One state’s unlikely Obamacare replacement plan: Single-payer

One of the most detailed plans to replace Obamacare this year comes not from a Republican critic, but from a group in swing-state Colorado that is proposing to scrap it for a single-payer model long sought by liberals.

Supporters, who won approval this week for a 2016 ballot measure after securing nearly 110,000 signatures deemed valid, will sell the overhaul as an Obamacare replacement plan designed in Colorado, instead of in Washington.

“We’re a purple state, and this is a purple plan,” said T.R. Reid, a former Washington Post reporter who is working with ColoradoCareYES, the group that spearheaded the ballot initiative campaign. “There’s broad appeal here.”

Conservative opponents, though, are panning the model as an even bigger government intrusion into health care that would require unsustainable tax increases.

“People can say it’s a repeal of Obamacare all they want, but it’s not repealing Obamacare,” said Jonathan Lockwood, executive director of the free market group Advancing Colorado. “It’s giving a higher dosage of the same failed prescription that Coloradans have no interest in.”

In addition, the National Republican Senatorial Committee has tried to tie Democratic Sen. Michael Bennet to the plan as he runs for re-election. In October, the group wrote that because of his support of Obamacare, “a Bennet-backed single-payer health care plan is no stretch for the imagination.”

Bennet, who hasn’t yet commented on the initiative, brushed aside questions when approached in a Senate hallway by a POLITICO reporter on Tuesday. “I’m focused on this today,” he said, referring to an unrelated vote.

The ballot initiative could attract a national audience and boost Colorado voter turnout on both sides — Democrats unhappy about the compromises made to pass Obamacare, as well as conservatives fearful that Obamacare is a stepping stone to a government-run single-payer system.

Bernie Sanders, the first major Democratic presidential candidate to advocate for single-payer since California Gov. Jerry Brown in 1992, isn’t weighing in on the Colorado measure. His campaign did not respond to a request for comment.

Colorado is an unlikely place for the battle over providing universal health care to residents, an approach far to the left of the Affordable Care Act. It was expected that a “Medicare for all” push would take hold in a state like liberal Vermont, which was the most visible trailblazer until Democratic Gov. Peter Shumlin pulled the plug on his plan last year because of cost.

The dynamics in Colorado are starkly different. Besides being a 2016 presidential swing state, this is a place where Republican congressman Cory Gardner unseated Democratic incumbent Sen. Mark Udall last year in a race that focused on reproductive rights. Gov. John Hickenlooper is a Democrat, as was his predecessor, Bill Ritter, who was preceded by a Republican.

Supporters say the elements that sank Vermont’s plan don’t apply in Colorado. Unlike Vermont, advocates are taking their case for "ColoradoCare" directly to voters for the 2016 ballot instead of trying to push it through a messy legislative process. Advocates also say Colorado’s plan has more details.

Most of the money to finance the model would come from a new payroll tax estimated to bring in $25 billion per year. Employers would pay two-thirds of the cost and workers would pay one-third. The state is also counting on $11.6 billion in annual federal funding it would otherwise receive through Medicaid and Obamacare.

Reid argues the new system would lead to lower administrative costs, more generous coverage without exorbitant deductibles and copays, and insure the people Obamacare has failed to cover — including undocumented immigrants.

A board of trustees would govern operations, be responsible for setting provider reimbursement rates and could negotiate lower prices with pharmaceutical companies. Yet similar to Vermont’s defunct plan, certain populations, including Medicare beneficiaries, are excluded from ColoradoCare. It wouldn’t abolish private insurance companies, who could still sell competing coverage.

For those reasons, the Colorado system isn’t “true” government-run single-payer, said David Himmelstein, the co-founder of Physicians for a National Health Program, a leading voice for the single-payer model.

Himmelstein, also a professor of public health at the City University of New York, said the plan is a “big advance” for the single-payer movement, but advocates have a heavy lift to get the measure passed.

“Any time someone says to a voter, ‘Vote for this, you’re raising taxes by $25 billion,’ that’s a tough one,” he said.

Colorado would need to rely on a piece of Obamacare to do the new plan — the so-called "Section 1332" waivers, which let states develop their own reforms as long as they insure the same number of people with benefits at least as comprehensive as what the ACA provides.

Ultimately, such a waiver would need to be approved by the federal government and couldn’t take effect until 2017. ColoradoCare supporters are aiming for the system to begin in January 2019.

Laura Chapin, a Colorado-based Democratic strategist, said the ballot measure will provoke a discussion about health care in the state. "But the more interesting thing is whether or not the opponents of it try to use it as a political organizing tool,” similar to how conservatives have used Obamacare to boost turnout. However, she cautions, getting a ballot measure approved in Colorado “takes a whole lot of money.”

“There is a very wide gulf between getting something on the ballot and getting something passed,” Chapin said.

Single-payer supporters in Colorado needed 98,492 signatures to get an initiative on the ballot, and the Colorado secretary of state projected they had collected 109,134 valid signatures. ColoradoCareYES had received more than $330,000 in contributions as of the end of September, the most recent state filings show.

“I cannot make predictions,” Chapin said of the measure’s fate. “I just know that getting ‘yes’ on a ballot measure means pushing a rock up a hill. And it’s been done but it’s hard.”

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