By Jack Healy
The New York Times, April 28, 2016
DENVER — For years, voters in this swing state have rejected tax increases and efforts to expand government. But now they are flirting with a radical transformation: whether to abandon President Obama’s health care policy and instead create a new, taxpayer-financed public health system that guarantees coverage for everyone.
The estimated $38-billion-a-year proposal, which will go before Colorado voters in November, will test whether people have an appetite for a new system that goes further than the Affordable Care Act. That question is also in play in the Democratic presidential primaries.
The state-level effort, which supporters here call the ColoradoCare plan, would do away with deductibles. It would allow patients to choose doctors and specialists without distinguishing between those “in network” and those “out of network.” It would largely be paid for with a tax increase on workers and businesses, and cover everyone in the state. Supporters say most people would end up saving money.
Insurance groups, chambers of commerce and conservatives have already lined up in opposition. They say the plan’s details are vague, its size and cost galling. The proposed health system would have a budget bigger than that of Colorado’s entire state government. A new 10 percent tax on payroll and incomes to pay for the system would push Colorado’s tax rates to some of the highest in the nation.
The proposal’s chance of success is dubious. Colorado has a mixed record when it comes to ballot measures, though it has passed some notable ones over the years, including marijuana legalization and the Taxpayer Bill of Rights, an anti-tax, anti-spending constitutional amendment.
But the proposal had enough support to garner 100,000 signatures, which put it on the ballot. It has also worried insurers, and some in the medical community and the business community, enough for them to organize in opposition, even enlisting a Democratic former governor to help in their campaign.
In this season of political discontent, the notion of dismantling the health insurance system has tapped an aquifer of frustration from voters. People say that even after the Affordable Care Act, they still pay too much in premiums, plus thousands in deductibles, and still have to worry about being bankrupted by a disabling car crash or an extended hospital stay.
“I think insurance is one of the biggest jokes and crooks,” said Brandon Barta, 38, of Denver. He said his father, Dixon, who worked at a gas station, never received aggressive enough treatment for his prostate cancer. He died last May at the age of 64.
“He was overlooked,” Mr. Barta said.
Mr. Barta said he was intrigued by the idea of a universal health plan that covered maternity care, checkups, emergency room visits and hospital stays, all the way through end-of-life care. Like millions of Americans, he has health insurance tied to his work. His coverage lapsed recently when he switched jobs to start working for a golf entertainment complex, and he is still waiting for his new plan to kick in.
Still, he has questions about how universal coverage would work and how much it would cost taxpayers like him.
The answers: If a majority of voters say yes, the system would start running in 2019, and essentially be a start-up health cooperative bigger than companies like Nike and American Express, according to the Colorado Health Institute, an independent policy group. A 21-person elected board would set the benefits and budgets. The system would be financed by payroll taxes of 3.3 percent for workers and 6.7 percent for employers. It would impose a 10 percent tax on investment income, people who are self-employed and some small-business income.
In the contest for the Democratic presidential nomination, Hillary Clinton, echoing many moderate Democratic leaders here, has said that she wants to keep and improve the Affordable Care Act, Mr. Obama’s signature legislative legacy. But her opponent, Senator Bernie Sanders, who won Colorado’s Democratic caucuses last month by nearly 20 points, has advocated abandoning the health law for a “Medicare for all” approach. His proposal is similar to the ColoradoCare plan.
The campaign over the Colorado initiative has had the unusual effect of putting conservative critics in the position of defending Mr. Obama’s health plan against an assault from the left. At the same time, it is energizing progressives, who say the Affordable Care Act was a giveaway to the insurance industry that, even with an estimated 20 million people newly insured, has left too many others without coverage.
“No matter how long we hang in there with the Affordable Care Act, we will never cover everybody,” said Jeanne Nicholson, a former Democratic state senator and nurse who is a leading supporter of universal care here. “We don’t understand why we should compromise and say some people can have bronze coverage, some can have silver and some can have gold. Why can’t we all have platinum plus?”
Nathan Wilkes, 42, who lives in the Denver suburbs, said that years of trying to get care for his son, who has hemophilia, had worn his family thin and made him an advocate for universal coverage. He said the family had spent thousands of dollars and destroyed its credit because of insufficient coverage. The Affordable Care Act offered some benefits, he said, but its gaps were still too big and “not sustainable.”
Unlike its conservative neighbors, Colorado jumped to get on board with the Affordable Care Act. It set up its own insurance marketplace and expanded Medicaid coverage for poorer residents. But there have been stumbles. People in mountain towns with few providers faced eye-popping premiums for coverage. Colorado’s biggest health cooperative, Colorado HealthOP, shut down in October, forcing more than 80,000 people to find new plans.
Colorado’s plan would replace many private workplace plans, but it would sit alongside Medicare and federal health coverage for veterans, and private insurers could still sell coverage to people who wanted more.
The Colorado Health Institute, an independent policy group, said the plan’s passage would be “the most far-reaching health care reform in any state” since the Affordable Care Act.
“It’s replacing a system that I think has become really dysfunctional,” said Irene Aguilar, a Democratic state senator and physician who is leading the effort. “The game has been rigged by the for-profit corporations to ensure they win.”
Opponents say that it could wreck the state’s humming economy and drive away doctors and businesses, and that its costs could spiral out of control.
If it passes, ColoradoCare would become part of the state Constitution, and become virtually impossible to significantly alter without a statewide vote. It would also fall outside the reach of the Taxpayer Bill of Rights, a 1992 amendment to the Colorado Constitution that put strict limits on spending and new taxes.
“It would be a disastrous economic impact on the state,” said Walker Stapleton, Colorado’s treasurer and a co-chairman of the opposition campaign. “If you think legalized pot brought a lot of people to Colorado, you should try free health care.”
Like many other Republicans here, Mr. Stapleton opposed the Affordable Care Act and continues to criticize how it has been put in place. But to defeat the new initiative, he now finds himself defending the federal health law.
Sean Duffy, a Republican and a spokesman for the opposition campaign, said many of his neighbors in the conservative Denver suburb of Highlands Ranch had eagerly signed the petition to put the question on the November ballot because they saw it as a way to get rid of Obamacare.
Some Democratic officials also oppose the state’s universal care effort. They include Gov. John Hickenlooper, who said during his 2014 re-election fight that he was “no big fan of the Affordable Care Act.”
Colorado’s previous Democratic governor, Bill Ritter, also opposes it.
Michelle Lucero, general counsel at Children’s Hospital Colorado, is among the health care officials lining up against the measure. (The hospital itself also opposes it.) She worries that it could threaten research dollars or drive away doctors.
“They’re going to choose to go to a state that’s not hamstrung by this,” she said.
