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Single-Payer Health Care Plan Before Colorado Voters

Colorado voters will decide on Nov. 8 whether their state should launch a single-payer health care system, similar to Canada's.

Supporters of Amendment 69 on the Nov. 8 ballot say a simplified health care funding system would cut health care spending in the state by $4.5 billion annually, cover hundreds of thousands of currently uninsured residents and rein in climbing health care costs.

“Colorado can send a shot that will be heard all over this country and all over the world,” Vermont Sen. Bernie Sanders told initiative supporters this past week in Boulder.

Vermont's own single-payer plan was abandoned in 2014 when the plan was projected to boost the state budget by 45 percent and require a new 11.5 percent payroll tax on employers and a 9.5 percent hike in household income taxes, a study by Gov. Peter Shumlin's consultants said. Shumlin, a Democrat, had campaigned on bringing a single-payer government-run health-care plan to Vermont.  He backed away in the face of public opposition and concern among state legislature's Democratic party majority about economic effects. "The risk of economic shock is too high," the governor concluded.

Single-payer plans have not fared well in other states. One single-payer plan failed to reach the ballot this year in Washington state, and, in 1994, California voters overwhelmingly defeated a single-payer initiative, known as Prop. 186, by a vote of  73 percent to 27 percent. Tennessee also experimented with a government-run health plan, known as TennCare, but political support evaporated as costs climbed.

Colorado's proposed constitutional amendment would form a political subdivision funded through federal payments, a 3.33 percent payroll tax for employees, a 6.67 percent payroll tax that employers would pay and a 10 percent tax on all non-payroll income. But these tax increases, amounting to $25 billion per year, would be offset by elimination of of $30 billion per year in premiums and other costs, supporters say.

The plan, which would eventually be overseen by an elected board, would end virtually all existing healthcare programs in the state, including Obamacare, Medicaid and employer-based health care in favor of a single-payer public system.

The Colorado initiative’s ballot title starts out, “Shall state taxes be increased $25 billion annually in the first full fiscal year … .” That’s a possible turn-off to voters right off the bat, supporters said.

The $25 billion experiment would be overseen by unaccountable bureaucrats, opponents say, and it would run up deficits, guarantee nothing and even put women’s reproductive health services at risk due to conflicts with a provision in the Colorado constitution.

Concerns about the initiative extend across the political spectrum, creating an unusually diverse opposition.

The argument that Colorado is repeating Vermont’s and other states' missteps is unfair, according to Owen Perkins, spokesman for the health care initiative. Colorado has 10 times the population of Vermont, and Vermont’s legislature attempted to cobble together a single-payer system that became too costly and unwieldy, Perkins said.

In contrast, the Colorado plan, dubbed ColoradoCare, would create a nonprofit cooperative with a framework grounded on the state’s existing health care costs, he said, and lawmakers would not be able to alter or add provisions that complicate its operations and increase costs.

"Since it’s a citizens initiative, it keeps the legislature from messing it up,” Perkins told AMI Newswire.

An analysis by the Colorado Health Institute, an independent health policy research center that advocates for expanded health care access, that found ColoradoCare would get less in federal funds than supporters say, while facing higher administrative expenses and receiving less in savings from bulk purchasing. The result is a buildup of operating deficits that would reach $7.8 billion by 2028, the study said.

“It’s not a health care plan,” Jonathan Lockwood, executive director of the nonprofit group Advancing Colorado, told AMI. “It’s a tax plan.”

Amendment 69 would create a public entity with annual revenues projected at $38 billion, which is larger than major corporations such as Nike, which had revenues of $30.6 billion last year.

Those on Medicare or serving in the military would not be covered by ColoradoCare.

“Unaccountable bureaucrats shouldn’t get between Coloradans and their doctors,” said Lockwood, who said that the initiative’s description of what medical services would be covered is vague and that Coloradans may not get the health care they have been promised.

One issue that has caused groups such as NARAL Pro-Choice Colorado to back away from the initiative is that women might lose access to abortion services. That’s because a provision in the Colorado constitution forbids public funding of abortions, and this could conflict with the initiative’s provisions.

“Amendment 69 does not offer any written protections for abortion coverage and is therefore not truly universal,” said a NARAL voter guide. “Due to a 1984 public funding ban on abortion, 69 has the potential to severely limit low-income women’s access to abortion coverage.”

The out-of-pocket cost of an abortion in Colorado is estimated at between $450 and $650, according to the Comprehensive Women's Health Center in Denver.

Supporters disagree with NARAL's assessment, Perkins said. Constitutional lawyers who are advising the “Yes on 69” group say a more recent constitutional amendment would take precedence over the amendment banning public funding of abortion.

“They’re fairly confident that it would cover all of a woman’s reproductive health needs,” Perkins said of Amendment 69.

But that view is not universal.

"Under proposed Amendment 69, the state government would take over all health care payments in Colorado," David Kopel, a constitutional law professor at Denver University, told AMI in an email. "Accordingly, people who currently have insurance plans which cover abortion would lose that coverage."

The state constitution prohibits any use of public funds by state agencies to pay for "induced abortion," Kopel said.

The Group ProgressNow Colorado also opposes Amendment 69, saying that although the initiative’s overall goal is laudable, the state should look to building on health reforms already in place rather than junking the entire health care system in the state.

States have traditionally been the venues for important social reforms – from women’s suffrage to marriage equality – and the current political environment at the national level has not been open to health care reform, Perkins said. Colorado could thus be a health care model for other states, he said.

“If people are only looking at the language of the ballot, it looks pretty intimidating,” said Perkins. But when "Yes on 69" volunteers and staff explain the details of the plan to voters in informal focus groups and gatherings, 55 percent of them have a favorable impression, he said.

Colorado has long been an incubator of new ideas. The state's voters helped spawn a national movement by approving legislative term limits in 1990, and an initiative legalizing recreational marijuana passed in 2012. But the Taxpayers’ Bill of Rights – a successful initiative restraining government spending that passed in 1992 – was eventually suspended for five years and faced ongoing court challenges.