David vs. Goliath over universal careBy David Olinger The Denver Post
The campaign to establish the nation’s first universal health care system in Colorado may be a longshot, but insurance companies and hospitals aren’t taking chances.
A single donor, Anthem Inc., has kicked in $500,000 to defeat the Amendment 69 initiative, or more than three times the amount given by all proponents combined.
Anthem is the umbrella company for Blue Cross Blue Shield health insurance plans. Other insurers and hospitals helped dwarf the modest contributions from those vying to make Colorado the first state to provide health care for all.
In a classic clash, an upstart band of universal health care advocates has run up against a powerful alliance of health care businesses.
The leading opposition group, Coloradans for Coloradans, reported $1 million from just 29 donors, with three-fourths of the money coming from insurance and health care businesses.
By contrast, more than 1,200 people gave a total of $152,574 to ColoradoCareYes through April 27, about $127 per donor.
Hundreds of initiative supporters are retired or working in the health care field.
While hospitals fight the initiative, doctors who support it say they see patients struggling to afford health care every day and others who postpone treatment because of the costs.
On the ballot
In Summit County, a particularly high-priced place for health care insurance, family practitioner Dr. Christine Ebert-Santos said she personally avoided a hospital visit when she felt chest pains recently because of her new $6,000 deductible.
“It’s just so difficult for Americans to pay for health care,” she said. “The amount you pay for the value you get is out of proportion.”
Anthem referred questions about the size of its donation to Sean Duffy, an opposition campaign spokesman who offered this explanation:
“You never think something is never going to pass, i.e., Donald Trump,” he said.
Duffy said the major donors, which also include Encana Oil & Gas, Associated General Contractors of Colorado and the Denver Metro Chamber of Commerce, worry about the tax and economic implications of a $25 billion health plan, the powers of its governing board and the complexities of the proposal.
“We’re probably one of the few ‘no’ groups that begs people to read the initiative,” he said.
The proposed constitutional amendment does get complicated — so complicated that Colorado Health Institute, an independent think tank, is still trying to evaluate proponents’ claim that it would cut Colorado health care costs by $4.5 billion a year.
“We still don’t know if this is going to save us money or cost us money as a state,” institute president Michele Lueck said. “What we can share is the interest around Amendment 69 is incredibly high.”
The amendment, which will be on the state ballot in November, starts from the basic idea that 10 percent of employment income — two-thirds from employers, one-third from employees — will pour into a government-controlled fund.
It lists 11 categories of guaranteed care, from doctor and hospital visits to mental health, rehabilitative and lab services.
It promises no deductibles and no co-payments “for designated primary and preventive care services” and allows people to choose their own doctors.
In general, proponents agree, their plan would be most beneficial to parents of modest means, because a father of five would pay the same 3.33 percent of payroll income as a single person.
Wealthy residents would pay the most. For a couple earning $450,000 or more from employment and other income, the health care tax would be capped initially at $45,000 but could rise with inflation.
Some retired people also would pay taxes on a portion of their Social Security, pension and IRA income.
According to the campaign, $33,000 for a single person and $60,000 for a couple would be exempt. So a single retiree earning $50,000 in Social Security and pensions would be taxed on $17,000.
Self-employed people also would pay the 10 percent health tax. Initiative supporters say the effective rate would be lower, however, because the payments would be deductible federally and in Colorado.
Opposed by hospitals
A 21-member board elected from seven geographical districts would control ColoradoCare, a political subdivision with revenues that would nearly double the state budget.
Those are highlights of a 12-page proposed constitutional amendment.
The Colorado Hospital Association has taken a firm stance against the plan, contending it would “threaten the sustainability of Colorado hospitals and health systems.”
One overriding concern among Colorado hospitals is that a state-run system would pay them less than it costs to treat patients and leave them unable to balance the books with private insurance payments.
The association says it already loses money on Medicaid patients, to the tune of $1.8 billion in “undercompensated care” in 2014.
“Without private insurance — and in a single public payer model used by ColoradoCare — hospital underpayment is likely to spread,” it says, creating a serious financial risk.
In a position paper, the association also suggests that Colorado-Care “would not likely incentivize consumers to use the health care system efficiently because low sensitivity to prices can lead to overconsumption of health care services.”
State Sen. Irene Aguilar, a Denver Democrat and medical doctor, disputes that idea.
She cites her experience with an office secretary she treated for 20 years, a woman who ended up costing the health care system and shortening her life because of high sensitivity to prices.
The woman had diabetes. Once a year, she would come to Aguilar for a checkup. She would say she had no insurance and no sick leave. When prescribed medicines, she would ask which three were most important because she couldn’t afford them all.
Her kidneys failed, which qualified her for Medicare and dialysis treatments. Dialysis sickened her. She lost her job, qualifying for Social Security disability payments. Amputation and heart disease followed.
Aguilar called her patient a classic reason to provide health care to all. “A secretary living on the edge,” she said. “She was dead by 64.”
In the opponents’ camp, Duffy said the small group of people who fashioned Colorado’s universal health care initiative are goodhearted.
But “their solution is very damaging to the state going forward,” he said, putting Colorado in a unique but treacherous situation.
“Can one state really do it?” he asked. “Can one state boil the ocean?”
David Olinger: 303-954-1498