Of all the amendments spelled out in this year’s 2016 state ballot information booklet, Amendment 69, the single-payer amendment, has by far the most pages devoted to its explanation.
The unusual amount of space needed to break down the ballot question exemplifies its complexity. The amendment would create the nation’s first taxpayer-financed health care system and would bring with it an estimated $25 billion in new taxes, to include a 6.67 percent employer payroll tax and an employee payroll tax of 3.33 percent. Other non-payroll income would also be taxed at 10 percent.
The taxes would finance ColoradoCare, a statewide system to cover health care services for Colorado residents. The amendment would also redirect existing state and federal health funding to pay for the services and administration of ColoradoCare, exempt the program from constitutional limits on revenue and require approval by Colorado residents for future tax increases. The amendment would also establish a board of trustees, initially appointed and then elected, to oversee the operations of ColoradoCare, and it would allow the board to terminate ColoradoCare if the waivers, exemptions and agreements from the federal government are not sufficient for its fiscally sound operation.
While many of this year’s ballot questions will see support along party lines, Amendment 69 has created unease on both sides of the aisle.
The ballot question has received its expected share of criticism from centrist and conservative groups within the state, to include the Colorado Springs Regional Business Alliance and Colorado Springs Forward, but several left-leaning organizations (ProgressNow and NARAL Pro-Choice Colorado) have joined their more conservative counterparts earlier this year in opposing the proposed law.
In August 2016, Colorado Treasurer Walker Stapleton spoke in Colorado Springs during a town hall called the “Dangers of Amendment 69.”
“In addition to the 10 percent payroll tax,” Stapleton 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 might be combined with a federal contribution of $13 billion, but Stapleton said there isn’t any way to know if costs will be static. He says the amendment creates “an unlimited insurance pool” that is accessible to anyone with a Colorado address.
Stapleton also pointed to unintended consequences should the initiative pass, including 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.
The yet-to-be-determined 21-member board, Stapleton said, can specify what will and will not be covered and the rates of reimbursement from the state, and has the power to raise taxes and fees independent of the Taxpayer’s Bill of Rights.
“They also have the power to disband the system altogether, in which case Colorado would be left in health care anarchy,” Stapleton said.
ColoradoCare would also take over portions of worker’s compensation, he said, but not entirely, which would create gaps in coverage. Seniors would also be subject to the 10 percent tax on any income above $24,000 annually, but without any benefits beyond those provided by Medicare. The tax would apply to active duty and retired military who use TriCare but would still have to pay into ColoradoCare.
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.
Colorado Secretary of State Wayne Williams said the board is unelected for three years and it would have unlimited power to raise taxes by any amount with no constraint.
Colorado Springs Forward, a local group of business people who are active in the political arena, has taken a stance against the proposed amendment. CSF’s Executive Director Amy Lathen told the Business Journal that 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.”
The proposal will kill business, she said.
“The bottom line is,” she said, “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.”
The list of organizations that publicly oppose the ballot question is long and includes the Colorado Hospital Association, the Colorado Hotel and Lodging Association, the Denver, Pueblo and Boulder chambers of commerce, Planned Parenthood of the Rocky Mountains, ProgressNow and Gov. John Hickenlooper.
A HEALTHIER SYSTEM?
The Colorado Health Institute, a nonpartisan health policy research organization, offered several scenarios regarding the implementation of ColoradoCare, should it pass. In one scenario, the system would nearly break even in its first year, but would “slide into ever-increasing deficits in future years unless taxes were increased.”
The institute found ColoradoCare could possibly 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.”
State Sen. Irene Aguilar, a ColoradoCare proponent and doctor, wrote a similar initiative that never made it to ballot in 2013. The success of ColoradoCare, she said, depends on federal Medicaid funding, which could mean the difference between a deficit and a $2 billion surplus the first year.
Owen Perkins, director of communications for ColoradoCare, added that there are safety nets built into the amendment.
“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.
There will also be a residency requirement for ColoradoCare members, Aguilar said.
“They would have to come here and not get treatment for six months to a year,” she said. “In most cases, that would deter those who are considering moving [for free health care].”
Citing National Academy of Sciences statistics, Aguilar summed up Colorado’s need for a reformed health care system.
“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,” she said. “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.”
Supporters of the amendment include the League of Women Voters of Colorado, the Public Health Nurse Association of Colorado, California Physicians Alliance, American Postal Workers Union and national political activists Noam Chomsky and Gloria Steinem.