, we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck.org, a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce the level of d eception in US
politics. Lori what have you got for us this week?

Lori Robertson: Our round up of whoppers from 2017 include s several items on
healthcare. House Speaker Paul Ryan said , he didn’t think anyone would be hurt by an
$800 billion reduction i n Medicaid spending over 10 years in the health care bill. But the
nonpartisan Congressional Budget Office estimated that 14 million fewer Americans
would have Medicaid coverage by 2026 .

Democratic Sen. Catherine Cortez Masto, wrongly claimed that “ over 1.2 million
Nevadans with preexisting conditions would be denied coverage or face exorbitant
unaffordable premiums”. The bill would not have allowed insurers to deny coverage.
Also, the 1.2 million figure is a high - end estimate for all Nevadans with some preexisting
condition .

Sen. Rand Paul, a Republican who voted against the health care bill, said subsidies
“are actually greater under the Republican Bill than they are under the current
Obamacare law.” That wa s wrong. CBO said the average subsidy under the bill would
be significantly lower than the average subsidy under the Affordable Care Act and the
government would save $424 billion over 10 years due to mainly to reductions in
government subsidies.

And that’s my fact check for this week, I am Lori Robertson Managing Editor of
FactCheck.org.

John Hickenlooper

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.

(Music)

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Tinnitus is vaccine condition
that afflicts millions of Americans , a condition for which there is really no viable
treatment to date . But a University of Michigan researcher may have found a solution ,
lead researcher Dr. Susan Shore says tinnitus marked by a const ant ringing in the ears
is really the results of misfiring brain signals . Her team ha s developing device aimed at
getting to the root cause of tinnitus neurons in the region of the brain stem called the
cochlear nucleus . When those cells become hyperacti ve they create a signal that is
transmitted to the part of the brain where sharing perception occurs and the constant
ringing can wreak havoc on sufferers ’ lives .

Dr. Susan Shore: What you are doing is you are tricking the brain into altering its
circuit ry to go back to normal.

Mark Masselli: The device is called a targeted bimodal auditory somatosensory
stimulation and works on two fronts it uses both weak electrical impulses target to the
brain stem region responsible for the problem and also sends ti me sound to interrupt
the auditory sensation caused by the tinnitus . Dr. S hore says they found it more
successful with tinnitus sufferers where we’re able to control the condition already
through certain facial movements .

Dr. Susan Shore: We developed t his treatment for a particular c lass of tinnitus in which
the person that has the tinnitus is able to modulate either the pitch or the loudness of
their tinnitus by pushing on their face or pushing on their forehead or clenching their
jaw.

Mark Masselli: The study group ha s been relatively small so far just a few dozen
participants but the results have been quite promising . Dr. S hore says that the severity
of the tinnitus was greatly reduced in most of the participants and some got to the point
where it no longer interfered with their daily lives. She says they're hoping to enlist
more participants to advance their research on preventing tinnitus symptoms from
reoccurring .

John Hickenlooper
Dr. Susan Shore: We need a good solution for tinnitus as it's affecting milli ons of
people.
Mark Masselli: A relatively simple targeted device that could potentially help millions of
tinnitus sufferers from the worst effects of their condition , allowing them to diminish or
even ignore what is often a debilitating condition for ma ny to live with , now that's a
bright idea .
(Music)
Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.
Mark Masselli: And I am Mark Masselli, peace and health.
Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org an d brought to you by the Community
Health Center.