FRISCO, CO — As the crowd emptied into the dark of a snowy parking lot from a packed community center in this mountain ski town Tuesday night, Brandon Stack and his wife Barbara were putting on their coats and looking a tad bewildered.
The middle-aged couple were among the more than 100 Coloradans who had just spent two hours listening to a panel of four debate the merits of ColoradoCare, the universal healthcare measure that will be on the statewide ballot for voters here this fall.
They were leaving more confused about the plan than when they arrived.
“I went in hoping to be convinced about the single payer, because I’m European and she’s Canadian,” Brandon Stack said, gesturing toward his wife. “But I’m going away still confused and unconvinced about the financing of it. I feel the way they’re presenting it is not getting it across. At least to me.”
If voters pass the ColoradoCare initiative in November, Colorado will become the first state in the nation to provide universal healthcare to all its residents, doing for everyone in Colorado what Medicare does for seniors. In October, the measure’s supporters turned in enough signatures to get their plan on the general election ballot. The effort has drawn support from Democratic presidential contender Bernie Sanders who told The Independent Colorado could “lead the nation in moving toward a system to ensure better health care for more people at less cost.”
But at the community center in Frisco Tuesday night, it was the costs involved in the proposed healthcare plan that became a central focus over which supporters and opponents clashed.
Championing the initiative on the panel was Democratic Sens. Jeanne Nicholson of Georgetown and Irene Aguilar of Denver. Opposing ColoradoCare was Breckenridge gynecologist Andy Catron, and conservative activist Jonathan Lockwood of the free-market group Advancing Colorado.
If passed, ColoradoCare would need $25 billion in new taxes deducted from payrolls. The plan would pay health care providers, doing away with the need for Coloradans to shop around for private insurance companies. ColoradoCare would be able to do all this by waiving the state out of the Federal Affordable Care Act, aka Obamacare, and offer “comprehensive, high-quality” universal health care through a 21-member board of elected members, a statewide health care panel that would oversee a team of executives.
To pay for it, employees in Colorado would chip in 3.33 percent of their gross pay, and their employers would pay in 6.67 percent of their payroll. Coloradans who earn non-payroll income would pay a “health care premium tax” of 10 percent of their income, capped at $350,000, that would be tax deductible and would come with some exclusions.
At the sometimes testy Tuesday forum, Nicholson and Aguilar framed the cost debate around the high-prices and administrative bloat of our current for-profit healthcare system, estimating around $4.5 billion in savings from healthcare spending in the first year. Providers under ColoradoCare, they said, would have just one system to bill and collect from with transparent accounting processes.
A common refrain from the supporters: Covering all Coloradans is the right thing to do, we’re all in this together, and we need one simple and comprehensive health insurance provider across Colorado. Any increase in taxes would be mitigated by lower and consistent healthcare costs.
“Our healthcare system would be protected from toxic, dysfunctional politics in government,” Nicholson said. “Any funds unspent at the end of the year and any decisions about the need to increase spending or cuts [would be] made annually by a vote of the people of Colorado.”
On the other side of a table on the stage, Lockwood likely set up a major talking point in what is sure to be an aggressive campaign against the ballot measure: It’s big new tax hike. “We oppose ColoradoCare because pretty much from the beginning this has been tough for people to get their hands around,” he said.
A common refrain from the opposition: The plan is built on a financial fallacy, we’d have to pass ColoradoCare before we know exactly how it will work in practice, and Congress must repeal Obamacare if we want better access to healthcare.
The room in Frisco was packed with a cross-section of hat-and-glove ski-town locals in flannel shirts and Marmot jackets. A handful of young faces stood out in a largely older crowd. One man wore an NRA ball cap, another looked as though he might have just gotten off work as a resort chairlift mechanic.
The people here in Summit County had recently seen their mountain town region featured on the front page of The Denver Post for having some of the most unaffordable health insurance costs in the nation.
Nicholson told the crowd that a 21-member state board of ColoradoCare trustees would be “much more likely to tackle the challenges that you are addressing in this particular rural area of the state where you need affordable access to excellent healthcare.”
Lockwood countered that the way the ballot measure is written, the first board members of ColoradoCare would be unelected. He called the proposal a “wish list” with few specifics on exact costs and what would be covered, or what would need to be cut to maintain certain costs.
“When you’re thinking about healthcare, question marks all over the place is not what I want to look at,” he said. “I want to see exactly how the costs will be saved, how exactly the plan will work, how exactly people are going to get healthcare delivered to them, and how the money is going to go all the way around.”
Granular specifics of the healthcare plan, however, were less of an issue for Tim Wells, who works at a local nonprofit helping residents enroll in healthcare and was sitting at the back of the room watching on. He’d heard about the forum at work and came to hear more about the ballot initiative he says he’ll likely vote for in November.
“I’m very much in favor of it, I don’t quite understand the financing of it and how we’re going to pay for it, but the concept I’m very much in favor of,” he said.
Next to Wells was Dianne Schlaefer, who’s been self-employed her whole life. She’s seen the changes health insurance has gone through over the past 25 years, especially for people like her who’ve had to shop around for their own insurance. She and Wells said they both appreciate Bernie Sanders’ national Medicare-for-all idea, but think trying something like it on a state level is just a better way to start.
“We tried it with pot. Let’s try it with healthcare,” Wells said of Colorado. “A small-scale experiment.”
ColoradoCare would be just that. Two years ago, Bernie Sanders’ Vermont was poised to be the first state to implement a single-payer healthcare plan for all residents. But the plan fell apart when Vermont’s governor, Peter Shumalin, said his state couldn’t pay for it. The Vermont experiment would have meant businesses would pay 11.5 percent from payrolls, and individuals would have paid a premium of up to 9.5 percent of their income.
In October, Colorado’s Democratic governor, John Hickenlooper, pointed to Vermont’s situation when asked his feelings about ColoradoCare. In recent weeks, he’s sharpened his criticism, telling an influential business group he can’t imagine the measure will actually pass, and indicating some businesses have looked askance at Colorado because of the possibility of ColoradoCare when considering a relocation here. Hickenlooper’s comments surprised Aguilar, who told The Independent she had an understanding that the governor would stay neutral on the plan.
In Frisco Tuesday evening, Aguilar, who is also a medical doctor, took questions from audience members such as how a Coloradan who breaks a leg in Texas might be covered under ColoradoCare. Her answer: Colorado would pay the bill for the hospital in Texas without a team of corporate executives trying to deny the payment like an insurance company would.
Another audience member wanted to know what happens to elderly Coloradans who are already on Medicare. What do they get out of ColoradoCare? The short answer: The goodwill of knowing they’re paying to help cover everyone else in the state. In return, Medicare recipients would have the opportunity of a supplemental that would likely be better than what they have now.
Catron, the gynecologist, said he crunched the numbers from ColoradoCare documents he said were written by a “left-wing union economist,” that stated universal healthcare would save $4.6 billion in administrative expenses at healthcare provider offices in 2019, the first year it’s in effect. Catron said there are 13,467 physicians practicing in Colorado right now, and dividing $4.6 billion by that number saves $341,576 per physician in the state. Carton said his small, two-physician OBGYN practice only brought in $168,915 in salaries last year.
“So they are going to save me four times of my entire non-physician staff costs?” he asked rhetorically. He said his own office staff spends about $47,184 in time costs dealing with health insurance companies. He said he feels it is “absurd” to believe expected savings from administrative expenses and providers not having to deal with insurance companies could finance an expansion of healthcare that will cover everyone in Colorado.
Aguilar attacked his math, saying there are more kinds of healthcare providers than merely physicians, such as physicians assistants, nurse practitioners, physical therapists, hospital providers and others for which Catron didn’t account. She accused him of trying to undermine work done by someone who has a PhD in economics.
Following the forum, Andy Searls and her friend Luisa Stafford, a retired insurance fraud investigator, were bundling up on their way out the door.
“We were confused,” Searls said about how she felt leaving the event.
She knows how she’ll vote in November, but didn’t want to say.
“I came in predisposed,” she said. “See, my insurance is very good. I am very fortunate. I have federal government insurance. I don’t want to have to pay more. I would have to pay more with this.”
“Are you on Medicare?” asked a woman walking by.
“Yes,” Searls said. “Me too,” said the woman, who didn’t want to give her name. “I don’t want to pay more. Ten percent of my income and I get zero, zip, nothing?”
Nearby was Atsu Saisho, a youngish medical student in residence at a nearby health clinic. He didn’t know much about ColoradoCare, so he’d shown up hoping to better understand the proposal.
“I didn’t have enough information to form an opinion before I got here,” he said.
And now, on his way out?
“I still kind of need more information,” Saisho said. “I feel like the con side, I guess, presented more statistics and numbers … It sounded like some of the people in here wanted more specifics as opposed to the big idea thing— because I think we all kind of get the big idea.”