Of the nine 2016 Colorado ballot measures that voters will consider in November, Amendment 69, also known as ColoradoCare, is easily the largest and most complex. The proposal would create a Colorado health-care system with a goal of guaranteeing that everyone in Colorado has health-insurance coverage. Since Amendment 69 won't supersede federal programs such as TRICARE, which focuses on veterans, it's not technically a single-payer plan, but it's close enough to have earned the endorsement of Vermont senator Bernie Sanders, a longtime advocate of health-care reform.
The leading opposition group to Amendment 69 is called Coloradans for Coloradans, which describes itself as "a bi-partisan, statewide organization that represents Coloradans from every industry and corner of our state who share a commitment to moving our state forward. We promote solutions that are by Coloradans and for Coloradans that lead to a stronger state." And while the ColoradoCare Yes campaign has attempted to brand the group as an insurance-industry-funded puppet, the No on Amendment 69 movement has managed to assemble a large coalition of local opponents, including Governor John Hickenlooper, a Democrat, state treasurer Walker Stapleton, a Republican, and both the Independence Institute and ProgressNow Colorado, political organizations that tend to be on the opposite ends of the ideological scale.
Below, find the transcript of our interview with Cody Belzley, Coloradans for Coloradans' policy director. Over the course of our conversation, she outlines objections to Amendment 69, of which she has many, as well as addressing what she admits is a current health-insurance system that isn't working very well. Note that we've made some parenthetical insertions for clarification and fact-checking purposes.
Westword: What are your organization's main objections to the amendment?
While 69 is a large and complex policy and there are lots of pieces to this puzzle, our basic objections come down to three things.
The first is that this is an extremely risky proposal. There are few things in life that are more personal and more important than health care. And Amendment 69 seeks to essentially eliminate the health-care system as we know it and replace it with a first-of-its-kind, never-before-tested, government-funded health-care system, and lock that health-care system into the state's constitution, making it really difficult to amend it or change it in the future. And we think that's a risk too great to take.
The second objection really relates to the uncertainties in Amendment 69. We encourage everyone to download the amendment language and read it. We think that when they do, what they'll find is that Amendment 69 essentially creates an outline or a framework for a new health-care system. But it leaves critically important questions about health-care benefits, access to health care and costs all unanswered, and essentially left to be determined by a 21-member elected board. We think that those uncertainties are deeply concerning and something we can't stand for.
And the last concern we have is the unaffordable nature of this proposal. Amendment 69 would levy $25 billion in new taxes. To provide some context, the entire state budget is about $27 billion. It would give Colorado the highest income-tax rate in the country, and all Coloradans would be asked to pay into this new health-care system whether or not they use ColoradoCare as their primary source of health-care coverage in the future.
From our perspective, Amendment 69 is just too risky, too expensive and full of too many uncertainties for Colorado.
Let's take those topics one at a time. Your first point is about putting these changes directly into the state constitution. Would your organization have fewer objections if the measure was going through a legislative process, as opposed to being placed in the constitution?
To be clear, we oppose Amendment 69 for a number of reasons. If it weren't in the constitution — if it was a statutory change as opposed to a constitutional change — I don't think that would be sufficient to gain the support of most people in our coalition. But the fact that it would be in the constitution is deeply concerning. Anyone who's lived in Colorado for any amount of time has heard about Tabor [1992's Taxpayer's Bill of Rights], Gallagher [a 1982 property-tax amendment], Amendment 23 [a school-funding measure passed in 2000 that continues to stir controversy]. Regardless of how you feel about the policies, I think most people will agree that locking those big and complex policies into the constitution has created challenges in terms of our ability to budget and govern our state appropriately. Amendment 69 is another large, complex and costly policy that would be locked into the constitution, making it very difficult to revise or change in the future.
Regarding your comment that ColoradoCare would be unprecedented, haven't other states looked at doing something like this?
There are a number of states that have pursued health-reform models, but most have done so in the context of a public-private hybrid model that still relies on private insurance as a significant piece of their health-care system. [Click for a rundown of health-care reform efforts in states such as California.] The State of Vermont actively investigated a single-payer-like or universal health-care plan at the state level. In fact, a Democrat who ran for governor on a promise to bring universal health care to Vermont ended up pulling the plug on his own proposal after years of investigation and looking at modeling, determining that the potential financial risk to Vermont's economy was just too great. [Vermont governor Peter Shumlin ended a four-year effort to enact what was dubbed Green Mountain Care in 2014.]
We would be the first state in the country to pursue a state-run, government-financed and government-administered health-care system.
People who are in favor of the single-payer system often note that the Affordable Care Act isn't truly universal, and it doesn't appear likely to become universal anytime soon. Many also have complaints about the current reliance on private health care. Is the private health-care system better than these critics believe?
Health care doesn't work as well as it could or should in America or in Colorado. Our health-care system is expensive, and costs are continuing to grow. It's not a universal system. There are certainly people left out of that system, and, most important from my perspective, they don't get the kind of health-care outcomes that we could or should get for the money we pay.
But Amendment 69 isn't a referendum on whether or not we like our health-care system today. We don't get to vote "no" on 69 and endorse our current health-care system. The choice in front of voters this fall is whether or not to abandon the public-private health-care system we have in place today in favor of something that's risky, something that's full of uncertainties, and something that will cost Colorado significantly. So the choice is, do you have confidence in this new, risky and untested system? Or should we all continue to work together within the basic construct that we have today to make our existing public-private system work more efficiently and effectively and deliver a better product than what we have today?
Tell me more about your second area of concern — the uncertainties of Amendment 69.
Amendment 69 essentially creates a skeleton for a new health-care system. It empowers a 21-member board of elected trustees to make important decisions about health-care benefits, about access to care and reimbursements to doctors and hospitals, and about costs.
How would these 21 experts be different from a group of legislators?
Before we get to that, let's talk about how in the twelve pages of amendment language, there are only eleven lines that talk about health-care benefits. They basically enumerate eleven categories of things that will be covered — things like hospitalization, prescriptions, prescription drugs, end-of-life care. There are absolutely no details presented within those categories about what the specific benefit levels will be. Similarly, in those twelve pages of documents, there's only one line that talks about doctors and hospitals and other health-care providers being reimbursed for the services they provide. It simply says that the board of trustees will be empowered to negotiate favorable rates for health-care products and services.
We know that if doctors and health-care providers aren't reimbursed adequately, it will have a negative effect on access to care. And so we're worried about whether or not our robust health-care system will continue to be available to Coloradans.
And the last piece is really about what this is going to cost. There's great uncertainty about whether or not the revenue produced will be sufficient to meet our growing health-care costs. In fact, an independent analysis from the nonpartisan Colorado Health Institute looked at Amendment 69 and determined that it's unlikely that the revenue will be sufficient. [Click to access CHI's "ColoradoCare: An Independent Analysis" report.] And in that case, the board of 21 trustees is essentially left with three choices. They can reduce benefits, they can reduce payments to doctors and hospitals in an effort to reduce costs, or they can raise our taxes again. So the $25 billion becomes a starting point, not an end cost.
Now, you asked about the governance structure and how this differs from our legislature. What's interesting is that this would create a 21-member board of elected officials outside the purview of state government — outside the traditional checks and balances of state government. This board would not be accountable to the governor, to any existing state agency or to the legislature. They would have the authority to establish their own processes for running elections and governing themselves. The only requirement for serving on the 21-member board is that you be eighteen years old and you live in the district you seek to represent. There's no guarantee that anyone will be elected to the board who has knowledge, understanding or expertise in health, medicine, health-care services, finances, business management. There's also no guarantee of political balance or diversity for the board. So you could very well end up in a position where you have a highly partisan or highly political board empowered to run a new entity outside the checks and balances of state government, responsible for a $36 billion budget — the $25 million of tax revenue plus the $11 billion in existing state revenue [specifically, Affordable Care Act waiver funds] that would be transferred to ColoradoCare's control — and be empowered to make critically important health-care decisions about your benefits and the health-care-reimbursement policies about funds that are paid to hospitals and doctors. These are very concerning aspects of this proposal.
You mentioned in talking about your first area of concern — the uncertainties — a fear of putting things into the constitution that would be difficult to remove. Wouldn't the lack of specifics be a positive in terms of what you're talking about? If the language was more specific, wouldn't that remove all flexibility when it comes to changing and improving the policy over time?
Certainly. This is a sort of catch-22 situation, where you have to put enough specificity into the constitution to create some guardrails, but not so much specificity that you lack the ability to change in the future. I think what's concerning from my perspective are the details that are locked into the constitution: the $25 billion tax increase and the unprecedented governance model that is part of the constitution, and the board that would ultimately be responsible for making decisions about the important details that aren't addressed in the constitution.
The third area you mentioned, and have touched on again, involves the amendment's costs, and you focused particularly on people who want to keep their current private insurance....
Nothing in Amendment 69 prohibits the existence of private health-care insurance. Amendment 69 also assumes that Medicare will continue to be the primary health insurer for senior citizens, and that the VA TRICARE will continue to be the primary source of insurance for our active and retired military. So this is not a true single-payer proposal. Seniors will continue to get their health-care services through Medicare, the VA TRICARE will continue to serve members of the military — and it is possible there could be a supplemental or secondary insurance market available as well.
But all Coloradans are taxed to pay for ColoradoCare. So whether or not you're using ColoradoCare as your primary source of insurance, you will pay into this new system. And to be clear, to raise $25 billion worth of taxes, you do have to raise a significant tax. So there's been a lot of talk and discussion about the 10 percent payroll tax, which is an important piece of this financing mechanism. The 10 percent tax is on all payroll incomes, two-thirds of it to be paid by the employer, one-third to be paid by the employee. But there's additionally a 10 percent income tax on non-payroll income. This includes everything from dividends on your savings and investments, capital gains, any revenue you generate through investment properties or real-estate holdings. But it also includes retirement income: Social Security income, pensions, IRAs. Anything above the $4,000 personal exemption limit would be subject to the 10 percent non-payroll tax. This is a significant tax burden to be shared by all Coloradans.
You're talking about dividends and investments — things associated with people who have higher incomes. But are you also arguing that this would be a regressive tax that would hurt people with lower incomes more?
Generally, income taxes are viewed to be regressive taxes. I think the other important detail here is that the ColoradoCare tax is capped at $350,000 for an individual filer, $450,000 for joint filers. So the highest-income-filing families within Colorado would be limited somewhat in their tax-burden exposure, and that increases the regressive nature of this tax burden.
What about exemptions for people at the bottom end of the scale?
Proponents have talked about if you're Medicaid-eligible, you'll receive some sort of tax refund. But what that looks like, how it would work, how it would function, remains to be seen. There's no language in Amendment 69 that exempts anyone from paying their portion of the tax.
The proponents of this proposal have talked about opponents not being from Colorado and maintained that the opposition is being funded primarily by the health-care industry nationally. Where does your funding come from? And is your organization rooted in Colorado and peopled by Coloradans?
Absolutely. Our campaign committee has complied fully with the Secretary of State's Office in providing all the financial disclosures necessary. We have appreciated financial support from large healthcare companies. But we've also enjoyed financial support from a number of individuals and small businesses in Colorado. In fact, more than 50 percent of our donations have come in increments of $100 or less. [Figures from September 19 show that $3,935,950 of $4,003,067 contributed to Coloradans for Coloradans came from corporations and business entities. The top four, whose contributions exceed $2 million, are from Ohio, California, Connecticut and Tennessee, respectively.]
Also, in addition to looking at financial support, I think it's important to look at the endorsers list. We have over 1,650 individuals, elected officials and organizations that have come out opposed to Amendment 69. They include groups as diverse as ProgressNow Colorado and the Independence Institute. They include elected officials and state legislators in Democratic leadership and in Republican leadership. They include people from all different parts of the state. While we are proud to have earned the support from major health-care companies, we're equally proud of the support we have received from Democrats, Republicans and independents from all parts of Colorado.
What will be your approach to getting your message out as we get closer to election day?
We were very fortunate to be successful in doing some early fundraising, which allowed us to purchase some TV time. We've had TV advertising running since Labor Day. We'll continue with digital advertising. But most important, we're going out there and meeting with every group that's interested in hearing from us. We've had more than 250 events and town hall meetings and forums so far, and we're looking at doing many, many more between now and election day. We're relying heavily on word of mouth and the support from those 1,650 individuals and organizations that have taken a position against Amendment 69 — talking to their friends and neighbors and colleagues about the risks of this significant proposal.
What's your sense of the direction this proposal is going right now?
It's hard to know. This is a strange political year, and so I have a hard time reading the political winds. But we're working hard, and we'll continue to work hard through election day to warn people about the risks of Amendment 69.