Single-Payer Health Care Takes a Big Hit at the Ballot

Despite Bernie Sanders' campaigning, Colorado voters overwhelmingly rejected plans to make their state the first in America to create a universal health-care system.
by | November 9, 2016

Read all of our coverage on 2016 ballot measures at governing.com/ballotmeasures.

Colorado could have become the first U.S. state to make universal single-payer health care a reality. But it won't.

At 10 p.m. ET, almost 80 percent of residents voted against the measure, with 54 percent of precincts reporting.

It's a disappointment for U.S. Sen. Bernie Sanders, who made single-payer a focal point of his presidential run and campaigned for the Colorado measure.

A poll earlier this year found that a majority of residents supported the measure, particularly millennials. But as the opposition raised more than three times in funding, the initiative's chances faded.

If passed, it would have created a publicly run health system in which all residents are provided care without having to pay premiums. To fund the effort, the state would have added 10 percent to its income tax, with employers shouldering more of the burden than employees. That would have provided approximately $25 billion a year to run the system, which would have been called ColoradoCares.

Residents who like their current insurance could have kept it, but they would have still had to pay the additional taxes. 

The measure had the support of many liberals but faced opposition from high-profile progressive politicians and organizations like Democratic Gov. John Hickenlooper, the Colorado Hospital Association and NARAL Pro-Choice Colorado.

Their opposition was mostly about the money.

Kelly Brough, chair of opposition group Coloradans for Coloradans, praised residents for "voting overwhelmingly against a measure that was clearly risky, untested and fiscally irresponsible,” she said in a statement on Tuesday.

Last month, a report by the independent Colorado Health Institute concluded that the system would break nearly even in its first year but would eventually slide into financial chaos. By 2027, it would be running about $8 billion short.

“Tax revenue simply cannot keep pace with the health-care industry,” said Katherine Mulready, vice president of legislative policy for the Colorado Hospital Association.

There are several other sticking points for the opposition.

For one, they said the measure offered a dangerous lack of oversight for a multibillion dollar system.

It would have been run by a 21-member executive board of members elected by plan beneficiaries who wouldn’t necessarily have had a background in health care. The board also wouldn’t have been considered a state entity, so it wouldn't have had to report to any state authority, such as the governor or legislature. (The state would, however, have needed a federal waiver to get ColoradoCares off the ground.)

Others worried the effort may have eventually been abandoned, as it was in Sanders' home state of Vermont. The state's latest attempt to institute a single-payer system ended abruptly after more than three years of work had been put into it. The reason? Money. It was going to cost significantly more than originally expected and result in large tax increases.

The amendment passing but ultimately not being enacted is a proposition “too risky, uncertain and unaffordable,” wrote the Colorado Hospital Association on their website. If that did happen, though, the funds would have been returned to taxpayers and health care would have returned to status quo.

Despite the strong opposition, there were Coloradoans who believed that the state would have been the perfect incubator for how a single-payer system could work in the United States.

State Sen. Irene Aguilar, a practicing physician, was among the most vocal supporters of the measure.

“We know that 20 percent of our population accounts for 80 percent of our total health-care costs,” said Aguilar. “This would provide enhanced funding for [providers] willing to focus on that 20 percent by improving the overall health of our sickest populations.”

Still, critics say the conversation on how to improve Americans' access to health care is one worth having.

“We support the ACA [Affordable Care Act] and helped push for Medicaid expansion. We’re deeply invested in people receiving the right care at the right time and the right place. We just don’t think this amendment is the right one answer to that,” said Mulready, of the Colorado Hospital Association. “It really does send a message. The industry should take that feedback for what it’s worth and deliver better patient-centered care.”

Read all of our coverage on 2016 ballot measures at governing.com/ballotmeasures.