ColoradoCare: What you need to know about Amendment 69’s single-payer health care proposal

Single-payer health care has been a dream of progressives for decades. Why do so many of them oppose ColoradoCare?
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Health care is expensive. Would Amendment 69 help? (Kevin J. Beaty/Denverite)

Single-payer healthcare -- everyone covered, no exceptions, no insurance company bureaucracy -- has been a dream of many people, especially liberals, for decades. Amendment 69 proposes to do just that at the state level, creating a new system of ColoradoCare paid for with a 10 percent payroll tax.

Yet the opposition comes not only from conservatives and business groups but from many liberal advocacy groups who would like to see single-payer at the national level. One of the benefits of a single-payer system is supposed to be its simplicity, but Amendment 69 is proving to be anything but, as its impacts would touch on everything from abortion to TABOR.

Here's the language you'll see on your ballot:

"Shall state taxes be increased $25 billion annually in the first full fiscal year, and by such amounts that are raised thereafter, by an amendment to the Colorado Constitution establishing a healthcare payment system to fund healthcare for all individuals whose primary residence is in Colorado, and, in connection therewith, creating a governmental entity called ColoradoCare to administer the healthcare payment system; providing for the governance of ColoradoCare by an interim board of trustees until an elected board of trustees takes responsibility; exempting ColoradoCare from the Taxpayer's Bill of Rights; assessing an initial tax on the total payroll from employers, payroll income from employees, and nonpayroll income at varying rates; increasing these tax rates when ColoradoCare begins making healthcare payments for beneficiaries; capping the total amount of income subject to taxation; authorizing the board to increase the taxes in specified circumstances upon approval of the members of ColoradoCare; requiring ColoradoCare to contract with healthcare providers to pay for specific healthcare benefits; transferring administration of the Medicaid and children's basic health programs and all other state and federal healthcare funds for Colorado to ColoradoCare; transferring responsibility to ColoradoCare for medical care that would otherwise be paid for by workers' compensation insurance; requiring ColoradoCare to apply for a waiver from the Affordable Care Act to establish a Colorado healthcare payment system; and suspending the operations of the Colorado health benefit exchange and transferring its resources to ColoradoCare?"

What does that mean?

Amendment 69 would implement a 10 percent payroll tax, with two-thirds of that paid by the employer and the rest paid by the employee. That tax could raise up to $25 billion -- yes, with a B -- in its first year. That money would be used to fund a public health insurance system that would cover everyone in Colorado and probably replace most private insurance.

People could still buy private insurance, but doing so wouldn't get you out of paying the tax, so there would be an incentive to participate in ColoradoCare. There would be no premiums and no deductibles -- the tax essentially is the premium -- though people might still have co-pays.

ColoradoCare would administer Medicaid. People who get health insurance through Medicare, TRICARE and the VA would keep their existing coverage.

The system would be administered by a 21-member elected board after the first three years. (An appointed interim board would get the system up and running.) ColoradoCare would operate outside TABOR and the limitations it places on growth of the state budget.

ColoradoCare would be obligated to cover a range of health care needs, including:

  • Ambulatory patient services, including primary and specialty care
  • Hospitalization
  • Prescription drugs and durable medical equipment
  • mental health and substance use disorder services, including behavioral health treatment
  • Emergency and urgent care
  • Preventative and wellness services and chronic disease management
  • Rehabilitative and habilitative services and devices
  • Pediatric services, including oral, vision and hearing care
  • Laboratory services
  • Maternity and newborn care
  • Palliative and end-of-life care

The board could raise taxes if necessary to cover the costs of the plan, provided that "members" -- defined as beneficiaries of the plan who are at least 18 years old and have lived in Colorado for a year -- vote to approve the increase.

Will it work?

That's the, well, $25 billion question. ColoradoCare backers suffered a substantial blow when the independent Colorado Health Institute estimated that the proposal would be running an $8 billion annual deficit within 10 years and that the deficit would only increase over time.

The Colorado Health Institute predicts that deficit will occur even though its analysts agreed with ColoradoCare supporters that it will save billions of dollars a year compared to the status quo. They just don't think those savings will be enough money to make up the deficit.

Supporters have their own analysis, which predicts that the savings from not duplicating bureaucracy across various insurance companies, from better access to preventive care and management of chronic conditions and from more coordination across the system will be enough to make the plan work.

If costs are more than the revenue generated by the tax, the board could increase taxes with the approval of ColoradoCare members without getting approval from voters as a whole. The other option would be cutting payments to providers, a hypothetical that has opponents predicting a doctor exodus if ColoradoCare passes.

There are other questions: Can single-payer work in an individual state or does it really require a national program? Will even more people move to Colorado for access to publicly funded health care? Will ColoradoCare be able to cover abortion services when the state constitution already prohibits spending public money on abortion?

Who supports it?

The measure has received support from groups in Colorado and around the country that support universal health care and a single-payer approach.

Democratic elected officials from the more left-leaning wing of the party like Rep. Joe Salazar, Rep. Jonathan Singer and Sen. Irene Aguilar support it. They appeared alongside Vermont Sen. Bernie Sanders at a recent rally in Boulder to urge voters to pass the amendment.

Many county-level Democratic and Green Party organizations also support it.

Who opposes it?

A substantial majority of Colorado's elected officials, starting with Gov. John Hickenlooper and continuing down through a good chunk of the state House and Senate -- on both sides of the aisle -- oppose Amendment 69. Business groups oppose it, which isn't surprising given the level of taxation envisioned by the amendment. Sole proprietors and business owners are particularly hard hit, as they'll have to pay both sides of the tax.

Insurance companies oppose it, which also isn't surprising given the way a single-payer system would sideline them, as do many hospitals and doctor groups.

However, so do many labor unions and progressive advocacy groups. They generally support the goal of single-payer, universal health care, but they believe it needs to happen at the national level.

The abortion rights group NARAL Pro-Choice Colorado came out against Amendment 69 in June. Its leaderships fears that a previous constitutional amendment that prohibits spending state money on abortions would mean that women who have access to abortion coverage now through private insurance would lose it under ColoradoCare. Proponents insist that would not be the case, but it would likely provoke a legal challenge.

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