ColoradoCare suffered a whopping defeat. Here’s why.

Coloradans hoping to pass single-payer health care this year will go to sleep disappointed.

Amendment 69, which sought to establish a statewide system called ColoradoCare to provide and fund health care for all Coloradans, has been defeated by a wide margin. As of 9:15 p.m., with 61 percent reporting, the measure snagged just 20.4 percent yes votes to 79.9 percent no votes.

ColoradoCare was proposed to alleviate what many see as a health care crisis in the state. Only about half of Coloradans receive health insurance from their employers, leaving those who don’t qualify for federal programs to fend for themselves or pay a tax penalty. As a result, 7 percent of all Coloradans are uninsured — admittedly far fewer than before the Affordable Care Act was passed — and a much larger number face deductibles so high that an injury or serious illness could leave them bankrupt.

But despite fervent support from many in the health care sector, the amendment faced opposition from politicians, deep-pocketed insurance companies and a wide swath of industries across the state. Outspent by more than 5 to 1, ColoradoCare just barely garnered votes from one in five Coloradans.

Here’s what happened.

What did Amendment 69 propose?

Amendment 69 hoped to make Colorado the first state in the nation to have universal health care. It proposed to impose taxes on employees, employers and non-wage income like capital gains to create and fund a statewide health care payment system called ColoradoCare. The program would have provided health care to all state residents without the need for insurance, regardless of ability to pay.

Who opposed it, and why?

There were 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 opposed it. U.S. Sen. Michael Bennet, former Govs. Bill Ritter and Bill Owens and Gov. John Hickenlooper all spoke out against it.

Business associations across the state opposed Amendment 69, including realtors, bankers, dairy farmers, contractors and the Colorado Oil and Gas Association. The most represented industry was health insurance: Dozens of insurance companies, including Anthem, Centura, Cigna and Kaiser Permanente, denounced the amendment — and gave generously to the opposition campaign, Coloradans for Coloradans.

One of their main reasons for the opposing the measure was the increased tax burden on employees and employers. Business owners said the extra taxes would have been burdensome and unpopular, driving business from the state. Detractors also said that health care providers potentially would be inadequately reimbursed under the new system, causing them to stop providing care in Colorado and, thus, decreasing Coloradans’ health care choices.

Another major complaint dealt with the structure of ColoradoCare, which would have been its own political entity, governed by an appointed 15-member interim board and, later, by a 21-member elected board. Opponents said that the board would have had too much power over health care decisions and, because the interim board would have been politically appointed and voters wouldn’t have been able to repeal elected board members, the board’s power would have gone unchecked.

Lastly, ColoradoCare faced a major obstacle with women’s health groups. Because of a law passed in 1984 that prohibits the state from funding elective abortions, the transfer of health care administration over to the state would likely have prevented women from receiving abortions under ColoradoCare, at least unless the 1984 law was repealed. NARAL Pro-Choice Colorado, Planned Parenthood of the Rocky Mountains and ProgressNow Colorado opposed Amendment 69 on these grounds.

Who supported it, and why?

Perhaps the highest-profile endorser of ColoradoCare was former Democratic presidential candidate 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 health care. But Sanders kept noticeably mum on ColoradoCare in the intervening year, and made no mention of it in Colorado Springs last week, where he stumped for Hillary Clinton. The Senator kept his support for Amendment 69 and his support for Clinton decidedly separate.

State Sen. Irene Aguilar, a physician, led the charge for ColoradoCare and was an integral part of the amendment’s design. Former state Sen. Jeanne Nicholson, a licensed public health nurse, also supported it, along with public figures like Noam Chomsky, Gloria Steinem and famed reporter T.R. Reid, from Denver. Reid, it should be noted, said recently that he would tweak the plan design before attempting to pass single-payer health care again.

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

Supporters also said that ColoradoCare would have streamlined efficiency and significantly cut administration costs, diverting money from insurance companies and putting it directly towards medical care for Coloradans.

Who paid for it?

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

The top five donors to ColoradoCare Yes included 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 was the fifth largest donor to the campaign.

The opposition, Coloradans for Coloradans, 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 health care system. Costs are high, many people remain uninsured or underinsured and the system is difficult to navigate. The ColoradoCare Yes committee focused its messaging on the idea that universal health care is a human right.

Sen. Aguilar said that the ColoradoCare campaign had a harder job to do than the opposition. “Getting people to say ‘yes’ is always the harder job, especially when you’re talking about something that’s new,” she told The Independent. “Universal health care is novel enough that it was an easy target for [the opposition campaign] to sow doubt and fear.” 

Coloradans for Coloradans, the opposition group, didn’t have to comment on single-payer health care 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 health care?

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 health care is important and that their system was the route to take. The opposition needed only to point out the imperfections. Aguilar says a larger advertising budget and more marketing expertise could have convinced voters that some of their fears were unwarranted. In particular, she pointed to the new tax burden, saying that “helping people to understand that this was a replacement for a cost they are already paying” would have increased support for ColoradoCare.

Was this loss expected?

Polling illustrated that, in the words of Aguilar, Amendment 69 was “a long shot” from the beginning. But the margins weren’t expected to be this extreme.

A Magellan Strategies poll at the end of August showed support for ColoradoCare at 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.

Opposition campaign leaders said they were relieved that Coloradans rejected an amendment that they felt was deeply flawed. “We’re grateful to the people of Colorado for carefully considering Amendment 69 and voting overwhelmingly against  a measure that was clearly risky, untested, and fiscally irresponsible,” said Kelly Brough, president and CEO of the Denver Metro Chamber of Commerce and chair of Coloradans for Coloradans.

Colorado Treasurer Walker Stapleton, the Coloradans for Coloradans campaign co-chair, said Amendment 69 was simply too good to be true. “Colorado voters understood that that a $25 billion tax increase to provide ‘free’ health care was a fantasy,” he said.

Aguilar remained in good spirits, saying that the ColoradoCare Yes campaign tried the best it could, and did well considering the circumstances. “We can’t be hard on ourselves, saying that we should have done better — we were just a very people-run group getting out there and trying to make some dramatic social change happen,” she said.

Despite the loss, she said that running the ballot measure campaign was an important first step towards single-payer health care nationwide. “There’s something you can’t measure, which is how much awareness have we raised in the populace,” she said. 

At the campaign’s election night party, she added, “We’ve gotten people talking about this. While I’d love for us to be the first state to make this happen, I’d settle for second or third.”

Photo credit: Chris Potter, Creative Commons, Flickr