Wednesday, October 19, 2016

Amendment 69 – Establish a Public, Statewide Health Care System

Amendment 69 would add Article XXX, ColoradoCare, to the state constitution. This new political subdivision of the state would finance health care services for Colorado residents, collect existing state and federal health care funding along with a new tax revenue stream, and be run by a board of trustees at first appointed by elected officials and then elected by its beneficiaries.

Medicaid, Medicare, TRICARE for the military and some other government programs would continue to operate. The list of health care services that beneficiaries would, at a minimum, receive is listed in the ballot text and on websites. It includes oral, vision and hearing care for children but not for adults.

Beneficiaries could choose their primary care provider. ColoradoCare would have no deductibles and, for primary and preventive care, no copayments. Copayments could be charged for other care, but only if they are not financially burdensome for the patient.

Beginning on July 1, 2017, ColoradoCare would collect the following transitional operating fund tax:
From employers: 0.6% of total payroll
From employees: 0.3% of payroll income
From all residents: 0.9% of some non-payroll income
Alimony, unemployment compensation, the first $20,000 to $24,000, depending on age, of retirement income, and income above $350K for individuals or $450K for joint filers would not be subject to taxation.

Beginning one month prior to implementation, ColoradoCare would switch to collecting the following premium tax:
From employers: 6.67% of total payroll
From employees: 3.33% of payroll income
From all residents: 10% of some non-payroll income
Although overall taxes would go up significantly with ColoradoCare, other health insurance costs would decrease or disappear altogether as the residents of Colorado shift from private insurers to a universal healthcare system. It is estimated that 80% of Coloradans would pay less under ColoradoCare.

Recommendation: yes/for

State health insurance exchanges under Obama’s Affordable Care Act, such as Connect for Colorado, have struggled because its beneficiaries need more medical services than originally anticipated. With universal coverage, similar to health care in other countries, ColoradoCare would have a better chance of success. Universal coverage means that all Colorado residents, not just citizens or taxpayers, would be covered. Additionally, coverage would be independent of one’s job or marital status.

Just as some people attend private schools yet we all pay for public education, ColoradoCare would allow residents to have private health insurance, but we would still expect taxpayers to pay for universal care. People with supplemental private health insurance may find that they save money by switching to ColoradoCare. During the initial period of the transitional operating fund tax, there would be an extra tax burden without an immediate health insurance benefit.

We can’t know about the future. We can only make predictions and ask questions. Would ColoradoCare encourage sick people to move to Colorado? Would ColoradoCare encourage businesses to flee the state because of higher taxes or come to the state because of the universal care benefit? It does seem that money would be more likely to stay in the state, stimulating our economy.

Proponents and opponents argue over whether ColoradoCare would be sustainable. Meanwhile, the current health care insurance system does not seem sustainable. Opponents argue that Colorado shouldn’t be a guinea pig, but some entity, probably bigger than Vermont, has to be the guinea pig. The proponents, including State Senator Irene Aguilar, MD, have been working toward health insurance reform for years through the legislative process without success. Another spokesperson for the proponents is Coloradan TR Reid who wrote The Healing of America about health care systems around the world.

A defect, for me, in ColoradoCare is the lack of guaranteed dental and vision care for adults. Insurance companies could fill the gap, but we would be back to a patchwork of health insurance solutions. My hope is that funds would allow dental and vision care to be covered or that beneficiaries would approve a tax increase to cover these needs.

I presume that elections for the ColoradoCare board members would be held similarly to the way a company asks shareholders to vote for their board of directors – notification via snail mail or email with various methods for casting one’s vote. I doubt that the county clerks and secretary of state would be involved in the election.

Website for the Yes Side (ColoradoCareYes)
http://www.coloradocare.org/

Website for the No Side (Coloradans for Coloradans)
http://www.coloradansforcoloradans.com/

Extra information and where you can get your questions answered
http://colorado69.org/


Approved Ballot Language

Amendment 69 (CONSTITUTIONAL)

Shall state taxes be increased $25 billion annually in the first full fiscal year, and by such amounts that are raised thereafter, by an amendment to the Colorado constitution establishing a health care payment system to fund health care for all individuals whose primary residence is in Colorado, and, in connection therewith, creating a governmental entity called ColoradoCare to administer the health care payment system; providing for the governance of ColoradoCare by an interim appointed board of trustees until an elected board of trustees takes responsibility; exempting ColoradoCare from the taxpayer's bill of rights; assessing an initial tax on the total payroll from employers, payroll income from employees, and nonpayroll income at varying rates; increasing these tax rates when ColoradoCare begins making health care payments for beneficiaries; capping the total amount of income subject to taxation; authorizing the board to increase the taxes in specified circumstances upon approval of the members of ColoradoCare; requiring ColoradoCare to contract with health care providers to pay for specific health care benefits; transferring administration of the Medicaid and children's basic health programs and all other state and federal health care funds for Colorado to ColoradoCare; transferring responsibility to ColoradoCare for medical care that would otherwise be paid for by workers' compensation insurance; requiring ColoradoCare to apply for a waiver from the affordable care act to establish a Colorado health care payment system; and suspending the operations of the Colorado health benefit exchange and transferring its resources to ColoradoCare?

YES/FOR _______
NO/AGAINST _________

Amendment 69 initiative language filed with the Secretary of State
http://www.sos.state.co.us/pubs/elections/Initiatives/titleBoard/filings/2015-2016/20Final.pdf

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