DENVER – In the weeks ahead of the Nov. 8 General Election, Denver7 will be profiling most of the state ballot measures and initiatives. In this edition, we take a look at Amendment 69, also known as ColoradoCare.
Here are 7 things you need to know about Amendment 69:
1. OVERVIEW AND HISTORY
The Affordable Care Act, signed into law in 2010, opened the door for the possibility of a state-run health care system through a section in its language, Section 1332, that allows states to receive a waiver for federal funding.
Traditionally, states are required to create their own exchanges and offer certain benefits in those exchanges.
But the Section 1332 waivers, if obtained by Colorado through the federal government, would allow the state to take subsidies usually passed on to people using the state exchanges or private insurers, and use that money for its own health care system.
Any waivers are reviewed and approved by the U.S. Department of Health and Human Services and the U.S. Department of the Treasury.
In the waiver applications, states are required to provide a list of the ACA’s provisions it wants to waive; data on what a waiver would provide; a 10-year budget plan; and a plan on how the state plans to implement the program should the waiver be approved, among many other things.
State Sen. Irene Aguilar, D-Denver, in 2013 introduced a bill in the state Legislature to create a single-payer system that would have involved a tax increase and a statewide vote. But she killed her own bill over concerns that no Republicans were supporting the bill and that special interests may get involved in the ballot vote.
The amendment was originally called Initiative 20 during the ballot signature drive. The signatures were validated by Colorado in November 2015.
Both Vermont and Hawaii have discussed using Section 1332, but have so far opted not to create their own state-run systems.
2. WHAT WOULD AMENDMENT 69 DO?
Amendment 69 seeks to create a single-payer comprehensive health care system for every Colorado resident. Those already covered under Medicaid or federal health care programs would remain eligible for those on top of the standard benefits from the state.
Under ColoradoCare, any person’s health care needs would be covered regardless of the cause of their ailment. People would not have to pay deductibles, and primary and preventative care would be free of copayments. Some people who don’t have the money to cover other copayments would be able to qualify for hardship waivers.
According to the proposed amendment language, there are 11 things Amendment 69 would change the state constitution to require under the new state health care system:
- Ambulatory patient services, including primary and specialty care
- Prescription drugs and durable medical equipment
- Mental health and substance use disorder services, including behavioral health treatment
- Emergency and urgent care
- Preventative and wellness services and chronic disease management
- Rehabilitative and habilitative services and devices
- Pediatric services, including oral, vision and hearing care
- Laboratory services
- Maternity and newborn care
- Palliative and end-of-life care
Since ColoradoCare would be a health cooperative and everyone covered would be considered members, state residents covered under the program would eventually elect a 21-person board of trustees – three from each of seven districts in the state.
But if it passes, the governor and Legislature would first appoint a 15-member interim board to create the election process for the permanent board and lay the groundwork for applying for the federal waivers and how the system is run should the waivers be approved.
A report from the Colorado Health Institute found nearly 83 percent of Coloradans would be eligible for coverage under ColoradoCare and the remaining 17 percent would be covered by federal insurance programs.
“ColoradoCare would launch the most far-reaching health care reform in any state,” the report concluded. “While the ACA sought to increase coverage by funneling more people into the current systems of private or public insurance, ColoradoCare would create a new system, displacing both Medicaid and private insurance.”
Questions remain over whether or not ColoradoCare would provide coverage for elective abortions.
3. HOW DO COLORADANS PAY FOR COLORADOCARE?
If Amendment 69 is approved by voters, there would be an initial tax increase (on top of the current 4.63 percent income tax rate) implemented on the first day of the new fiscal year, July 1, 2017, that would bump the employee tax rate by 0.3 percent of earned wages and the employer tax rate by 0.6 percent of total wages paid out.
Single-filing households will see their first $350,000 taxed, and joint-filling taxpayers can expect the first $450,000 of their income subject to taxation.
An existing tax exemption for people’s retirement income will remain in place up to $20,000 for people aged 55 to 64 and up to $24,000 for those 65 and older.
The initial 0.9 percent tax increase on both wage income and non-payroll income is expected to raise about $2 billion in the first year, which will be used to build the initial ColoradoCare fund and to implement the initial stages of the program.
Once all the waivers are approved by the federal government, the full tax increase will kick in, which is expected to generate approximately $25 billion a year.
Under the full tax hike, employees will pay an extra 3.33 percent of earned wages and employers will pay a total of 6.67 percent of wages paid in order to fund the program. Non-payroll income, like interest and dividend gains, would also be taxed at 10 percent.
Below is a breakdown of what taxpayers and employers could expect to pay in various income situations.
Employers could see savings on insurance premium costs and through tax deductions, according to the state election guide.
The guide says some people covered under federal programs, such as Medicare or Medicaid, may see higher costs depending on their taxable income, and people who don’t currently pay for insurance could see the increased taxes offset out-of-pocket and penalty costs.
The board, once appointed or elected, would be able to increase tax rates through a special ColoradoCare election, but the call for a vote on increases would only be allowed once a year.
The program would also be exempt from the Colorado law that forces the state to reimburse taxpayers with any excess revenue raised under the program.
4. HOW DOES THE BOARD WORK?
The initial board would be comprised of 15 people appointed by the governor and Legislature and would be the group laying the foundation for the program and applying for the federal waivers.
Once the waivers are approved, residents would elect a 21-person board to replace the interim board. It would be comprised of three representatives from seven districts across the state that would be close-to equal in population size.
The elected board members would serve four-year terms, and would be in charge of putting together a team of executives to operate the program, establishing a public office for beneficiaries and providers, making rules for oversight and funding, and creating a CPA position who would negotiate drug, equipment and service prices, among many other things.
5. SUPPORT FOR AMENDMENT 69
The measure has drawn support from Sen. Bernie Sanders, as well as state senators Irene Aguilar and Jeanne Nicholson and many county Democratic and Green party groups.
Arguments in favor of the program say ColoradoCare would provide more comprehensive coverage for all people than the current status of the ACA, which sometimes leave people uninsured or with very high deductibles, which ColoradoCare prohibits.
Another argument is it will control health care and insurance costs, which have skyrocketed in recent years as private insurance companies pull out of the federal and state ACA exchanges over concerns subsidies are not being evenly spread throughout all insurance companies, leaving some receiving money from others and larger companies having to pay more back to smaller companies.
And still another argument is that transparency necessities outlined in the bill provide a better program for citizens to serve as watchdogs of their insurers, as compared to private insurance companies, which are motivated by profit.
ColoradoCareYes is the chief political action committee backing the pro-69 push. It has so far raised $835,797.66. Its largest contributors are Boulder psychologist Ivan J. Miller and Co-operate Colorado Executive Director Lyn Gullette. Its top-10 contributors are all private citizens.
Of the money raised, the PAC has spent $813,636.63 of it. Much of the expenditures were made during the initial ballot drive. Spending waned over the summer, but picked up again in September when the PAC spent $74,000.
Its largest expenditures have gone to Colorado Springs-based consulting firm Kennedy Enterprises.
6. OPPOSITION TO AMENDMENT 69
Opposition to Amendment 69 has been far more widespread than support for it. Though progressives have supported the measure, many high-profile Democrats oppose it, including Gov. John Hickenlooper, Sen. Michael Bennet and state Sen. Morgan Carroll.
Republicans Reps. Mike Coffman, Doug Lamborn, Ken Buck and Scott Tipton all oppose the measure as well, as do Secretary of State Wayne Williams and Attorney General Cynthia Coffman – both Republicans.
The Colorado voting guide says arguments against the measure include the vast tax increases that could overburden taxpayers and double state spending.
Another argument is that the initial tax increase will show no immediate payoff to taxpayers until the full program is put in place upon waiver approval from the federal government. Then, once the program can be utilized, taxes will jump by 3 percent for employees and 6 percent for employers.
There is also no set implementation date, which causes worry for some concerned over how long the waiver process would take, and others worry that board members aren’t required to have any health industry experience.
Others still argue that a single-payer system could limit the number of health care providers and reduce patients’ access to timely care, and that the board could ask for even further tax increases each year, causing costs to spiral.
Coloradans for Coloradans is the main opposition PAC to Amendment 69 and has so far raised $4,040,793.
Its largest contributors are all health care companies – most of which are based outside Colorado, but some of which have offices here and have voiced concerns that ColoradoCare could hurt their businesses and cause Coloradans employed by them to lose their jobs.
Health insurer Anthem, Inc. has contributed $1 million so far to the PAC. United Healthcare Services, Inc. has contributed at least $450,000; Centura Health has given $250,000; Healthone System Support has given at least $250,000; PHRMA has given $100,000; SCL Health has given at least $100,000; Davita has given at least $75,000 and Cigna Health and Life Insurance Company has given at least $60,000.
Centura and Healthone are the only companies based in Colorado out of those listed, though the list of contributions from health industry companies to Coloradans for Coloradans goes on and on in campaign finance documents.
It spent $2.5 million on anti-69 promotion in May, and spent $341,625.94 in September, though it has so far spent only $76,075 in October as polls indicate strong opposition to the measure.
7. POLLS SHOW STRONG OPPOSITION TO MEASURE
There have been two polls conducted in Colorado related to Amendment 69 – one at the end of August and one conducted mid-September.
A Colorado Mesa University, Rocky Mountain PBS and Franklin & Marshal College poll conducted mid-September showed 56 percent opposition, and a Magellan Strategies poll conducted at the end of August showed 65 percent opposition. Both polls had a sample size of greater than 500 people, with margins of error within 4.3 to 5.1 percent.
The Aurora Sentinel and Colorado Springs Independent have supported the measure, while the editorial boards of the Coloradoan, Denver Post, Longmont Times-Call, Loveland Reporter-Herald and Greeley Tribune have all come out in opposition to the measure.
Stay posted to Denver7 for more upcoming reports on state and local ballot initiatives Coloradans will be voting on Nov. 8. Previous initiatives covered can be found below: