Medical News

Amendment 69

While everyone would agree that high quality, cost-effective healthcare for every citizen of The United States, let alone Colorado, should be our goal, the proposed Colorado state amendment 69 does not get us there. A bloated state government with a bureaucratically appointed governing board controlling the entire healthcare market in the state of Colorado would be an unmitigated disaster. Taxes would increase on every citizen, there would be little to no cost-containment provisions to keep the cost of care down, physicians and private insurers would flee the state, and it would take 1-2 years of increased taxes before the program was even implemented.

The estimated cost to implement ColoradoCare is $25 billion per year (estimated by Colorado state analysts). This would almost double the entire operating state budget for Colorado (according to the Colorado Fiscal Institute, the 2014-2015 Colorado state budget was $23.1 billion). This is to be paid for by increased taxes, both payroll and non-payroll. Initially, to build-up a “transitional fund” and before any healthcare is actually paid for by ColoradoCare, a 0.6% employer and 0.3% employee payroll tax increase will be levied upon every Coloradan. In addition, a 0.9% non-payroll income tax will be levied on all ColoradoCare plan beneficiaries. These taxes will be in place from January 1, 2017 until 30 days prior to implementation of ColoradoCare. Then, the taxes will increase again to a 6.67% employer payroll tax premium, a 3.33% employee tax premium for every working Coloradan, and a 10% non-payroll income tax premium on every plan beneficiary. In addition, the governing board can vote annually to increase these tax premiums further should the need arise (though it does require the majority vote of plan beneficiaries).

ColoradoCare would be administered by an initial governing board of 15 members appointed by government officials. Then, an elected board of 21 members will take over. Neither the initial nor the elected board members need have any experience in healthcare, its delivery, or its administration. They are responsible for the functioning of ColoradoCare, establishing and following annual budgets, and hiring a management team. There are no provisions for what happens if the budget is not accurate, quality is not maintained, or benefits are not provided. Section 7 (3) of the amendment states: “COLORADOCARE SHALL USE PAYMENT MODELS THAT OPTIMIZE QUALITY, VALUE, AND HEALTHY OUTCOMES FOR BENEFICIARIES.” It does not, however, specify what that model will look like. Such a model does not exist currently despite multiple attempts by the federal government and private insurers to establish a “pay for performance” payment program that truly does control costs, optimize quality, and provide for better outcomes.

Green Mountain Care was established in Vermont in 2011 as the first single-payer system in the United States and was abandoned in 2014 because the tax increases were “too big for the state to absorb” according to Governor Shumlin. Also, the impact of the tax burden would be extremely detrimental to small businesses in the state of Vermont. “In my judgment,” said Shumlin at a press conference, “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.” In Colorado, it could take 2 years of increased taxes and insurers fleeing the state before we realize the same thing and abandon ColoradoCare leaving healthcare in Colorado a shambles. With regard to federal efforts, the Affordable Care Act (known as ObamaCare) promised to insure the uninsured and make healthcare affordable – thus the name. Since the implementation of the Affordable Care Act, across the nation healthcare premiums have increased and insurance options have decreased due to insurers leaving the marketplace.

Though it would be nice to do away with deductibles and co-insurances, doing so would likely increase the overall cost of providing care. In the current market, most patients will carefully consider their health before seeing the doctor because they know there will be a copay, deductible, or some other form of payment. So, the stubbed toe might wait a day or two before seeing the orthopedist and the sore throat might wait a day or two before seeing the primary care physician. Some of those patients will not end up seeing the doctor because, as with most minor ailments, they get better with time. However, if there is no additional expense to the patient to see the doctor, it is more likely that those appointments will be made thus increasing the overall cost to the healthcare system.

During the transition phase of ColoradoCare, private insurers will likely flee the state. We have seen this happen around the country with the Affordable Care Act (ObamaCare). Because of the pool of patients left to these plans, they would be at high risk of financial loss. This would potentially leave a large segment of the population without a good choice for health coverage during the transition years and potentially beyond. Physician reimbursement will likely drop significantly with ColoradoCare in an effort to control costs. This will drive many physicians to leave the state because of inability to maintain their offices and to provide care for their patients. It will certainly discourage young physicians and especially specialists from moving to Colorado. All of this will combine to decrease access to care for the average Coloradan.

All of the above facts aside, it is very difficult (or near impossible) to think of an example where government control of an entity has actually increased efficiency, quality, and accessibility. We all want affordable, quality, universal healthcare – but ColoradoCare is clearly not the way to achieve it.

We urge you to vote NO to Amendment 69 on Election Day.

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