Homestretch: Amendment 69, ColoradoCare

If you’re voting by mail this election, you probably know that Colorado voters this year must decide whether to pass a constitutional amendment establishing a statewide, single-payer healthcare system called ColoradoCare that will provide and fund healthcare for all.

Or, y’know, maybe you don’t. State rules require the text of a ballot measure to fit into one single sentence (in the form of a question), making the text of Amendment 69 a dense, multi-clause behemoth that many voters are struggling to understand. Here’s proof:

If this camp includes you, fear not. Here’s a brief overview of what ColoradoCare is, what its odds are of passing and what victory — and defeat — would mean for the state.

What is Amendment 69?

Casually referred to as “the universal healthcare ballot measure,” Amendment 69 is a proposed amendment to Colorado’s constitution that would make us the first state in the nation to have universal healthcare. The amendment proposes to create and fund a statewide healthcare payment system called ColoradoCare, which will provide healthcare to all state residents without the need for insurance, and regardless of ability to pay.

Amendment 69 will impose a new income tax on all residents and their employers to create ColoradoCare, a “political entity of the state” comprised of an elected 21-member board that will manage funds, cooperate with healthcare providers and make decisions about how best to implement a statewide healthcare system.

Why do we need ColoradoCare? Don’t we already have ObamaCare?

Under President Obama’s Affordable Care Act, citizens who don’t receive healthcare from federal programs like Medicare, Medicaid or the U.S. military must either obtain health insurance or pay a tax penalty. Only about half of Coloradans receive health insurance from their employers, leaving those who don’t qualify for federal programs to fend for themselves with the state healthcare exchange or private insurance.

ObamaCare has slashed the number of uninsured Coloradans by half, but 6.7 percent of residents still don’t have insurance. And a much larger number have insurance plans with annual deductibles that are are so high — many plans on the statewide health exchange have deductibles of $6,000 or more — that an illness or accident can still bankrupt them, even with insurance.

I need more details.

If passed, ColoradoCare would first impose a .3 percent income tax on employees, a .6 percent tax on employers and a .9 percent tax on non-wage income, like capital gains, with a maximum of $350,000 subject to the non-wage tax. This revenue, estimated at about $2 billion per year, would pay for the costs of hiring staff, renting office space, applying for a waiver to the Affordable Care Act to allow Colorado to implement ColoradoCare, and other administrative costs associated with setting up the statewide system. A significant portion of this revenue would be saved for future medical costs.

Once the system for ColoradoCare is established, predicted for the 2019/2020 fiscal year, and the Board of Trustees is ready to begin paying for healthcare, taxes would increase to 10 percent payroll, and 10 percent non-wage income. Employers and employees would share the burden, with employers paying two thirds and employees paying one third of the 10 percent. This is estimated to result in $25 billion in revenue the first year. 

Much is left up to the elected Board of Trustees, and also to the interim, appointed 15-member board that will establish the protocol for electing the official board. These trustees, who are not required to have experience in healthcare or healthcare administration, would be responsible for setting up, implementing and working out the specifics of the ColoradoCare system.

ColoradoCare would use funds from Affordable Care Act plan stipends, plus federal money towards healthcare, in its administration. It would take over the administration of Medicaid and basic children’s health plans, currently funded by the federal government, and acquire any funds for these programs. ColoradoCare would also take over for worker’s compensation insurance in Colorado. It would, perhaps obviously, be exempt from the Taxpayer’s Bill of Rights (TABOR), which currently limits tax revenue statewide.

Who supports it, and why?

Perhaps the highest-profile endorser of ColoradoCare is former Democratic presidential nominee Bernie Sanders, who bucked the party line with his vocal support for the amendment more than a year ago. In October, the Vermont senator visited Boulder to stump for Amendment 69, urging Coloradans to “stand tall” and vote for a program that could “lead the nation” in the fight for universal healthcare.  Sanders noticeably kept mum on ColoradoCare in the intervening year, and made no mention of if in Colorado Springs last week, where he stumped for Secretary Hillary Clinton — the senator keeps his support for Amendment 69 and his support for Clinton decidedly separate.

Other lawmakers who support Amendment 69 include state Sen. Irene Aguilar, a former physician who was an integral part of the amendment’s design, and former state Sen. Jeanne Nicholson, a licensed public health nurse. The amendment also has the support of public figures like Noam Chomsky, Gloria Steinem and famed reporter T.R. Reid, from Denver. Reid, it should be noted, has said that if the amendment should fail, he would tweak the plan design for the next go-around. 

ColoradoCare has garnered national attention from universal healthcare advocates, with support coming not only from state organizations like the Public Health Nurse Association of Colorado and the state chapter of the League of Women Voters, but also physician associations and advocacy groups in California, Washington, Oregon, Maryland and New York.

The main argument for ColoradoCare is that healthcare is a human right and the current system isn’t working. Many supporters of Amendment 69 praise single-payer healthcare in Colorado as a pathway towards universal healthcare nationwide.

Supporters also say that ColoradoCare will streamline efficiency and significantly cut administration costs, diverting money from insurance companies and putting it directly towards medical care for Coloradans.

Who opposes it, and why?

There are far more high-profile detractors to ColoradoCare than supporters. Four Colorado U.S. Representatives, more than a dozen state senators and more than a dozen state representatives from both parties oppose it. U.S. Sen. Michael Bennet, former Govs. Bill Ritter and Bill Owens and Gov. John Hickenlooper have all spoken out against it.

Business associations across the state oppose Amendment 69, including realtors, bankers, dairy farmers, contractors and the Colorado Oil and Gas Association. Perhaps the most represented industry is in health insurance. Dozens of insurance companies, including Anthem, Centura, Cigna and Kaiser Permanente, have denounced the amendment — and given generously to the opposition campaign, Coloradans for Coloradans.

One of the main reasons for opposition is the increased tax burden on employees and employers. Business owners say the extra tax burden will be difficult and unpopular, driving business from the state. Detractors also say that healthcare providers may not be adequately reimbursed under the new system, causing them to stop providing care in Colorado and, thus, decreasing Coloradans’ choices when it comes to healthcare.

Another major complaint deals with the 21-member elected board and the 15-member appointed interim board that precedes it. Opponents say that the board will have too much power to influence healthcare decisions. Because the interim board will be appointed and the elected board cannot be repealed by voters, opponents worry about being able to check the board’s power.

Finally, ColoradoCare has a major problem with women’s health groups. Thanks to a law passed in 1984 which prohibits the state from funding elective abortions, the transfer of healthcare administration over to the state would likely prevent women from receiving abortions under ColoradoCare. Both NARAL Pro-Choice Colorado and Planned Parenthood of the Rocky Mountains oppose Amendment 69 on these grounds.

Who has money in this fight?

Pro-Amendment 69 committee ColoradoCare Yes was outspent 5 to 1 by the opposition, Coloradans for Coloradans. As of Oct. 31, the last campaign filing deadline before tomorrow’s election, ColoradoCare Yes has raised about $891,000 and spent $862,000. The opposition has raised almost $4.1 million and has spent just under $4 million.

The top five donors to ColoradoCare Yes include psychologists Lyn Gullette and Ivan Miller, attorney Ralph Odgen and activist Eliza Carney, all of whom serve on the board of Co-operate Colorado, the nonprofit arm of the Colorado Foundation for Universal Healthcare. Co-operate Colorado itself is the fifth largest donor to the campaign.

The opposition, Coloradans for Coloradans, has received the majority of its funding from insurance companies, including Anthem, Kaiser Permanente, United Healthcare Services and Centura Health.

What were the political strategies?

ColoradoCare’s campaign centered around the weaknesses of our current national healthcare system. Costs are high, many people remain uninsured or underinsured and the system is incredibly complex to navigate. The ColoradoCare Yes committee focused its messaging on the idea that universal healthcare is a human right.

Coloradans for Coloradans, the opposition group, didn’t have to comment on single-payer healthcare as a concept. They simply had to poke holes in the implementation of it in Amendment 69. Opponents argued that it was too much to cover in a constitutional amendment, and would lead to major problems if it didn’t work out as planned, as it would be impossible to change. They also expanded their complaints about the impact on business — namely, that costs would go up for employers — to more broadly claim that ColoradoCare would drive some business out of the state completely.

The appointed and elected boards of trustees described in the proposed amendment offered plenty of opposition campaign fodder with its uncertainty: Who would these board members be? Who would choose them? Why was their no stipulation that they had to be experts in healthcare?

Lastly, the fact that Colorado currently has a law on the books that would likely prevent ColoradoCare from covering abortions made it a no-go for many women’s health organizations.

Ultimately, ColoradoCare had to argue both that universal healthcare is important and that their system was the route to take. The opposition needed only to point out the imperfections.

If ColoradoCare passes, who will win? Who will lose?

Because plenty of details remain to be worked out, it’s hard to say exactly who will win and lose under ColoradoCare. A lot depends on income, current insurance costs and participation in other federal insurance programs. But according to the ballot summary, here’s what we can expect:

Winners:

Employers and employees with expensive insurance.

Employers who currently pay more than 6.66 percent on insurance, and employees who pay more than 3.33 percent, would win under this system, because their costs would go down. For that amount, employers also wouldn’t have to pay workers compensation insurance. Other employees could see their premiums increase but will face no deductibles under ColoradoCare.

The uninsured.

People who currently don’t have insurance (and aren’t covered by programs like Medicare and Medicaid) must pay a tax penalty, which amounts to either $695 or 2.5 percent of a person’s income, whichever is greater. That means that those making less than $21,060 per year and currently paying the penalty would do better under ColoradoCare, as the 3.3 percent tax rate would still be less than the cost of the penalty, and would actually include healthcare coverage.

Losers:

Employers who aren’t currently covering any health insurance or pay less than 6.66 percent.

Small businesses with fewer than 50 employees, who currently don’t have to pay for employee insurance, would see costs increase. ColoradoCare would, however, eliminate the need to buy workers’ compensation insurance.

Elderly people with higher retirement incomes.

The elderly, who are already covered under Medicare, would have to pay into the ColoradoCare system for no added benefit. Elderly folks 65 and older making less than $24,000 (or $20,000 for those between 55 and 64) wouldn’t have to pay the tax, but those making more than that in retirement income would see their overall costs go up. However, for those with supplementary insurance, ColoradoCare could prove a less costly alternative.

Medicaid recipients.

Beneficiaries of Medicaid who currently pay nothing for healthcare would be subject to the 3.3 percent employee tax to the extent that they earn wage income.

Will it pass?

The numbers don’t look good.

A Magellan Strategies poll at the end of August showed support for ColoradoCare at only 27 percent, with 65 percent of respondents opposed. A Colorado Mesa University poll conducted in mid-September showed support at 30 percent and opposition at 56 percent.

For what it’s worth, more than a dozen people The Colorado Independent spoke with last week had already voted or planned to vote in support of the amendment, saying they “kind of hoped it wouldn’t pass” based on some concerns about specifics, but still wanted to show their support for the idea of universal healthcare.

Photo credit: Dawn McIlvain Stahl, Creative Commons, Flickr