Colorado rejection likely the nail in single-payer coffin

Contributor : Bill Melville, Principal Analyst

Publish date: 10 Nov, 2016

In many regards, Colorado has become a bellwether. With healthcare, the Centennial State just played that role again. Colorado voters’ overwhelming rejection of a ColoradoCare, a single-payer proposal, shows showed the remote chances any single-payer proposal faces in the United States.

In the end, ColoradoCare was all smoke, no fire. In fact, the only fire around ColoradoCare was from the amendment going down in flames. Unrest over the Affordable Care Act was seen as a wildcard. When you lose 80-20, there are no wildcards involved.

Converting Colorado to a European-style healthcare system was not new. One of the amendments chief backers, state Sen. Irene Aguilar, M.D. (D-Denver), repeatedly introduced single-payer bills that went nowhere.

So the backers went to the Nov. 8 ballot for a constitutional amendment. Colorado has a low threshold for ballot initiatives – well, had. On the same ballot as ColoradoCare, voters approved Amendment 71, which requires petitioners collect at least 2 percent of signatures from each of the state’s 35 Senate districts and a 55 percent vote to pass constitution amendments.

The amendment would have done away with most private insurance to create that would have created a statewide health cooperative. Coloradans would have paid no deductible, no copays on primary care and could choose any physician.

As strong opposition lined up, the voter reaction was uncertain.

Troubles with healthcare reform in Colorado presented a possible opening. Once boasting a robust state health insurance exchange, Colorado had suffered numerous challenges and setbacks.

The state’s resort counties had some of the nation’s highest premiums, a CO-OP that underpriced the market failed spectacularly in 2015, and other major insurers left the market or drastically cut their exchange footprints for 2017, leaving rural counties with few choices.

After all, Colorado voters shocked the country by legalizing marijuana in 2012. That led to an atmosphere (no pun intended) that made it tough to predict the fate of a single-payer initiative.

The details of ColoradoCare laid bare the costs, likely the biggest factor for rejection. To pay for the $36 billion program, the state would have instituted a 10 percent payroll tax, with workers paying a third. Even the self-employed would pay the 10 percent.

Whatever comes out of Washington in 2017 won’t have much in common with single-payer. Other states have run into similar roadblocks. Cost ultimately killed Vermont’s efforts to build a state-run single-payer. If a small, liberal state cannot pull off such a transition, it’s hard to see it working anywhere.

In Colorado, advocates say they will try again. With a minimal number of signatures, the question can return to the ballot. But they should not expect any different result in Colorado or any other state.

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