Election 2016: Health care professionals raise concerns about Amendment 69; supporters say it will cure state’s health care ills

Sept. 17--Although a number of ColoradoCare supporters who have spent years championing universal health care say Amendment 69 could be a cure for Colorado's health care woes, many hospital officials fear bad results should voters approve the initiative this November.

In the first part of a two-part series last week, experts and politicians on both sides of the aisle answered key questions about Colorado's universal health care initiative on the ballet in the November election. This week, we'll delve deeper into the initiative. Who's behind the measure? What do health care professionals say about it? How does it compare to what other states have done?

Voters, during this year's general election, will decide if Colorado will become the first state to have a universal health care payment system.

The ColoradoCare System Initiative, or Amendment 69, also is known as ColoradoCare. If passed, it would create a health care payment system designed to finance universal health care for all Colorado residents.

Proponents claim, "it would cover Coloradans like Medicare covers seniors and save everyone money," said Joel Dyar, a state field director for ColoradoCareYES.

Opponents say, "it would double the state budget, hurt small business, (it) provides no guarantees for coverage and would hurt Colorado's economic growth," said Tony Gagliardi, state director of the National Federation of Independent Businesses, in which 93 percent of member businesses are against the measure.

To aid voters in making their decision in November, The Tribune and its partners at Colorado Mountain News Media offers answers to questions voters have about ColoradoCare.

Who is behind it?

The organization, ColoradoCareYES, traces several of its roots back to the '208 Commission' on health care established in 2006 under Gov. Bill Ritter to find a solution for healthcare in Colorado.

That commission, according to Owen Perkins, spokesman for the ColoradoCareYES campaign, found a single-payer system such as ColoradoCare would work best. But basically no action was taken on it, he said.

Since then, Sen. Irene Aguilar, D-Denver, a medical doctor who served on that commission, along with several other state legislators have championed the idea of universal health care in Colorado. After failing to pass universal health care in the Legislature, Colorado efforts shifted to Amendment 69 and Aguilar helped craft the ColoradoCare.

"There were people here who were involved in trying to get it through the Legislature in the past, and I think everybody sort of realized how saddled down it gets," Perkins said.

All the amendments and compromises that came along with trying to pass universal health care took away its strength and eventually killed the legislative efforts, he said.

The current grassroots movement -- predominantly funded by Colorado residents -- keeps ColoradoCare free of those politics, he said.

What have other states done as far as other efforts at universal health care?

"Nobody has passed anything like this in the United States at the state level," Perkins said. "There are some other states that are following Colorado's lead and working on similar proposals; I believe Washington and I think Michigan is working on something."

Colorado's plan is unique in terms of state implementation, but it's not without precedent models all over the world, he said.

"We're actually the only industrialized country in the world that doesn't have a universal health care system like this in place on the national level," he said.

Within the United States a similar model does exist in Medicare. Essentially ColoradoCare will take Medicare and extend that style of health insurance coverage to everyone in Colorado, Perkins said.

"It's the Medicare-for-all idea and taking one of the most effective and popular and efficient government programs, Medicare, and replicating that model."

Would it be transparent?

Because of ColoradoCare's proposed cooperative business model, the organization should be fully transparent.

"It would be subject to sunshine laws and open meetings and full disclosure as to what's going on at the meetings and the decisions they make," Perkins said.

Because ColoradoCare would be tied to state government laws, that board would need to follow existing government transparency rules, Perkins said.

"Board meetings would be open and transparent. They can't raise premiums without a vote of the people of Colorado," he said.

However, Katherine Mulready, Colorado Hospital Association's vice president of legislative policy, said the initiative would create some accountability issues.

"It will be governed by a 21-member board not subject to campaign finance requirements or voter recall," she said. "There's no real requirement to have health care experience to be elected."

How would it affect hospitals?

Hospitals could see a loss of talent if public payers don't pay the full price of care.

Public payers, such as Medicare and Medicaid, are renowned for paying less than 75 cents on the dollar, said Mulready of the Colorado Hospital Association.

Kevin Unger, CEO and president of Poudre Valley Hospital in Fort Collins, said it would be difficult for him to recruit and retain physicians if they knew they could make more money elsewhere.

"They'll choose other alternatives," Unger said. "Northern Colorado is close enough to Wyoming and Nebraska if they decide to leave."

Unger said some hospitals would likely close as a result of underpayment.

ColoradoCare also wouldn't eliminate the need to process other insurance providers, Unger said. Northern Colorado hospitals still see a number of folks from out of state.

How will it affect physicians?

Physicians are paid for the services they provide as professionals, Mulready said, so when reimbursements get cut, it's a big deal.

"It's trying to do more with fewer resources," Mulready said. "We are concerned with the real impacts of trying to do more with less."

Mulready said reimbursement cuts could also affect how much money is available to invest in new technology. Without the means to diagnose patients to the best of their ability, physicians could get frustrated.

"Decreased reimbursement would impact both physicians' and hospitals' ability to provide the kind of care we deliver today," Mulready said.

For their part, supporters of the initiative say it would actually mean doctors would make more, because they would get the same rate for all patients. Perkins, with ColoradoCareYES, said organizers have the goal of reimbursing health care providers at a higher rate than Medicare does, though the 21-member board would set the specifics.

-- Greeley Tribune reporter Kelly Ragan contributed to this story.

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