In Colorado, a push for sin­gle-payer health­care

Modern Healthcare - - NEWS - By Shelby Liv­ingston

Years be­fore Sen. Bernie San­ders touted sin­gle-payer health­care as a core is­sue in his in­sur­gent pres­i­den­tial cam­paign, a Demo­cratic state law­maker in Colorado was peren­ni­ally in­tro­duc­ing leg­is­la­tion for a sin­gle-payer sys­tem in the state.

That leg­is­la­tion, backed by state Sen. Irene Aguilar, a physi­cian, never gained much trac­tion. But last year, its sup­port­ers col­lected more than 150,000 sig­na­tures to bring the plan be­fore vot­ers di­rectly on the Nov. 8 bal­lot. “It grew out of frus­tra­tion and out of painful aware­ness that peo­ple are suf­fer­ing, and they don’t need to be be­cause we’re spend­ing more than we need to,” said Lyn Gul­lette, di­rec­tor of op­er­a­tions for the cam­paign be­hind the bal­lot ini­tia­tive, which would amend the state’s con­sti­tu­tion.

San­ders, who de­feated Hil­lary Clin­ton by nearly 19 points in the state’s Demo­cratic cau­cus, has en­dorsed and cam­paigned for the mea­sure. But a Septem­ber poll sug­gested just 27% of vot­ers were likely to sup­port it.

The plan, which will ap­pear on the Colorado statewide bal­lot as Amend­ment 69, would es­tab­lish a uni­ver­sal health­care sys­tem that would fi­nance health­care ser­vices for most Colorado res­i­dents un­der a fed­eral waiver avail­able to states un­der the Af­ford­able Care Act. The pro­gram, chris­tened ColoradoCare, would be funded by pay­roll taxes rather than in­surance pre­mi­ums, and ben­e­fi­cia­ries would have no de­ductibles and no co­pays for pre­ven­tive and pri­mary care.

Ad­vo­cacy groups rep­re­sent­ing hos­pi­tals and health in­sur­ers are warn­ing the plan would up­end the cov­er­age ex­pan­sions un­der the Af­ford­able Care Act, re­quire un­sus­tain­able tax in­creases and un­der­mine com­pe­ti­tion and pa­tient choice while fail­ing to fix the un­der­ly­ing driv­ers of health­care costs.

“We are con­fi­dent that it would threaten the sus­tain­abil­ity of Colorado hos­pi­tals,” said Kather­ine Mul­ready, vice pres­i­dent of leg­isla­tive pol­icy and chief strat­egy of­fi­cer at the Colorado Hos­pi­tal As­so­ci­a­tion. “It’s a very risky and un­cer­tain pro­posal that’s never been tested at the state level be­fore.”

Other crit­ics ques­tion the fi­nan­cial vi­a­bil­ity of the plan. An in­de­pen­dent anal­y­sis by the non­par­ti­san Colorado Health In­sti­tute de­ter­mined that ColoradoCare would face a deficit of $7.8 bil­lion by 2028. Ver­mont passed a law in 2011 to a cre­ate a sin­gle-payer sys­tem but aban­doned the plans at the end of 2014 be­cause the state de­ter­mined it wouldn’t be able to pay for it. ColoradoCare would elim­i­nate the state-run health in­surance ex­change and trans­fer those funds to the new sys­tem. Fed­eral pro­grams like Medi­care and Vet­er­ans Health Ad­min­is­tra­tion cov­er­age would re­main un­changed, and res­i­dents would still have the op­tion of buy­ing pri­vate health in­surance, though they would still pay taxes to sup­port ColoradoCare.

Ben­e­fits would in­clude pri­mary, men­tal health, spe­cialty and den­tal care and be gov­erned by an elected 21-mem­ber board of trus­tees who would de­cide ben­e­fit de­tails and set rates for providers con­tract­ing di­rectly with the sys­tem.

“ColoradoCare will cost thou­sands less for the vast ma­jor­ity of Coloradans—over 83% of them—while main­tain­ing and ex­ceed­ing the cur­rent stan­dards for ben­e­fits re­quired un­der the ACA,” a cam­paign spokesman said.

The new sys­tem would be fi­nanced by a new 10% pay­roll tax shared by em­ploy­ers and work­ers, as well as mem­ber co­pay­ments, and fed­eral and state funds that now pay for Med­i­caid and other health pro­grams. It would also im­pose a 10% tax on non­pay­roll forms of in­come.

The Colorado Hos­pi­tal As­so­ci­a­tion, which rep­re­sents more than 100 hos­pi­tals and health sys­tems, says the tran­si­tion to an en­tirely dif­fer­ent sys­tem threat­ens to stall the progress made to­ward ex­tend­ing in­surance cov­er­age to ev­ery­one in the state, which ex­panded Med­i­caid el­i­gi­bil­ity un­der the ACA and cre­ated its own in­surance ex­change for health plans sub­si­dized by the law. The state’s unin­sured rate de­clined to 6.7% in 2015 from 14.3% in 2013.

Hos­pi­tals fear ColoradoCare will mean lower rates for health­care providers and cre­ate uncer­tainty for the state’s hos­pi­tal as­sess­ment pro­gram, which funds en­hanced Med­i­caid pay­ments for some hos­pi­tals as well as an­other pro­gram that pro­vides dis­counted care for low-in­come res­i­dents.

The Colorado Med­i­cal So­ci­ety, which rep­re­sents more than 7,000 physi­cians, sur­veyed 795 of its mem­bers in Au­gust and Septem­ber and found that 78% would vote against Amend­ment 69, while 16% would vote in fa­vor and 6% were un­sure. The sur­vey found that 88% of spe­cial­ists and 72% of pri­mary-care physi­cians sur­veyed strongly op­posed it.

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