Colorado Could Opt Out of ACA, Implement a Single-Payer Health Care System

Initiative does not prohibit the purchase or sale of private coverage duplicating the public plan.

Colorado could be the first state to implement a single-payer health care system. Voters will decide next year on the issue, according to the Denver Post.

Under the comprehensive health care system, residents would choose their own health care providers, but ColoradoCare would pay the bills. The measure is going to the vote after proponents submitted 158,831 signatures, 110% of the total number required, according to the secretary of state’s office.

However, ColoradoCare won’t come cheap: the state would need to raise $25 billion a year through a proposed 10% payroll tax. The tax would break down to employers paying about 7% of workers’ wages and employees paying about 3%.

If the measure did pass, then Colorado would become the first state to opt out of the Affordable Care Act, according to CBS Denver.

The drafting of ColoradoCare was spearheaded by state Senator Irene Aguilar, MD, and psychologist Ivan Miller, PhD.

“Colorado deserves a better option, and now they can vote on one,” Dr Aguilar said in a statement. “Health care costs continue to rise every year, hurting Coloradans’ chances to get ahead. It’s time we get the insurance industry out of the driver’s seat and put families in charge of their health care.”

Opponents disagree. Jonathan Lockwood, executive director of Advancing Colorado, has said that ColoradoCare could kill healthcare in the state and lead to the loss of human lives.

“ColoradoCare will triple our taxes, lead to rationing of health care and will make Colorado a less attractive state for Millennials, businesses and families,” Lockwood said in a statement. “Coloradans do not want to see their taxes triple and all the progress with health care reform thrown in the trash for a single-payer health care system. We can get more people covered, more affordably and more realistically with market-driven reforms that ensure choice and options.”

The organization Physicians for a National Health Program (PNHP), which advocates for a universal, comprehensive single-payer health program in the United States, analyzed the ColoradoCare initiative and noted that it is not really a single-payer plan.

For example, the initiative does not prohibit the purchase or sale of private coverage duplicating the public plan and it would only serve as supplemental for individuals covered by Medicare, Veterans Affairs, and TriCare. In addition, ColoradoCare does not cover dental care for adults or long-term care for most individuals.

The initiative would cover all or nearly all of Colorado’s uninsured population, including undocumented immigrants, includes the ability to negotiate lower prices with pharmaceutical companies, and allows for a free choice of primary care doctor.

However, despite the strength PNHP notes, there are more weaknesses, including the fact that the initiative makes no mention of how hospitals or other institutions would be paid (the Colorado Hospital Association has yet to weigh in, officially) and the initiative makes no mention of whether the choice of specialist or hospital could be restricted.

In addition, PNHP notes that the campaign uses anti-government rhetoric, which is problematic.

“While the ballot measure spells out the program's governance and Board structure in considerable detail, key aspects of the program are not specified, and/or left to the discretion of the Board,” wrote Ida Hellander, MD, director of health policy and programs at PNHP, and David U. Himmelstein, MD, and Steffie Wollhandler, MD, MPH, both internists, professors at the City University of New York School of Public Health, lecturers in medicine at Harvard Medical School, and co-founders of PNHP.

Lockwood has raised his own concerns about the board in general.

“The worst part of the ColoradoCare proposal is that if it passes, it will allow an unelected ‘board’ to raise taxes on income with no restraints, and no recourse for consumers,” he said in a statement prior to the initiative officially getting on the ballot. “ColoradoCare isn’t just government picking winners and losers, it is government making us all losers.”