It’s hard to look past the presidential election, or even the battle for the senate, but there are a few initiatives on the ballot that are significant. On election day, voters in Colorado will decide whether to create a single-payer health insurance system in their state that would replace both private insurance from employers and the Affordable Care Act’s exchanges. The vote will tell something about whether Americans in a relatively progressive state would now favor going beyond Obamacare to a system of “Medicare for all” like Bernie Sanders proposed in the primary. Based on what I’ve seen in Colorado, I’m not optimistic.
The Colorado initiative, which will be Proposition 69 on the ballot, would provide insurance to all Coloradans, except those eligible for Medicare or the Veterans Administration. ColoradoCare would virtually eliminate not only the uninsured but the rising ranks of the underinsured. In Colorado, about 353,000 remain uninsured– the vast majority of whom, according to the Colorado Health Institute, say they can’t afford insurance. As more Coloradans have obtained insurance, the numbers who are underinsured have been growing – from 13.9 percent in 2013 to 16.9 percent today.
ColoradoCare’s insurance would require no annual deductible. Its benefits would be more generous than most private plans or plans offered under the ACA’s exchanges. It would be financed through a ten percent payroll tax, of which employees would pay a third and employers two-thirds. ColoradoCare would set rates for providers.
ColoradoCare was the brainchild of Dr. Irene Aguilar, an internist and State Senator, and former Washington Post reporter T.R. Reid, who in 2010 published a book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. Last year, sponsors of the initiative gathered the 100,000 signatures to put it on the ballot. It is endorsed by several county Democratic organizations in Colorado and by Moveon in Denver and Public Citizen and by the Denver chapter of the Postal Workers. Its website features endorsers Noam Chomsky, Bernie Sanders, and Gloria Steinem.
The opposition, however, consists of the major Republican and Democratic officials in the state, including Gov. John Hickenlooper, Sen. Michael Bennet, major businesses, and business associations,, a major union, the United Food and Commercial Workers, and all but one (The Aurora Sentinel) of the state’s newspapers. Funding is similarly one-sided. Proponents have raised $867,000 to back the campaign for Proposition 69; opponents have raised $4.1 million. The largest contributors to Colorado for Coloradans, which is campaigning against Proposition 69, are three health insurance companies and two health care systems. Anthem alone contributed a million dollars, more than the entire budget for ColoradoCare Yes.
The case against Proposition 69 focuses, as one might imagine, on taxes and spending. Proponents claim the measure would eventually save Coloradans money, but it would raise taxes on businesses and individuals. Businesses claim the measure would drive some of them out of Colorado and discourage others from coming in. The Colorado Health Institute denies that ColoradoCare would prove unfundable like Vermont’s single-payer initiative. Colorado has a larger population and a higher median income than Vermont has. But the Colorado Health Institute says that ColoradoCare “would lack the revenue to sustain itself,” after it begins in 2019. That would probably means still higher taxes. (ColoradoCare proponents disagree. They charge that the health institute’s estimate understates the federal contribution to the program, but it is an arguable point.)
Colorado, like many American states, has a record of resisting tax increases. In 1992, Coloradans passed an initiative creating a Taxpayer Bill of Rights that limits taxes and spending. My guess is that even without the disparity in campaign spending between proponents and opponents, Proposition 69 would fail because of the public’s reluctance to pay the taxes it calls for. And the few polls taken indicate strong opposition to the measure. These could prove wrong, but I doubt it.
If the polls are accurate, and Proposition 69 goes down to defeat, it means that it would be very hard right now to win support nationally for a proposal like Sanders’ Medicare for All. If Sanders had won the Democratic nomination, he would, I believe, have run headlong into public opposition to higher taxes for increased government spending. Sanders’s proposal met skepticism even among Democrats voting in the primaries. That doesn’t mean Sanders’ proposal or that of ColoradoCare is wrong, only that the public is not ready to support the means to achieve Medicare for all on a state basis or nationally.
My guest is that if genuine health care reform takes place at all – and it certainly is needed as more private insurance companies drop out of Obamacare — it will have to occur in a more piecemeal fashion through the establishment of a public option or the reduction in the age requirement for Medicare. Partly under pressure from Sanders’ campaign, Hillary Clinton has endorsed these measures. One hopes that she’ll get a chance to put one or both of them into effect, but these measures are sure to be resisted by Republicans on Congress who appear determined to destroy any program of universal insurance. I hope I’m wrong, but the outlook does currently appear dim for reform either in Colorado or nationally.