The Colorado Statesman
November 9, 2015
Like many progressives, Irene Aguilar once felt disheartened that President Barack Obama’s signature legislation, the Affordable Care Act, didn’t do more to reform the nation’s broken health care system.
That was before she became a member of the Colorado Legislature.
“I was really disappointed in him until I spent one session in the General Assembly, at which point I was amazed by what he had accomplished,” Aguilar, a Denver Democrat and physician, said from the Senate well on April 12, 2013, near the end of her second year as a lawmaker.
State Sen. Irene Aguilar, D-Denver, and former state Sen. Jeanne Nicholson, D-Black Hawk, rally supporters for ColoradoCare, a ballot initiative to provide universal health care for state residents, on Oct. 23 in Denver. The measure will be on the November 2016 ballot as Amendment 69.
Aguilar’s remarks came just before she killed her own proposal to create a single-payer, universal health care system in Colorado. Although Democrats were in charge of both legislative chambers at the time, Aguilar knew she did not have the Republican votes needed to amend the state constitution in order to create the system.
This wasn’t Aguilar’s first disappointment working on universal health care coverage for Coloradans, an issue that has become her crusade.
Aguilar planned on running the same bill the year before upon passage of a bill that created the Connect for Health Colorado exchange, an important structural piece of Obamacare, where those seeking health insurance can shop.
But Aguilar never got that chance because the health exchange bill — sponsored by then-state Sen. Betty Boyd, D-Lakewood, and then-state Rep. Amy Stephens, R-Monument — had become a significant political issue. Conservatives, who hate anything having to do with Obamacare, took their ire out on Stephens by branding the bill “Amycare.”
Aguilar recalled these events during a recent interview with The Colorado Statesman.
“(Stephens) was concerned about my universal health care bill becoming a distraction, and I quite foolishly said, ‘Well, I’ll just wait until your bill passes.’ Then ‘Amycare’ exploded, and her bill literally passed the day before the session ended, because it got so political.”
And in 2009, before she joined the Senate, Aguilar worked behind the scenes on a universal health coverage bill sponsored by then-state Rep. John Kefalas, D-Fort Collins, who is now a senator.
This time, her own party’s governor stood in the way – Bill Ritter.
“Ritter was against it, and he kept it from getting out of the House,” she said. “And I sat down with him, and he said, ‘I don’t know if people in Colorado are ready for this yet.’”
The politics surrounding health care legislation has frustrated Aguilar, who said “intransigence” among fellow lawmakers has resigned her to the belief that major changes to health care policy will never get off the ground at the Capitol.
“I think what’s hard, and, if you ask legislators, they’ll all admit, very few legislators really understand health care and health insurance and how it works,” she said. “They have no internal knowledge in which to make an assessment and judgment on that. So when they get two or three people in the health industry telling them, ‘Oh no, you don’t want to do that,’ it becomes hard.”
Seeing legislative efforts fail, Aguilar is now taking her argument for universal health coverage to voters. A couple weeks ago, she and other supporters of ColoradoCare — a proposal to provide health coverage to all state residents — turned in more than 156,000 petition signatures to the secretary of state’s office.
ColoradoCareYes campaign executive director Ivan J. Miller speaks with state Rep. Susan Lontine, D-Denver, at a rally after supporters of the universal health care ballot measure turned in petitions on Oct. 23 in Denver’s Civic Center Park.
Photo by Jennifer Goodland/The Colorado Statesman
On Monday, Secretary of State Wayne Williams announced that the measure had qualified for the 2016 ballot, based on verification of a random sample of submitted signatures. Barring a successful protest, the secretary of state’s office said, the initiative will tentatively be known as Amendment 69.
But as universal health care inches closer to next November’s election, the same forces that have doomed Aguilar’s past efforts are starting to organize in opposition.
“If this gets on the ballot, we will bring resources into Colorado to fight it to the utmost,” said Tony Gagliardi, state director of the National Federation of Independent Business. “We will do everything we can do make sure the citizens understand this is not good for Colorado.”
At a ColoradoCare rally in Denver’s Civic Center late last month, Aguilar warned supporters that the fight “is not going to be easy.”
“It’s not going to be as hard as it is in the Legislature, where there’s billions of dollars spent on lobbying every year,” she said. “But it’s still going to be a hard fight, because people out there are going to try to scare you off.”
‘A fundamental moral imperative’
ColoradoCare, which was referred to as Initiative 20 during the petition-gathering process, would finance health care for every Colorado resident. A small co-payment might be involved when seeing a doctor. And doctors simply would submit a single bill to ColoradoCare, according to campaign literature.
No deductible would be required. And the plan would include vision and dental benefits, as well as full mental health and substance-abuse treatment.
State Sen. Irene Aguilar, D-Denver, says she has been trying to get universal health care measures through the Legislature but blames “money in politics” for roadblocks and reluctance on the part of lawmakers at a rally in support of the ColoradoCare ballot measure on Oct. 23 at Civic Center Park. Aguilar is an internist practicing at Clinica Tepeyac, which specializes in treating the uninsured, in Denver.
There would be no changes made to federal health care programs, such as Medicare and Medicaid, or health services provided by the Veterans Administration.
The system would operate as a cooperative, like a credit union. A board of trustees would govern the co-op, which would operate as a political subdivision of the state, separate from the Legislature, the governor or any other governmental entity.
ColoradoCare would be funded in part with Affordable Care Act waiver funds that the federal government provides to states that create their own health care plans. States can opt out of Obamacare as long as their own plans cover at least as many people as the ACA.
Funding would also come from the creation of an additional 10 percent in state income taxes to fund the health care premiums. Employers would pay 6.67 percent in payroll premium taxes of a worker’s wages, while employees would pay 3.33 percent.
In determining cost, the ballot uses the example year of 2019, when an estimated $25 billion in health care premium taxes would need to be collected to pay for the new system.
The money would go into the co-op, and neither the employer nor employee would be required to pay premiums to private health insurance companies. If revenues exceed costs, taxpayers could receive refunds or the money could be used to enhance benefits or stockpile reserves. If the taxes aren’t enough to cover costs, Coloradans could be asked to approve a tax increase.
But ColoradoCare supporters say the system would save billions, mostly in administrative costs. The campaign estimates the program would save residents and businesses more than $6 billion in health care expenses in 2019.
At the rally, T.R. Reid, a campaign spokesman who is also a health care policy author and filmmaker, argued that the United States pays more for health care than any other advanced country, yet its citizens benefit less.
“When we demonstrate to the rest of the country that we can provide health care for everybody at a reasonable cost, the other states are going to follow,” he said.
So, the ColoradoCareYes campaign believes it has economics and common sense on its side. But supporters will also appeal to voters’ humanity.
Reid said providing universal health coverage is “a fundamental moral imperative.”
“We learned from childhood that we need to care for the least of our brethren and, if we don’t care for them when they’re sick, you’re not meeting your basic moral obligation,” he said.
‘Obamacare on steroids’
But the ColoradoCare campaign will be making those arguments in the face of stiff opposition that is only beginning to organize.
For months, Jonathan Lockwood, executive director of the right-wing advocacy group Advancing Colorado, has been one of the few conservatives calling attention to Initiative 20.
“When people see it’s a massive tax hike, they may think, ‘Oh, it’s not going to pass.’” he said of fellow conservatives who might dismiss the initiative’s chances. “But when (Initiative 20 organizers) are not being honest and upfront about what this really is, I think people should be fearful that this actually could pass.”
Jeff Wasden, president of the Colorado Business Roundtable, said he recently heard an Initiative 20 presentation from Lockwood but added that he hasn’t had a chance to dig into the weeds of the issue. Still, he expects ColoradoCare will receive “strong and vigorous opposition from the business community.”
“This is an incredibly onerous and crippling financial commitment on the part of small businesses,” he said.
The National Federation of Independent Business has long-been opposed to any single-payer health care effort. Gagliardi has opposed Aguilar’s work on this issue at the Legislature.
“Sen. Aguilar and I had a conversation about this a week ago,” he said in a recent interview with The Statesman. “But we are just diametrically opposed to this solution for health care.”
Then there’s the opposition sure to come from health groups. Kevin Downey, a spokesman for the Colorado Hospital Association, which includes more than 100 medical providers, said the group has yet to take an official position on Initiative 20. But Aguilar won’t be holding her breath for an endorsement.
“They came out about a year ago and supported a multi-payer solution, which I thought was sort of interesting that they just sort of on their own came out with that policy,” she said, laughing. “I think it was a preemptive way of saying, ‘Yeah, we don’t believe in what you’re trying to do, Sen. Aguilar.’”
Kelly Sloan, a policy fellow at the conservative Centennial Institute at Colorado Christian University, is in the early steps of organizing a coalition of business and insurance industry groups to file organized opposition to Initiative 20.
“A lot of people are really concerned about this,” Sloan said. “It’s another example of Colorado being used as a social laboratory, and I think people are getting a little bit sick of that.”
Sloan warns that Colorado could end up like Vermont, where lawmakers passed universal health care coverage in 2011 but later had to scrap the system over cost concerns.
Sloan also said universal health care in Colorado will lead to other issues.
“We’ll attract more homeless people,” he said. “More poor people who can’t afford health care will be moving here to get health care. That’s going to be a huge issue.”
And opponents will surely do everything they can to tie ColoradoCare to Obamacare, which ignites a special fire among conservatives — never mind that Initiative 20 actually seeks to get the state out of Obamacare.
“This is Obamacare on steroids,” said Assistant Senate Minority Leader Kevin Lundberg, R-Berthoud. “It’s going to be a magnitude beyond any tax increase we’ve ever seen. I just see a colossal disaster lining up, but I believe the people of Colorado will understand this.”
Lundberg, who chairs the Senate’s Health and Human Services Committee, said he is particularly concerned that the ColoradoCare board of trustees would not be required to function under the direction of the Legislature.
“It’s going to be extremely centralized control of all of our medical services,” he said.
ColoradoCare backers are also starting to reach out to groups they hope will combat the opposition’s efforts.
“I have been very low key about trying to seek support until we could prove that we could get the public will to get the signatures to make it happen,” Aguilar said. “And now we’ll be much more assertive.”
Aguilar said she expects progressive groups to get behind the effort, as well as those backing the presidential campaign of Vermont Sen. Bernie Sanders, a proponent of universal health care. Aguilar said she also plans to court small business groups and unions.
The campaign will seek personal narratives from small business owners like Chip Bair of Idaho Springs, founder of the Beau Jo’s Pizza chain and supporter of Initiative 20. Bair said ColoradoCare would allow him to provide coverage for all 400 of his employees, something he’s been unable to do under the current health care system.
“Our system here in the United States is we can do wonderful health care, but it’s going to cost twice as much as anywhere else on the planet,” he said. “And that is just not right.”
So far, the ColoradoCareYes campaign has raised about $320,000, according to early campaign finance filings with the secretary of state’s office. That’s just a drop in the bucket of the money that is expected to fly around this campaign, especially given that voters will consider the measure during a presidential election year.
“I think the presidential election will probably benefit us,” Reid said. “I think (U.S. Sen.) Michael Bennet and Hillary Clinton will probably have to endorse our plan. And then we in turn help them because we’re going to turn out the people who vote Democratic.”
Neither Bennet nor Clinton has taken a position on Initiative 20. And if they don’t, that’s completely OK with Aguilar.
“You know, politics being what it is, as long as they don’t say ‘I hate it,’ I’ll be happy,” she said.