It’s been a difficult month for Amendment 69 supporters.
The November ballot issue would create the nation’s first taxpayer-financed health care system, and Colorado would act as guinea pig for the rest of the United States. But even progressive groups expected by many to support such a system have recently turned against it, concerned about its unintended consequences.
The left-leaning groups ProgressNow and NARAL Pro-Choice Colorado have joined a growing number of conservative state and local organizations in condemning Amendment 69, and the Colorado Springs Regional Business Alliance, with Colorado Treasurer Walker Stapleton, attempted to unify the growing anti-amendment sentiment during a town hall called the “Dangers of Amendment 69” on Tuesday, Aug. 23 at The Antlers hotel.
ALL THAT’S WRONG
During his presentation, Stapleton offered the state of Vermont as a cautionary tale. Vermont considered a single-payer system.
“Over three years, the governor had advisers crunch numbers and they came to the conclusion it would bankrupt the state,” Stapleton said.
While Vermont pursued a legislative solution, Stapleton pointed out Amendment 69 is a ballot initiative because “it had no support in the legislature.”
He explained the basics.
“Proponents proposed a 10 percent payroll tax on all businesses operating in the state of Colorado,” Stapleton said. “If you’re a small business owner, you would pay the employer side of the tax of 6.7 percent and the employee side.
“In addition to the 10 percent payroll tax,” he said, “there is a separate tax on every dollar of income earned by a business in Colorado. So if you’re earning interest income, investment income, rental income, capital gains — that is all subject to a separate 10 percent tax.”
Single-payer proponents expect to raise $25 billion, which would be combined with a federal contribution of $13 billion.
“The problem is, they can’t tell you with any specificity that these will be the costs or that they will be static,” he said, adding the amendment creates “an unlimited insurance pool” that is accessible to anyone with a Colorado address.
Stapleton pointed to several unintended consequences should the initiative pass. He said those included an exodus of specialty care doctors, an influx of sick patients from other states and a board with too little oversight and too much power.
“This is supposed to be organized by a 21-member board, which can specify what will and will not be covered, the rates of reimbursement that the state will provide, and they have the power to raise taxes and fees independent of the Taxpayer’s Bill of Rights if the income is not sufficient to pay for the system,” he said. “They also have the power to disband the system altogether, in which case Colorado would be left in health care anarchy.”
ColoradoCare would also take over portions of worker’s compensation, Stapleton said, but not entirely, which would create gaps. In addition, seniors would be subject to the 10 percent tax on any income above $24,000 annually, he said, but without any benefits beyond those provided by Medicare. The tax would apply to active-duty and retired military who use TRICARE but would have to pay into ColoradoCare, he added.
Companies outside Colorado would be subject to payroll taxes inside Colorado, he said.
“You can imagine all the businesses that would end up fleeing Colorado,” he said.
Finally, the system wouldn’t take effect until 2019, but Coloradans would begin payments in 2018, while still having to cover their traditional insurance premiums, and the coverage would not be valid out of state. So health care costs would be paid out-of-pocket with hopes of reimbursement from the board, he said.
Colorado Secretary of State Wayne Williams was in the audience and offered his opinion.
“The board … is completely unelected for three years,” Williams said. “That’s an unelected board with unlimited power to raise taxes by any amount with no constraint.
“We run an election every year in Colorado,” he added. “There’s absolutely no reason for a three-year delay in electing this board. Second, in order to be on the board, you have to agree that you like it. So you have to essentially take a loyalty oath to be on it. Third, it puts this into the [state] constitution, so if there’s a problem, any problem you want to fix, it is virtually a multi-year process to fix it. This is not a Democratic, a Republican or pro-voter process.”
‘A MORAL DISCOMFORT’
According to the Colorado Health Institute, a nonpartisan health policy research organization, ColoradoCare under one scenario would nearly break even in its first year, “but it would slide into ever-increasing deficits in future years unless taxes were increased.”
The institute finds ColoradoCare would save money compared to the current system by cutting billions of dollars in administrative costs and insurance company profits.
“That funding could be reallocated to provide coverage to the 6.7 percent of Coloradans who remain uninsured, achieving universal coverage,” CHI states. “However, the revenue designated for ColoradoCare to pay for the new universal coverage wouldn’t be able to keep up with increasing health care costs, resulting in red ink each year of its first decade.”
Based on CHI’s findings, (coloradohealthinstitute.org) ProgressNow Colorado and NARAL Pro-Choice Colorado have encouraged voters to vote against the initiative.
“[The Colorado Health Institute has revealed] significant unintended consequences that could result from the passage of Amendment 69,” ProgressNow announced last week in a news release. The ProgressNow Colorado board of directors voted to oppose the ballot measure “despite broad agreement” with ColoradoCare’s campaign goals.
“The first thing I want is to acknowledge the goals and passion of the supporters of Amendment 69,” said ProgressNow Colorado executive director Ian Silverii in a release. “Too many people remain uninsured and underinsured. As a result, far too many people in this country die prematurely from preventable and treatable conditions.
“The truth is, nothing would make progressives in Colorado happier than taking a bold step toward single-payer health care,” Silverii continued. “But there are real policy problems with Amendment 69 that its supporters did not anticipate. When our trusted partners on the issue of protecting reproductive choice tell us that a measure could create serious roadblocks for women who need abortions, we have to take that seriously. When one of the state’s leading health care research organizations tells us this is a plan that doesn’t work fiscally, we have to take that seriously.”
State Sen. Irene Aguilar, a ColoradoCare advocate and doctor, wrote a similar initiative that never made it to ballot in 2013.
“I think it’s disappointing to see groups leaning progressive or liberal come out against it,” she said. “But it’s not a nail in the coffin or anything.”
The biggest disappointment, she said, “is how organizations (not businesses) look at just the talking points, but don’t assess its impact on them in a meaningful way.”
The success of ColoradoCare, Aguilar said, would depend on federal Medicaid funding, which could mean the difference between a deficit and a $2 billion surplus after the first year.
Owen Perkins, director of communications for ColoradoCare, said CHI’s “primary error is speculating [Colorado] would not get a full Medicaid waiver from the federal government. That is an essential component to ColoradoCare. If you read the CHI report carefully, there are lots of different scenarios. The best case has us way in the black by billions of dollars. The worst case is just as bad.”
There are safety nets built into the amendment, Owens said.
“If we don’t get the necessary waivers, this won’t go forward,” he said. “This was carefully planned and worded so Colorado can’t go into anything recklessly.”
The amendment has to provide the same level of coverage as the Affordable Care Act or better, the same benefits or better and at the same cost or less, Perkins said.
As for arguments that doctors would leave the state as it becomes inundated with sick people seeking free care, Aguilar said she’s heard them all.
“My husband is an intensive care doctor and very well paid under the current system. But there’s a moral discomfort of seeing people come in suffering from diseases who never should have gotten to this point,” she said. “It’s well worth the investment to do this in a more humane way.”
There will also be a residency requirement for ColoradoCare members, she added.
“They would have to come here and not get treatment for 6 months to a year,” she said, adding the board would determine that requirement. “In most cases, that would deter those who are considering moving.”
Perkins said the only state to border Colorado and expand Medicaid coverage was New Mexico, and that didn’t result in a flood of sick people coming to Colorado from Utah, Texas, Oklahoma or Arizona.
“There’s no evidence people have moved because of the availability of free health care,” he said, pointing to Saskatchewan as the sole Canadian province to offer universal care 60 years ago.
“It didn’t see an influx of sick people, but rather an influx of doctors because they saw it as a place of stability in health care and good for business,” he said.
“There was a desire for people around Canada to bring the same system to their province. That’s exactly what we think will happen in Colorado and the rest of the country. People won’t move, they’ll want it in their state.”
Regarding the November election, Perkins said he is “very confident” the amendment will pass.
“Every poll we’ve seen, whether ours or independent opposition, gives us the winning majority.”
‘BAD IN EVERY WAY’
That winning majority is what concerns Colorado Springs Forward, a local group of business people who are active in the political arena. Executive Director Amy Lathen said the organization is “very much opposed to Amendment 69 and will do whatever we can to partner with the state and folks working locally to oppose it.”
Lathen said the amendment is “bad in every way. The tax increases proposed are very large and will kill business. … The bottom line is, it will drive business out of Colorado, and not just existing businesses, but it will hurt our ability to recruit businesses both locally and to the state.”
Despite progressive groups opposing the amendment, Lathen said Colorado Springs Forward “doesn’t take anything for granted. We assume this will pass, and we will behave accordingly.”
Jonathan Lockwood, a political lobbyist and executive director of Advancing Colorado, a conservative, free-market nonprofit, has debated Aguilar and the merits of ColoradoCare in the past. Lockwood didn’t mince words.
“Advancing Colorado is happy to see a wide-range opposition coalition because we were at the tip of the spear fighting ColoradoCare and their deception,” he said.
“Coloradans do not want to see women’s rights, vulnerable populations and Millennials exploited by RomneyCare advocate State Sen. Irene Aguilar’s killer proposal. ColoradoCare could literally kill women, kill children, kill senior citizens and we must avoid passing this dangerous single-payer agenda. Amendment 69 lied to get in the election and they will lie to get in the constitution.”
“That’s so ridiculous,” Aguilar responded, citing National Academy of Sciences statistics.
“Five hundred and thirty five people die every year in Colorado because they can’t access medical care due to no insurance or they are underinsured. About 6.7 percent of Coloradans are uninsured — that’s about 400,000 people. … Around 16.5 percent who have insurance can’t afford to use it.
“It’s a lack of access kills them,” she said. “That’s bollocks.”