Health care in Colorado could be radically different in a few years. All it’ll take is thousands of signatures this year and a million more votes the following November.
No more insurance markets. No more employee benefits. Just an insurance card that entitles all Colorado taxpayers and their dependents to coverage.
That’s the hope of those pushing ColoradoCare, a ballot initiative to establish a single-payer system in Colorado. The philosophy behind the push, according to State Sen. Irene Aguilar, is simple: “We’re all going to use health care, so we’re all going to pay for health care.”
Aguilar, speaking before a Fort Collins crowd earlier this summer, also noted that universal health care already exists in this country: It’s how it’s paid for that causes such havoc.
“We have a universal health care system in our state, but it doesn’t kick in for you unless you A) can’t afford it and, B) are so sick you need it, or C) go broke,” she said, referring to services such as Medicaid and the government picking up tabs for health care for the indigent.
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The push, in one iteration or another, has been around for several years, previously under the name Co-operate Colorado.
This most recent try has proponents optimistic that it will hit the necessary milestone of ballot validation — 99,000 valid signatures — and strong headwinds in the November 2016 general election, where top-ballot races usually pull broader swaths of the population than nonpresidential and off-year elections.
“We’re enthusiastic and working hard and I think we’re going to pull this off,” ColoradoCareYES campaign director Lyn Gullette said Thursday.
She didn’t have updated numbers immediately available for the statewide signature gathering process, though the group doesn’t aim to submit signatures for authentication until October.
Aguilar, a Denver Democrat and medical doctor, cites health care as a primary reason she involved herself in public service. She’s held meetings throughout the state, including in Fort Collins earlier this summer, to push for ColoradoCare.
While she lauds coverage expansion under the federal Affordable Care Act, also known as Obamacare, it’s not enough, she told the Fort Collins crowd. It also further advanced “the games that are played in our health care system,” she said, citing examples of prescribed care not being covered by people’s insurance.
The Affordable Care Act also explicitly allows for experimentation like ColoradoCare. Its waiver program allows state-designed programs that meet or exceed standards of coverage to use Affordable Care Act funds.
ColoradoCare, in contrast to the federal plan, would simply cover what’s needed. Via payroll and nonpayroll income tax, where applicable, Colorado residents would be covered. It would also be a major disruption to the way health care economics work in the state.
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The Colorado Hospital Association, which counts more than a hundred medical providers among its ranks, hasn’t taken an official position on ColoradoCare, Vice President of Legislative Policy and Chief Strategy Officer Katherine Mulready said. But the group is nonetheless wary because of how vast of an impact it could have.
The association has historically supported initiatives to cover more people, she said, but this overhaul — and the disproportionate clout it could give to ColoradoCare when it comes to setting the dollars-and-cents side of health care — gives the group pause.
“When you consolidate that entire payer market to one payer that has the ability to set rates, that’s a very big fear point for those of us that do health care delivery,” Mulready said.
She points to the $1.2 billion cited by ColoradoCare in savings where “market power reduces drug, medical equipment and hospital expenses.” What kind of human and workforce toll would that have, she wonders.
Health care providers nationwide are working to maintain their ability to properly serve patients’ needs, and it’s an issue that the CHA is paying attention to as well. She worries the same market forces cited as a benefit by ColoradoCare could push more providers to states where they command better pay.
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She also reiterated an oft-used adage for those in nonprofit and other social service industries: You can’t fulfill your mission if you can’t keep your doors open.
“Workforce is a big issue for the hospital association, it’s a big issue for most health care associations,” Mulready said, adding it’s something the CHA and providers are trying to work on. “It’s an existing problem. It’s my sense that ColoradoCare wouldn’t fix that problem; it could exacerbate it.”
As for Aguilar, she predicted in her Fort Collins meeting that hospitals would be lukewarm on the proposal. She cited Denmark’s recent switch to universal health care and its number of hospitals dropping immediately. The European country, with a population similar in size to Colorado, saw 75 hospitals become 50, with the retraction projected to continue.
Not that it’s a bad thing, she said: It just better reflected the needs of a keep-people-healthy system versus a charge-for-every-service system.
“I hate to call it a game, but it’s become such a game in our country right now,” she said.
ColoradoCare timeline
Petitioners need to gather 99,000 certified signatures statewide to place the initiative on Colorado’s November 2016 ballot. If the measure were to pass, here’s a look at the possible timeline for implementation:
November 2016: Voters approve ColoradoCare.
December 2016: Governor proclaims its passage.
March 2017: Interim ColoradoCare governing board of trustees is appointed.
July 2017: Transition Fund Tax begins.
September 2018: Supervisory and technical staff is hired, ombudsman office is established, service contracts are in place.
January 2019: ColoradoCare beings full operation; health care premium collection begins and coverage for all Coloradans begins.
December 2019: First election for ColoradoCare board of trustees is held.
How it works
ColoradoCare in a nutshell:
Funding: A mix of federal funds — Affordable Care Act waiver grants and Medicaid waiver funds — and a Health Care premium tax on payroll and non-payroll income and businesses.
Coverage: All Colorado residents.
Cost to people: Billing from health care providers goes directly to ColoradoCare; some patients or services may require a co-pay.
Tax cost: 6.67 percent of payroll for employers; 3.33 percent of gross income for employees; 10 percent of nonpayroll income.
Governance: 21 elected representatives from seven districts in the state would make up the board of trustees, which would oversee the professional staff. While it would be a political subdivision of the state, it would not fall under the Legislature, governor, or any administrative department or agency.
Goal: Reduce administrative waste in health care coverage while making health care coverage universal.
Concerns: How seriously would a single-payer health care system shift the health care marketplace in Colorado?
Get involved
Find events and volunteer to carry the petition at ColoradoCareYes.Co.
Find a petition to sign in Fort Collins most afternoons at the Old Town Library, 201 Peterson St., and Harmony Library, 4616 S. Shields St., and at most major events.
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