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Colorado Creation of ColoradoCare System, Amendment 69 (2016)

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Colorado Creation of ColoradoCare System, Amendment 69
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Election date
November 8, 2016
Topic
Healthcare
Status
On the ballot
Type
Constitutional amendment		Origin
Citizens
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The Colorado Creation of ColoradoCare System Initiative, also known as Amendment 69, is on the November 8, 2016, ballot in Colorado as an initiated constitutional amendment.[1]

A "yes" vote supports creating ColoradoCare, a healthcare payment system designed to finance universal healthcare for Colorado residents partly through an additional 10 percent payroll tax—two thirds paid by employers and one third by employees—providing approximately $25 billion per year in revenue.
A "no" vote opposes this proposal, leaving the Colorado healthcare system unchanged.

Overview

ColoradoCare

Amendment 69 is a citizen-initiated constitutional amendment that would establish a political subdivision of the state called “ColoradoCare.” The measure was designed to establish a statewide program to provide universal healthcare coverage and finance healthcare services for Colorado residents. Amendment 69 would not prevent people from purchasing private health insurance. A 21-member board of trustees would govern ColoradoCare. As ColoradoCare would operate as a cooperative, members would vote for candidates to serve on the co-op's board and decide whether taxes should be increased to provide additional funding to the program. To fund ColoradoCare, a 10 percent payroll tax would be implemented, with employers paying 6.67 percent and employees paying 3.33 percent. Other non-payroll income would also be taxed at 10 percent.[1][2]

ACA and state healthcare systems

A section of the Affordable Care Act (ACA) allows states to create their own healthcare systems. If given a waiver, Colorado would be eligible to receive subsidies that would otherwise go to state residents to use on the private market. This means that Colorado could receive federal funding towards ColoradoCare.

State of the ballot measure campaigns

Opponents, organized as Coloradans for Coloradans, had outraised supporters five-to-one, as of October 18, 2016. ColoradoCare Yes had received about $836,813, while opponents raised $4,048,293. The top donor to the “Yes” campaign was Lyn Gullette, who contributed $168 thousand. The top donor to the “No” campaign was health insurance firm Anthem, Inc., which provided $1 million. Polls indicate low support for Amendment 69, with 28.5 percent of voters supporting and 60.5 percent opposing the measure.

Initiative design

ColoradoCare is intended to provide universal healthcare coverage for most Coloradans. Beneficiaries of Medicaid and military programs, such as Tricare, would continue to receive healthcare coverage through the federal government.

What would ColoradoCare do?

The system would aim to cover all state residents. Amendment 69 would require the following 11 categories to be included as comprehensive benefits:[1]

  • ambulatory patient services, including primary and specialty care
  • hospitalization
  • prescription drugs and medical equipment
  • mental health services and substance abuse services, including behavioral health treatment
  • emergency and urgent care
  • preventive and wellness services
  • chronic disease management
  • rehabilitative and habilitative services and devices
  • pediatric care, including oral, vision, and hearing services
  • laboratory services, maternity, and newborn care
  • palliative and end-of-life care

Amendment 69 would mandate that ColoradoCare pay for healthcare services regardless of the cause of the patient's illness or injury. ColoradoCare would replace the medical care portion of workers' compensation insurance. Beneficiaries that would be eligible for Medicaid or the Children’s Basic Health Plan would receive benefits required by federal law in addition to ColoradoCare's standard benefits.

ColoradoCare would not charge beneficiaries any deductibles, nor would designated preventive and primary care services have copayments. Other copayments would be waived in cases of financial hardship.

Beneficiaries would be permitted to choose their primary care professionals and still be covered if they are temporarily living, or traveling, in another state.

How would ColoradoCare be funded?

The Colorado Department of Revenue would collect the following taxes to fund ColoradoCare:[1]

  • A 10 percent payroll tax, with employers paying 6.67 percent and employees paying 3.33 percent.
  • A 10 percent tax of all non-payroll income.

Non-payroll incomes would include income from self-employment, interest and dividends, capital gains, business proprietors' income, and any Social Security benefits, pension payments, and annuities that do not qualify for the pension/annuity subtraction. The Colorado pension/annuity subtraction allows a certain amount of retirement benefits and pension income to be exempt from income taxes. The additional 10 percent income tax proposed by Amendment 69 was designed to apply to these sources of income in accordance with this deduction, which exempts up to $20,000 or $24,000 in income from pensions and annuities, depending on the age of the taxpayer.[3]

  • To qualify for this subtraction, a taxpayer must be over 55 years old or be a beneficiary earning a pension or annuity due to the death of the pension earner.
  • The amount of pension/annuity income that can be subtracted caps at $20,000 per year for those under 65 years old.
  • The amount of pension/annuity income that can be subtracted caps at $24,000 per year for those 65 or older.

According to the measure's fiscal impact statement, the taxes for ColoradoCare would generate $25 billion in revenue for the program in budget year 2019-2020.[4]

Tax revenue collected for ColoradoCare would be exempt from the Colorado Taxpayer Bill of Rights (TABOR).

The ColoradoCare Board of Trustees would conduct an annual assessment of the program's revenues and costs. Should more revenue be needed to maintain ColoradoCare's fiscal stability, the board would refer to members a ballot question asking them whether taxes should be increased. A majority vote would be needed to increase taxes.

How would ColoradoCare be administered?

ColoradoCare was designed as a cooperative. Beneficiaries of ColoradoCare would be considered members, and members would elect a Board of Trustees to govern ColoradoCare. The measure would create a 21-member Board of Trustees and seven electoral districts. From each of these seven electoral districts, members would elect three Trustees. Districts would need to be compact and contiguous and have roughly the same number of residents. Trustees would serve four-year terms and receive "reasonable compensation and expense reimbursement."[1]

The board's duties would include:[1]

  • hiring an executive team to administer the operations of ColoradoCare;
  • establishing separate ombudsman, also known as a public advocate, offices for beneficiaries and providers
  • establishing a Central Purchasing Authority for negotiating favorable prices for prescription drugs, medical equipment, and services;
  • approving and making publicly available an annual budget;
  • establishing procedures for managing surplus funding, maintaining operating reserves, increasing benefits, and issuing refunds to members;
  • establishing an efficient and accessible system of medical records and billing records;
  • establishing and funding an office to prevent and investigate fraud;
  • establishing rules and procedures to ensure financial sustainability;
  • establishing rules for independent annual performance and financial audits;
  • establishing rules to ensure transparency in operations and decision-making;
  • ensuring beneficiary confidentiality while allowing for research of ColoradoCare’s database; and
  • establishing an appeals procedure that allows beneficiaries and providers to challenge coverage and payment decisions.

How would the transition to ColoradoCare occur?

Amendment 69 would create a 15-member interim Board of Trustees appointed by the Colorado Governor and legislative leaders. This board would lay the groundwork by coordinating with providers and state and federal agencies. It would then develop an election process to create a new board of trustees elected by Colorado residents, along with rules to ensure the new board's operations, records, and meetings are transparent to the public.[1]

During this time, the interim Board of Trustees, along with state agencies, would seek all waivers, exemptions, and agreements from the state and federal government needed to implement ColoradoCare.

Text of the measure

Ballot title

The ballot title is as follows:[5]

“ Shall state taxes be increased $25 billion annually in the first full fiscal year, and by such amounts that are raised thereafter, by an amendment to the Colorado Constitution establishing a healthcare payment system to fund healthcare for all individuals whose primary residence is in Colorado, and, in connection therewith, creating a governmental entity called ColoradoCare to administer the healthcare payment system; providing for the governance of ColoradoCare by an interim board of trustees until an elected board of trustees takes responsibility; exempting ColoradoCare from the Taxpayer's Bill of Rights; assessing an initial tax on the total payroll from employers, payroll income from employees, and nonpayroll income at varying rates; increasing these tax rates when ColoradoCare begins making healthcare payments for beneficiaries; capping the total amount of income subject to taxation; authorizing the board to increase the taxes in specified circumstances upon approval of the members of ColoradoCare; requiring ColoradoCare to contract with healthcare providers to pay for specific healthcare benefits; transferring administration of the Medicaid and children's basic health programs and all other state and federal healthcare funds for Colorado to ColoradoCare; transferring responsibility to ColoradoCare for medical care that would otherwise be paid for by workers' compensation insurance; requiring ColoradoCare to apply for a waiver from the Affordable Care Act to establish a Colorado healthcare payment system; and suspending the operations of the Colorado health benefit exchange and transferring its resources to ColoradoCare?[6] ”

Ballot summary


Ballotpedia’s “Ballot Box Update: Amendment 69”

The ballot summary is as follows:[4]

Background. Health care in Colorado is currently paid for by a variety of public and private sources, including private health insurance and government programs such as Medicaid and Medicare. Under the federal Patient Protection and Affordable Care Act, all people, with limited exceptions, are required to have health insurance coverage of some kind or pay a tax penalty. The majority of Coloradans receive health insurance through an employer. If employer-based health insurance is not available or is declined, a person may purchase private insurance through an insurance broker, the state health insurance exchange, or directly from an insurer. Persons meeting age, income, or other eligibility criteria may qualify for health care coverage through a publicly funded program such as Medicare, Medicaid, or military and veterans' health care programs.

Persons eligible for ColoradoCare coverage. If Amendment 69 is passed and fully implemented, Colorado residents will be eligible for health coverage through ColoradoCare, a new statewide system to finance health care services. ColoradoCare will pay for covered health care services for Coloradans who do not have other forms of health coverage and will provide supplemental coverage to persons who have other coverage. ColoradoCare could replace the current health coverage for many people. However, some people may still choose to purchase private health insurance, and certain government health programs will continue to provide health coverage. Persons with these alternate forms of coverage will still be required to pay the new taxes that fund ColoradoCare.

ColoradoCare, when fully implemented, will affect government health programs and the workers' compensation system. Medicaid and the Children's Basic Health Plan will be administered by ColoradoCare, and the state and federal funds for these programs will be redirected to ColoradoCare. Medicare, military and veterans' health care programs, and certain federally operated health care programs will continue to operate, and persons receiving coverage through these programs will be eligible for supplemental coverage through ColoradoCare. ColoradoCare will also pay the medical portion of workers' compensation benefits, which is currently covered by workers' compensation insurance policies that are purchased by employers.

Initial implementation. If Amendment 69 is passed by voters, several steps must be taken before ColoradoCare may begin paying for health care services. The ColoradoCare board of trustees, together with various state agencies, must seek federal approval to transfer administration of the Medicaid program to ColoradoCare and waive various requirements of the federal Patient Protection and Affordable Care Act. The federal act allows states to develop alternative ways to pay for health care services, provided that certain federal requirements are met. Amendment 69 allows the board to terminate ColoradoCare if the waivers, exemptions, and agreements from the federal government are not sufficient for its fiscally sound operation.

During the 2017 legislative session, the state legislature must pass laws to implement Amendment 69. This includes laws that implement the new taxes, allocate state and federal funds, eliminate the state health insurance exchange, transfer the responsibility for administering various state health care programs to ColoradoCare, and amend workers' compensation laws.

During the initial implementation phase, ColoradoCare will not pay for health care services. Individuals will be responsible for maintaining health insurance coverage and paying any necessary premiums until ColoradoCare is fully implemented and begins making payments for health care services. During this phase, taxpayers will pay the taxes that fund ColoradoCare at the initial, lower tax rates. Both the initial and full tax rates are detailed in the "Taxpayer impacts" section below.

Health care benefits and delivery of services. Amendment 69 outlines the types of health services that ColoradoCare must cover, which are the same services as those that are currently required to be covered by private health insurance under federal law. These services include primary and specialty care, hospitalization, prescription drugs, medical equipment, and emergency and urgent care. The ColoradoCare board of trustees may also specify additional covered health care services. ColoradoCare will contract with health care providers to pay for covered health care services. The ColoradoCare board will determine the rates paid to participating providers. Persons accessing health care services through ColoradoCare may choose a primary care provider from among those participating in ColoradoCare.

ColoradoCare is prohibited from charging deductibles, but may require copayments for some health care services. A deductible is the amount of medical costs a patient must pay before an insurance plan starts to cover medical costs. Typically, a copayment is a fixed amount that a patient must pay at the time of service. Consistent with current federal law, ColoradoCare may not charge copayments for primary and preventative care services, such as annual doctor visits. Under Amendment 69, copayments for other services may be waived if the copayment would cause financial hardship for the patient.

ColoradoCare elections. ColoradoCare will be governed by a board of trustees. Initially, a 15-member interim board of trustees will be appointed by state legislative leadership and the Governor. The interim board will determine procedures for electing a 21-member board of trustees. The first board of trustees election must be scheduled within three years of the effective date of the measure. Amendment 69 outlines the length of terms of the elected trustees, term limits, and procedures for filling vacancies. ColoradoCare trustees are not subject to recall elections, but may be removed by a majority vote of the board.

ColoradoCare elections will be conducted independently from other Colorado elections in a manner determined by the board of trustees. Existing voter registration requirements do not apply to ColoradoCare elections. For ColoradoCare elections, all Coloradans who are at least 18 years of age and have continuously resided in the state for at least one year are eligible to vote. The interim board must establish seven voter districts in Colorado with substantially the same number of residents prior to the first election of the 21-member board. Three nonpartisan trustees will be elected from each of the seven districts. The trustees must live in the district they seek to represent. The interim board must promulgate rules regarding the selection and eligibility of trustee candidates, the regulation of campaign contributions and spending, and the certification of election results.

Administration. In addition to determining the procedures for electing a 21-member board of trustees, the interim board must establish rules and procedures, approve an operating budget, and hire employees and consultants for ColoradoCare. Once the elected board assumes responsibility for the operations of ColoradoCare, its duties will include:

  • establishing rules and procedures for the operation of ColoradoCare, determining benefits for Coloradans, and setting payment rates for providers;
  • hiring an executive team to administer the operations of ColoradoCare;
  • administering all state funds for health care services provided to Coloradans;
  • facilitating the creation of medical records and billing records systems and ensuring the confidentiality of patient records;
  • establishing an internal office for fraud investigation;
  • funding external offices in the Division of Insurance to respond to inquiries and complaints from the public and health care providers and make recommendations to the board; and
  • ensuring the financial stability and transparent operations of ColoradoCare and approving a publicly available annual budget.

Taxpayer impacts. To fund ColoradoCare, Amendment 69 creates new taxes on wages paid by employers and income received by individuals. The new taxes will be in addition to the state's current 4.63 percent income tax. Table 1 highlights the initial and full tax rates under the measure and the tax rates paid by employers and individuals. While all employers and individuals will be required to pay the new taxes, the taxes paid may be offset by savings that result from no longer having to pay for private health insurance once ColoradoCare is fully implemented.

The initial taxes are expected to generate approximately $2 billion per year. The full taxes are projected to generate more than $25 billion in revenue each year. The initial taxes will be collected starting July 1, 2017, and tax rates will increase to their full amounts 30 days before ColoradoCare assumes responsibility for health care payments in Colorado.

For employees, the new taxes are assessed on wages earned. For employers, the taxes are based on the total wages for all employees. For individuals earning other non-wage sources of income, the taxes are paid solely by the income earner. Wage income includes wages, salaries, tips, and other income reported on an employee W-2 form. Non-wage income includes capital gains, dividends, interest, rental income, non-corporate business income, and retirement income, including Social Security income, reported as taxable income on a taxpayer's federal income tax form.

ColoradoCare summary 1.png

The new taxes apply to the first $350,000 in taxable income for single filer taxpayers and the first $450,000 in taxable income for joint filers. These amounts are increased by inflation each year. The measure applies an existing state income tax exemption for retirement income to the new taxes. Under this exemption, retirement income up to $20,000 for those aged 55 to 64, and up to $24,000 for those 65 and older, is not taxed. Joint filers may claim up to double these amounts. Certain types of income are excluded from the new taxes, including unemployment compensation and alimony. Table 2 shows the amount of taxes owed under the full tax rates by representative households and the employers of persons in those households.

ColoradoCare summary 2.png

Potential taxpayer savings. Individuals and employers who discontinue private health insurance once ColoradoCare is fully implemented may have savings that offset the new taxes they are required to pay under Amendment 69. Potential savings will differ for each individual based on their health care costs, level of coverage, and tax liability. Key factors in determining potential savings include:

  • the cost of health insurance premiums that the individual would no longer pay; and
  • annual deductibles and out-of-pocket health care costs that would be eliminated or reduced under ColoradoCare.

About half of the Colorado population receives health insurance coverage through an employer, with the costs typically shared between the employee and employer. For employers who provide health insurance benefits to their employees, savings considerations include: health insurance premium costs, administrative costs, and allowable tax deductions for providing employee health insurance.

The net taxpayer impact of Amendment 69 for persons with Medicare, Medicaid, and other types of health coverage will depend on the plan type and taxable income of each person. For instance, persons not currently required to pay health insurance premiums, such as Medicaid recipients, may have higher costs under the measure to the extent that they have taxable income. Costs will increase for Medicare recipients if their income exceeds the maximum allowable deduction for retirement income. Medicare recipients may have savings if they choose to use ColoradoCare instead of private supplemental insurance. Persons who are uninsured do not pay insurance premiums, but may have high out-of-pocket costs and be subject to a tax penalty under federal law. The new taxes may offset these out-of-pocket costs and the tax penalty for persons without health insurance.

Voter approval for tax increases. The measure exempts ColoradoCare from the existing constitutional requirement to seek approval of tax increases at a regularly scheduled November election. Instead, tax increases for ColoradoCare must be approved at a ColoradoCare election scheduled by the board of trustees. The board of trustees may request a tax increase no more than once per year.

Constitutional limits on revenue. Under current law, if the state or a district of the state collects revenue in excess of constitutional limits, the revenue must be refunded to taxpayers. ColoradoCare revenue is exempt from these limits under Amendment 69.

Constitutional changes

The measure would amend the Colorado Constitution by adding an additional article, Article XXX, which can be read here.

Fiscal impact statement

See also: Fiscal impact statement

The fiscal impact statement is as follows:[4]

ColoradoCare revenue. Amendment 69 creates ColoradoCare, a new subdivision of the state that will be the recipient of tax revenue from new taxes on employers and individuals and transfers of state and federal funds that are currently used to operate state health programs, such as Medicaid. New tax revenue to ColoradoCare is estimated to be $2.0 billion in budget year 2017-18 and subsequent years until ColoradoCare assumes responsibility for health care payments in Colorado or, if federal approval is not received, until the board of trustees acts to terminate ColoradoCare. When fully implemented, ColoradoCare is expected to receive total revenue of up to $36.2 billion, including $25.0 billion in new tax revenue and up to $11.2 billion in transferred state and federal funds, assuming implementation in budget year 2019-20. Additional detail on the new taxes created by the measure to fund ColoradoCare, including the initial and full tax rates on individuals and employers, is provided in the "Taxpayer impacts" section above.

ColoradoCare spending. Based on available revenue, ColoradoCare will spend up to $2.0 billion per year beginning in budget year 2017-18 until fully implemented. However, initial spending is expected to be less than this amount, with most revenue to ColoradoCare placed in capital and operating reserves, rather than spent, prior to full implementation of ColoradoCare. During the initial years, the exact spending levels will depend on decisions by the ColoradoCare board of trustees and will likely include costs for seeking federal approval to fully implement ColoradoCare, procuring information technology systems, developing operating procedures, hiring staff, leasing office space, and conducting board elections.

Based on anticipated tax revenue and state and federal funds transferred to ColoradoCare, it is estimated that ColoradoCare will spend up to $36.2 billion per year on health care payments and administrative expenses once fully implemented. The amount of spending by ColoradoCare will depend on numerous factors, including the terms and conditions of federal waivers, the availability of funds, and the payment rates to health care providers set by the ColoradoCare board of trustees. In the event revenue is not sufficient to meet its spending obligations, ColoradoCare will be required to reduce its expenditures or increase tax revenue. Reductions in expenditures could be achieved by limiting benefits, increasing the share of health care costs paid by covered individuals, or lowering payments to health care providers.

While the exact date of ColoradoCare's full implementation is not known, the revenue and spending figures for full implementation included in this analysis are based on the assumption that ColoradoCare will assume responsibility for health care payments on August 1, 2019.

State revenue. Amendment 69 may reduce state tax revenue, most of which is deposited into the state General Fund; however, the exact impact cannot be estimated at this time. This potential reduction comes from two sources. First, assuming most people covered by private health insurance discontinue private coverage when ColoradoCare coverage becomes available, insurance premium and corporate income taxes paid by health insurance carriers will decrease by at least $100 million per year once ColoradoCare is fully implemented. Based on the assumed start of date of ColoradoCare, this impact would occur beginning in budget year 2019-20.

Second, Amendment 69 may affect the amount of individual and corporate income subject to the existing 4.63 percent state income tax in several ways, which could both increase and decrease state tax revenue. For individuals and businesses, the amount of ColoradoCare taxes paid may be claimed as a tax deduction, which could reduce state tax revenue. However, a shift away from employer-based health insurance following implementation of ColoradoCare may increase taxable income for both individuals and businesses by eliminating health insurance premium payments that currently do not count as taxable income for individuals and that may be claimed as a business expense deduction by employers. Additionally, the changes to health benefits under the measure could affect employee wages, which could increase or decrease income tax revenue. The net change from these various impacts to individual and corporate income tax revenue will depend on several factors, including the amount of ColoradoCare taxes and health care premiums paid, the amount of tax deductions claimed in any given year, and the net change in employee wages.

State spending. Amendment 69 is estimated to increase state spending by $4.3 million in budget year 2016-17, $19.5 million in budget year 2017-18, and $24.6 million in budget year 2018-19. This new spending includes:

  • administration of the new payroll and income tax;
  • planning and implementation activities to assist in establishing ColoradoCare;
  • payment of the new payroll tax; and
  • information technology costs.

Unless future implementing legislation for Amendment 69 specifically allows for the new tax revenue to be used to pay state agency costs or the ColoradoCare board agrees to pay these costs, it is assumed that these costs will be paid from existing state resources, including the General Fund, cash funds, and federal funds.

State agency savings. When ColoradoCare is fully implemented, spending by state agencies will decrease by $147.3 million in budget year 2019-20. These savings will result from state agencies discontinuing payments for private health insurance for state employees beginning August 1, 2019. The estimated savings reflect the net impact after accounting for other ongoing costs under the measure for tax administration and payment of payroll taxes.

Termination of health insurance exchange. When ColoradoCare becomes fully operational, the state's health insurance exchange, Connect for Health Colorado, will no longer operate. This will result in savings of approximately $40 million per year. Connect for Health Colorado is funded through fees assessed on health insurance carriers, tax-deductible donations by insurance carriers, and grants. Connect for Health Colorado will have costs between $5 million and $10 million over a two-year period to wind down operations and fulfill various contractual obligations.

Local government impacts. Spending by cities and counties in Colorado will initially increase under the measure due to the new payroll tax created under Amendment 69. If ColoradoCare is fully implemented and local governments choose to discontinue payments for employee health insurance through private insurance carriers, net savings may result.

Article X, Section 20 of the Colorado Constitution requires that the following fiscal information be provided when a tax increase question is on the ballot:

  • estimates or actual amounts of ColoradoCare fiscal year spending for the current year and each of the past four years with the overall percentage and dollar change; and
  • for the first full year of the proposed tax increase, an estimate of the maximum dollar amount of the tax increase and of ColoradoCare fiscal year spending without the increase.

"Fiscal year spending" is a legal term in the Colorado Constitution. It equals the amount of revenue subject to the constitutional spending limit that the state or a district is permitted to keep and either spend or save for a single year.

Because ColoradoCare is a newly created district, ColoradoCare has no spending history, as shown in Table 3.

Co ColoradoCare fiscal note 1.png

In FY 2017-18, ColoradoCare is expected to collect $2.0 billion from the new taxes, as shown in Table 4. This amount reflects estimated revenue in the first full fiscal year and differs from the $25.0 billion amount shown in the ballot title of this measure, which represents revenue in FY 2019-20, the final full year of the fully phased-in new taxes.

Co ColoradCare fiscal note 2.png

Support

Colorado Care YES logo

ColoradoCare Yes is leading the campaign in support of Amendment 69.[7]

Sen. Irene Aguilar (D-23), a former doctor, played a role in designing ColoradoCare.[8]

Supporters

Officials

Parties

  • Progressive Democrats of America[9]
  • Arapahoe County Democratic Party Platform
  • Boulder County Democratic Party
  • Colorado Democratic Party Platform
  • Democratic Party of Denver
  • Garfield County Democratic Party
  • Gilpin County Democratic Party
  • Greater Boulder Area Green Party
  • La Plata County Democrats
  • Latino Initiative, Colorado Democratic Party
  • Mesa County Democratic Party Platform
  • San Miguel County Democrats

Organizations

  • League of Women Voters of Colorado[12]
  • Our Revolution[13]
  • Together Colorado[9]
  • Campaign for a Healthy California
  • Move-On Denver Metro Council
  • Health Care for All Colorado
  • Healthcare-NOW
  • Physicians for a National Health Program - Western Washington
  • Public Health Nurse Association of Colorado (PHNAC)
  • Rocky Mountain Peace and Justice Center
  • Building Babies Brains Foundation Ltd
  • California Physicians Alliance
  • Call to Action
  • Colorado Community Rights Network
  • Colorado Health Champions
  • CREW
  • Doctors To The World
  • Health Care for All Oregon - Rogue Valley
  • Healthcare is a Human Right, Maryland
  • Nurses for ColoradoCare
  • NYC Teachers Cooperative
  • Our Revolution UW-Madison
  • Public Citizen
  • United Earth Ecclesia

Religious communities

  • American Friends Service Committee (Quaker)[9]
  • Mountain View Friends Meeting (Quaker), Denver
  • Unitarian Universalist Fellowship, Alamosa

Businesses

  • 13th Moon Midwifery[9]
  • A Heartfelt Production
  • A Touch of Green
  • Achieve: Be Fit!
  • Ajax Tech
  • All Mountain Homes, LLC
  • Always Best Care Senior Services
  • Angel Medflight International Air Ambulance
  • Avietech
  • Axiom Action
  • Beyond the Bedroom
  • Boulder Psychotherapists Guild
  • Boulder Strategies LLC
  • Carly's Gold
  • Center Management Group LLC
  • Civic Satisfaction
  • Clinica Family Health
  • Cloud Ridge Press
  • Coaching and Physical Therapy
  • Colorado Elder Care Solutions
  • Colorado Plastics
  • Commonwealth Tree and Garden
  • Community Supported Family Medicine
  • Contemporary Solutions
  • Cyclingvideosonline.com
  • Deadline Specialists, Inc.
  • DEI
  • Diaz Group
  • Dot's Nederland LLC
  • DRM Home Care
  • DTC Family Health
  • Eagle Eyecare
  • Ebert Family Clinic
  • ECE Engineering Services, LLC
  • Eco-Cuisine, Inc.
  • Emilie Management
  • EMIS, Inc. Medical Publishers
  • ENKI Corp
  • Ezra's Closet
  • Factory Direct Furniture Catalog Service
  • FAR Network Press
  • Gilpin Ambulance Authority
  • Gold Lantern Music
  • GriffMonster, LLC
  • Grush Engineering
  • Guardi LLP
  • Head2Toe HealthCare, LLC
  • Health Confidence, LLC
  • Health Rising Wellness LLC
  • Heartlight Family Clinic
  • Independent Practice
  • Integral Physical Therapy
  • InterTran Energy Consulting
  • ISHG
  • James Robert Deal, Attorney
  • JB Wright & Assoc., Inc
  • Keeton Corporation
  • Kohl's
  • Krupnick Counseling Associates
  • KW Farms
  • Lark Information Technology, Inc
  • Life Spring Healing Arts
  • LightLouver LLC
  • Limitless Idea Project
  • Louisville Chair Massage
  • LStern Media
  • Mainstay Physical Therapy
  • Mardec, Inc.
  • Matthew Dehning Glass
  • MCM Inc
  • Medicine Buddha Clinic
  • Middle Park Medical Center
  • MindBodyHealth Associates LLC
  • Mountain Family Health Centers
  • Mountain West Workers Free Clinic
  • Mountain West Workers Free Clinic
  • MTIC
  • My Family Doctor
  • New Awareness Therapy Services
  • NNOC
  • Northern Colorado Stained Glass Supply
  • Northern Lights Wholistic Bookstore
  • Peak Campaigns
  • Peak Communications
  • Peterson Design
  • Physical Therapy Doctors
  • Pivot Evaluation
  • Poochie's Dog Walking
  • QuoinDev Corp
  • radioBANG
  • Randall W Lwacock LLC
  • Red Wagon Organic Farm
  • RedqDogz
  • Roberts Properties Llc
  • San Luis Valley Local Foods Coalition
  • San Miguel County Commissioners
  • Sapphire Pediatrics
  • Sawaya Law Firm
  • SigmaMed
  • SPAN
  • Specialists in Women's Care, pc
  • Stephen M. Allen, MD (private practice)
  • Still Mountain Acupuncture
  • StreckTech
  • Strike Debt Bay Area
  • Studio Harris, Inc.
  • Sun Dog Automotive
  • SunSpirit Retreat
  • Taxpayer, Inc
  • Ted's Plumbing And Hydronics
  • The Growth Engine LLC
  • The Growth Engine LLC
  • Therapists for Single Payer
  • TransitPlus
  • TriCar Ltd
  • UI Writer
  • Umed
  • Wilcox and Ogden
  • Write Stuff Strategies

Unions

  • American Postal Workers Union, Denver Metro Retiree Chapter[9]

Individuals


ColoradoCare Yes video featuring T.R. Reid and Colorado State Sen. Irene Aguilar, MD

Arguments

Supporters make the following arguments in support of Amendment 69:

  • The amendment would effectively make healthcare a right.
  • The current system leaves too many people uninsured.
  • The amendment would set the whole nation on the path to universal healthcare.
  • ColoradoCare would be more efficient than the current model and save billions in medical expenses.
  • The amendment would increase the quality of healthcare available to most Coloradans.
  • ColoradoCare would operate as a co-operative owned by its members.
  • ColoradoCare would serve the interest of its members, the residents of Colorado, not private interests.

ColoradoCare Yes made the following arguments in support of their measure:[15]

“ Covers everyone

100% of residents will be covered, leading Colorado to be the first state in the U.S. to achieve universal health care.

Improves Quality

ColoradoCare will greatly expand access to and improve the quality of healthcare. Health benefits include primary, mental health, and specialty care, including dental. Patients can choose their primary care providers. … As a non-profit cooperative owned by all the members–all Coloradans, ColoradoCare will save money overall while covering everyone.

Increases Savings

ColoradoCare’s universal health care system—private providers paid with combined funds—reduces layers of administrative costs, allows for bulk purchasing of drugs and medical equipment, and reduces fraud and duplication.

An economic analysis of health care spending in Colorado has calculated that comprehensive health coverage for every resident could be paid for with pre-tax payroll premiums of 3.33% for employees and 6.67% for employers.[6]

”

U.S. Sen. Bernie Sanders (I) of Vermont, a Democratic presidential candidate in 2016, endorsed Amendment 69, stating:[16]

“ Colorado could lead the nation in moving toward a system to ensure better health care for more people at less cost. In the richest nation on earth, we should make health care a right for all citizens. No one should go bankrupt or skip getting the care they need because they cannot afford it.[6] ”

Sen. Irene Aguilar (D-32), a doctor and a member of the Board of Directors at Denver Health, stated:[17]

“ By taking the profit motive out of health care and streamlining administrative costs, ColoradoCare saves $4.5 billion in annual expenses compared to the current corporate insurance model. This savings enables better care at a lower cost to residents, businesses and cities. Residents are free to choose any provider in the state. There are no deductibles, no insurance premiums and no co-pays for primary and preventive care. Health insurance funds stay in Colorado to create local jobs and a stronger economy.

Most important, 100 percent of Coloradans will be covered. Crippling medical debt and bankruptcy from medical bills will cease to exist.[6]

”

Noam Chomsky, linguist, author, and political activist, answered questions on his support for ColoradoCare and "universal healthcare" more generally in the Boulder Weekly. The following is an excerpt from the questions and answers:[18]

“ How important is Amendment 69 in the context of American democracy? Why is it important right now, at this point in history?

The U.S. health care system is an international scandal. By standard estimates, costs are about twice as high per capita as other industrial societies, and outcomes are relatively poor. Furthermore, standard estimates significantly understate the costs, because they do not take into account the costs to individuals — time wasted maneuvering the complexities of the system, for example... This massive waste traces back largely to the inefficiency of the privatized system — and even Medicare, which is far better than the general system, suffers from having to work through private insurers. Polls have shown for a long time that the public favors public health care, often by large margins — a rather striking fact, since there is little articulate support for it in the mainstream and substantial criticism. For example, when Obama proposed the ACA, a public option was favored by about 5 to 3, but was not considered. Often the states are laboratories in which constructive ideas and legislation can be pursued, and if successful, extended beyond. ...

Why doesn’t the U.S. have universal health care like other industrialized nations?

The U.S. is to an unusual extent a business-run society. That is a major reason why it ranks so low among industrial countries in social justice measures generally. The political power of financial institutions, pharmaceutical corporations, and other concentrations of private power is so great that the public will is often overwhelmed. One even reads in the press that although the public might want national health care, it is “politically impossible” — meaning that private power will not permit it.[6]

”

Other arguments in support of the measure include:

  • Barb Mattison, President of the League of Women Voters of Colorado, argued, "We have too many people using emergency rooms for their care. Every one of us now supports all that through our healthcare premiums. We need to even things out in Colorado, make care affordable for everyone."[12]
  • Sen. Jeanne Nicholson (D-16), a licensed public health nurse, stated, "With ColoradoCare there will be no deductibles and there will be no co-insurance. ... That money that people are spending now can be freed up to spend on other things that will benefit Colorado's economy."[11]

Official arguments

The official arguments in favor of Amendment 69 as listed in the voter guide are as follows:[4]

“

1) Amendment 69 creates a more equitable health care payment system that provides coverage for all Coloradans. All people should have access to affordable health care regardless of their ability to pay. The current health care system leaves many people uninsured or unable to access care due to insurance denials or high deductibles. ColoradoCare prohibits deductibles and may reduce financial barriers to needed care. The measure helps ensure that individuals and families will not face financial ruin when accessing needed health care services.

2) Amendment 69 offers a means to control health care costs and improve patient outcomes. In the United States, health care costs are higher than in any other industrialized country. Under Amendment 69, health care costs could be controlled by lowering administrative costs, adjusting payment rates to health care providers, and reducing the amount of unpaid care provided by health care providers. By creating a centralized system for health care records, ColoradoCare may improve the coordination of care and create cost savings by more efficiently sharing information between providers, monitoring medical conditions, and reducing diagnostic testing.

3) ColoradoCare provides a more transparent system that serves the interests of Coloradans, instead of the interests of private corporations. The current private health insurance system is profit-motivated, which contributes to rising health care costs. ColoradoCare offers an alternative that shifts incentives toward improving patient care by allowing Coloradans to elect health care decision-makers. Under Amendment 69, Coloradans also have control over tax increases for ColoradoCare, increasing local control over health care costs. Unlike private insurance companies, ColoradoCare board meetings are subject to open meetings laws, which allows Coloradans to monitor decisions made by the board.[6]

”

Campaign advertisements

The following campaign advertisements were produced by supporters of Amendment 69:

Yes! On Amendment 69.

Opposition

Opposition campaign logo

Coloradans for Coloradans, also known as No on 69, is leading the campaign in opposition to Amendment 69.[19]

Opponents

Officials

Former officials

  • Gov. Bill Ritter (D)[20]
  • Gov. Bill Owens (R)[23]
  • Lt. Gov. Gail Schoettler (D)
  • Secretary of State Bernie Buescher (D)
  • Senate Minority Leader Mike Feeley (D)

Organizations

  • American Council of Engineering Companies of Colorado[23]
  • American Subcontractors Association Colorado
  • Arvada Chamber of Commerce
  • Associated Builders & Contractors, Rocky Mountain
  • Associated Collection Agencies of Colorado, Wyoming and New Mexico
  • Associated General Contractors of Colorado
  • Aurora Chamber of Commerce
  • Boulder Chamber of Commerce
  • Citizens Due Diligence
  • Club 20[24]
  • Colorado Agricultural Council
  • Colorado Association of Commerce and Industry
  • Colorado Association of Health Plans
  • Colorado Association of Mechanical and Plumbing Contractors
  • Colorado Association of Realtors
  • Colorado Automobile Dealers Association
  • Colorado Bankers Association
  • Colorado Bioscience Association
  • Colorado Business Roundtable
  • Colorado Cattlemen’s Association
  • Colorado Children’s Campaign
  • Colorado Commercial Insurance Network
  • Colorado Competitive Council
  • Colorado Concern
  • Colorado Contractors Association
  • Colorado Contractors Coalition
  • Colorado Counties, Inc
  • Colorado Dairy Farmers
  • Colorado Farm Bureau
  • Colorado Hospital Association
  • Colorado Hotel and Lodging Association
  • Colorado Integrated Care Network
  • Colorado Medical Society
  • Colorado Mining Association
  • Colorado Oil and Gas Association
  • Colorado Orthopaedic Society
  • Colorado Pain & Rehab
  • Colorado Restaurant Association
  • Colorado Rural Health Center
  • Colorado Society of CPAs
  • Colorado Society of Eye Physicians & Surgeons
  • Colorado Society of Osteopathic Medicine
  • Colorado Springs Forward
  • Colorado Springs Regional Business Alliance
  • Colorado State Association of Health Underwriters
  • Colorado Workers Compensation Network
  • Council of Insurance Agents & Brokers[25]
  • Delta Area Chamber of Commerce
  • Denver Metro Chamber of Commerce
  • Douglas County Business Alliance
  • Downtown Denver Partnership
  • Grand Junction Chamber of Commerce
  • Greeley Chamber of Commerce
  • High Plains of NE Colorado Tea Party
  • Highlands Ranch Chamber of Commerce
  • Jefferson County Business Lobby
  • Jefferson County Economic Development Corporation
  • Land Title Association of Colorado
  • LeadingAge Colorado
  • Logan County Economic Development Corporation
  • Longmont Area Chamber of Commerce
  • Mechanical Contractors Association of Colorado
  • Mechanical Service Contractors Association of Colorado
  • Metro Denver Association of Health Underwriters
  • Metro Denver Economic Development Corporation
  • Metro Mayors Caucus
  • Montrose Economic Development Corporation
  • NARAL Pro-Choice Colorado[26]
  • National Active and Retired Federal Employee (NARFE) Association, Colorado[27]
  • National Certified Pipe Welding Bureau, Colorado Chapter
  • National Electrical Contractors Association, Rocky Mt. Chapter
  • National Federation of Independent Business, Colorado (98% of its members oppose)[28]
  • Northern Colroado Association of Health Underwriters
  • Northern Colorado Economic Alliance
  • Northern Colorado Legislative Alliance
  • Northwest Chamber Alliance[29]
  • Northwest Douglas County Economic Development Corporation
  • Planned Parenthood of the Rocky Mountains[30]
  • Professional Independent Insurance Agents of Colorado
  • Progressive 15
  • Progress Now[31]
  • Pueblo Chamber of Commerce
  • Rocky Mountain Sustainability Center
  • Sheet Metal & Air Conditioning Contractors, Colorado Chapter
  • South Metro Denver Chamber of Commerce
  • Special District Association of Colorado
  • Upstate Colorado Economic Development Corporation
  • Visit Denver
  • Wheat Ridge Chamber of Commerce

Businesses

  • Acaria Homecare[23]
  • Action 22
  • Active Insurance Solutions
  • Addison Auto Center
  • AFLAC
  • Alexander Benefits Consulting
  • AlphaGraphics
  • Anderson and Chapin, PC
  • Anthem Blue Cross Blue Shield
  • Arthur J Gallagher & Co
  • Aspen Group Benefit Advisors
  • Associates Health Group, LLC
  • Autopaycheck, Inc
  • Aviation Management Consulting Group
  • B&A Properties, LLC
  • B&H General Contractors, Inc.
  • Backcountry Family Dental
  • Bank of America
  • Benefit Dynamics
  • Bene-fit Solutions, LLC
  • Berkley
  • Beta Health Association
  • Black Mountain Ranch, LLC
  • Body of Knowledge, LLC
  • Bona
  • Box Elder Ranch
  • Brainspire Solutions
  • Broomfield Medical Associates
  • Brown Farms & Ranches
  • Business Planning Resource Network
  • C & L Water Solutions, Inc
  • CairnTech Solutions
  • Case Benefits Colorado
  • Centura Health
  • Century Financial Group
  • CHA Workers’ Compensation Trust
  • Cherry Creek Benefits, LLC
  • Children’s Hospital Colorado
  • Cigna
  • CJ Chiropractic, LLC
  • CoBank
  • Cobecon
  • Collegiate Peaks Eyecare
  • Colorado Springs Interventional Pain Management
  • ColoradoInsuranceStore.com
  • Columbine Health Plan
  • Complete Benefit Solutions
  • Confluent Homes
  • Conversation Starters LLC
  • COPIC
  • Craig Hospital
  • Currier Ranch
  • Custom Blending, LLC
  • DaVita
  • DB Golenda Insurance, Inc
  • Delta Denta
  • Denver Center for the Performing Arts
  • Diamond Excavating
  • Digital Insurance, Inc
  • Dreamcatcher Properties
  • Eaglecrest Consulting
  • EC Data Systems, Inc.
  • EKS&H
  • El Technologies, LLC
  • Electrical Systems Professionals, Inc
  • Elizabeth A. Gobble, CPA
  • Emmett J. King, LLC
  • Employer’s Resources of Colorado
  • Encana Corporation
  • Encompass Medical Partners
  • Erickson Financial
  • Fall River Employee Benefits
  • Ferry Foundation
  • First Insurance Services, Inc
  • Flagstaff Benefits Group, Inc
  • Flood and Peterson
  • Fort Collins Area Chamber of Commerce
  • Foxhoven & Associates, LLC
  • Fringe Benefit Group
  • Front Range Pain Medicine
  • Gordon Property Enterprises, Inc.
  • Group Insurance Analysts, Inc
  • Glenwood Insurance Agency
  • Greenway & Associates
  • Gunnison Glass
  • Gypsum Animal Hospital, Inc.
  • HealthONE
  • Healthy Colorado Insurance, LLC
  • Hepp Realty, Inc
  • Holiday Cleaners, Inc
  • Holmes Murphy
  • HUB International Insurance Services
  • Hughes Group
  • Husch Blackwell
  • Insurance Benefit Connections, Inc
  • ICI Financial, LLC
  • IMA Financial Group
  • Ingmire-Phillips Insurance
  • InnovAge
  • Innovative Benefit Solutions, LLC
  • Insurance Marketing Enterprises, Inc
  • Insurance Solutions Group
  • JC’s British & 4×4
  • Jessica K. Peck, Attorney at Law, LLC
  • Just Wisdom Teeth
  • Kaiser Permanente
  • Kallgren Dermatology
  • KB Farms
  • Kennedy Insurance
  • Kirchhof Group, Inc
  • Koelbel & Co
  • Korb Construction, LLC
  • Kraft Family Dairies
  • LC Fulenwider, Inc
  • LEI Companies, Inc
  • Liberty Road Show
  • Lockton Companies
  • Managed Benefit Systems, Inc.
  • Martin Insurance Group
  • Medical Center of the Rockies
  • Merrick & Company
  • MHIB Group
  • Midtown Occupational Health Services, PC
  • Mike Mitchell Farms, LLC
  • Moody Insurance Agency
  • Morgan Co.
  • Mountain West Dermatology, P.C.
  • Mountain West Insurance
  • MW Family Services
  • MyTherapyCompany
  • Native Excavating Inc.
  • New West Physicians
  • Netstructures, Inc
  • NFP Corporate Services
  • Niederman Insurance Agency
  • Northern Colorado Diesel, LLC
  • OfficeScapes Group
  • Ormond Co, Inc
  • Peak Insurance Solutions, LLC
  • PHCC of Colorado
  • Pinnacol Assurance
  • Pipefitters Local 208
  • Podium Benefits
  • Poudre Valley Hospital
  • Precision Media Solutions
  • Premiera LLC
  • Pyxant Labs Inc.
  • Richards, Seeley, & Schaefer
  • Rizzuto Transportation
  • RK Mechanical
  • RNL Design
  • Rock Creek Spine
  • Rocky Mountain Benefits, LLC
  • Rocky Mountain Orthopedic Associates
  • Roper Insurance
  • Russell Benefits Group, Inc
  • Sage Benefit Advisors
  • San Luis Valley Health
  • Sandbak & Company
  • Sharklet Technologies
  • Sharon’s Cattle Service
  • Shirazi Benefits
  • Sisk & Co
  • Sky Blue Builders
  • South Federal Family Practice
  • Southern Colorado Dermatology Clinic
  • Spillane Insurance
  • Sperr Puttman Akins Lamb, PC
  • StaffScapes, Inc
  • Steamboat Restaurant Group
  • Stonebridge Financial Solutions, Inc.
  • Strater Hotel
  • Summit Dental Group
  • Summit Ford
  • Sweeney & Associates, LLC
  • Talbott’s Mountain Gold
  • Teltech Communications
  • Tharp Cabinet Company
  • The Benefit Queen
  • The Benefit Team
  • The Midland Stop
  • The Sequencing Center
  • Trilogy Benefits, Inc
  • U-Fulfilled
  • UC Health
  • Unify Payroll
  • UnitedHealth Group
  • United Healthcare
  • United Properties
  • University of Colorado Hospital
  • USI of Colorado
  • Vail Valley Oral/Maxillofacial Surgery
  • Vail Summit Orthopedics
  • Vail Valley Partnership
  • VirtHealth.tech, LLC
  • Visiting Angels
  • VolkBell Benefits, LLC
  • w3w3 Talk Radio
  • Warner Pacific
  • Western Orthopedics
  • Western Pacific Insurance Network Inc.
  • Western Rockies Interventional Pain Specialists
  • Wolcott Insurance Services, Inc
  • Workplace Resource
  • Wright & McGill

Unions

  • IBEW 68[23]
  • Sheet Metal Workers Local 9
  • United Food & Commercial Workers

Arguments

Opponents make the following arguments against Amendment 69:

  • Amendment 69 would increase the tax burden of employees and employers.
  • Amendment 69 would decrease consumer choice in healthcare.
  • ColoradoCare would cost too much and stimulate businesses to leave the state.
  • Amendment 69 would establish another government agency, the ColoradoCare Board of Trustees, to influence healthcare decisions.
  • ColoradoCare would reimburse healthcare providers too little.
  • ColoradoCare would not cover elective abortions.

State Treasurer Walker Stapleton (R), co-chair of Coloradans for Coloradans, contended:[32]

“ While I realize that there’s a lot of uncertainty regarding healthcare coverage by many Coloradans, this is absolutely not the answer. ... This will result in $25 billion in unfunded liabilities in Colorado, and the people who will bear the brunt of this cost will be our employers, especially our sole proprietors, small-business owners and the generators of our economic growth.[6] ”

Denise Akromas Wentz, a physical therapist and co-owner of Wentz Foot & Ankle Specialists in Salida, wrote in the Denver Post:[20]

“ According to Amendment 69, every healthcare provider in Colorado (physicians, clinics, hospitals, nursing homes, physical therapists, etc.) will be forced to enter into a contract where the terms of the contract are unknown. That is equivalent to expecting employees to accept jobs not knowing how much they are going to be paid. Per the language of the amendment, providers will be reimbursed at a rate "competitive with other states."

However, there are no other states for comparison. The fear among providers is the reimbursement would be at state Medicaid rates, forcing many providers and hospitals out of business.[6]

”

Former Rep. Bob Gardner (R-12) wrote in The Gazette:[33]

“ These 15 "trustees" - a fancier word for bureaucrats, by the way - would get to say which procedures and which drugs would be covered by insurance and which ones wouldn't from 2017 until 2020. How would they get that power? Amendment 69 makes it illegal for any other health insurance company to do business in the state of Colorado. And when those companies are all gone, all decisions about any kind of payment to anyone in the healthcare system fall under the thumb of those unelected trustees.

They'd get to decide how long you should have to wait in the emergency room, how many months your elderly mother should have to wait for hip replacement surgery, and what treatments for your kids will and won't be paid for.

If you don't like the sound of that system, you should know there'll be no opting out. If you're wealthy, you could pay for healthcare from your pocket. Otherwise, your family's care exists solely at the whim of the 15 bureaucrats.[6]

”

Other arguments against the measure include:

  • Kelly Brough, President and CEO of the Denver Metro Chamber of Commerce, said, "Won’t want to risk our access to quality healthcare, our income or our state’s economy on this experiment."[32]
  • Jonathan Lockwood, Executive Director of free-market advocacy group Advancing Colorado, argued, "ColoradoCare is a charade and their campaign has been deceptive on every level, preying on Millennials and the underserved communities, promising them relief that will deliver pain."[34]
  • Former Gov. Bill Ritter (D), a co-chair of Coloradans for Coloradans, stated, "The constitution is already burdened with too many constitutional measures, let alone one of this cost and magnitude."[19]

Official arguments

The official arguments against Amendment 69 as listed in the voter guide are as follows:[4]

“ 1) Amendment 69 imposes new taxes, which may harm the Colorado economy by burdening taxpayers and eliminating jobs. The tax increases under this measure will nearly double state government spending, which currently totals $27 billion for the entire state budget. In the initial years, taxpayers will pay about $2 billion a year into a system without receiving any direct benefits. Many individuals and businesses will pay more with the new taxes than they currently pay for health care. Additionally, taxpayers must pay the new taxes even if they do not utilize the services offered through ColoradoCare. Under Amendment 69, higher taxes and an uncertain economic climate could discourage businesses from operating in Colorado. Finally, ColoradoCare may cause private health insurance businesses to downsize or leave the state, leaving many people unemployed.

2) Amendment 69 offers no guarantee that ColoradoCare will improve patient care, expand access, or reduce health care costs. Coloradans may never receive the benefits promised under ColoradoCare if federal approval is not granted or revenues are not sufficient. The measure does not specify critical details of how ColoradoCare will be implemented, and has no required implementation date. The measure concentrates control for making important decisions and spending billions of taxpayer dollars in a 21-member board with limited accountability and no required health industry experience. ColoradoCare may not solve fundamental problems of rising health care costs and limited access. If the state fully transitions to ColoradoCare and it fails, it could take years to re-establish a private health insurance market and government programs, and taxpayers will have paid billions of dollars for a failed system.

3) ColoradoCare may limit consumer choice and strain the health care system. Health care providers may be unwilling to serve ColoradoCare patients if reimbursements are too low, or they may choose to leave Colorado due to uncertainties in the health care market. This could reduce options for patients and increase wait times to receive services. Also, the health care system could be further burdened by people coming to the state to receive health care without adequately contributing to the taxes that pay for their care. If the system fails to control costs, health services covered by ColoradoCare may be reduced. Additionally, private health insurance may not be available or affordable if Amendment 69 passes. This could leave people with limited options for accessing alternative coverage or needed care, forcing some people to leave the state.[6]

”

Campaign advertisements

The following campaign advertisements were produced by opponents to Amendment 69:

Colorado Association of Realtor's ad against Amendment 69

ColoradoCare and abortion

See also: Colorado Abortion Funding Prohibition Amendment, Initiative 3 (1984)

In June 2016, NARAL Pro-Choice Colorado decided to oppose Amendment 69. NARAL Colorado's Board of Directors said, "While we strongly support the goal of improved healthcare for all Coloradans, and many of our members individually support the idea of universal health care, Amendment 69 in not providing guarantees to abortion access means it is not truly universal."[26] Planned Parenthood of the Rocky Mountains announced its opposition to Amendment 69 in September 2016.[30]

At issue for the pro-choice organizations is whether a 1984 ballot initiative, titled Initiative 3, would impact ColoradoCare's ability to cover elective abortions. Coloradans narrowly approved the amendment, with 0.78 percent or 10,000 more voters voting "yes" than "no." Initiative 3 added the following language to the Colorado Constitution:[36]

Text of Section 50:

Public Funding of Abortion Forbidden.

No public funds shall be used by the State of Colorado, its agencies or political subdivisions to pay or otherwise reimburse, either directly or indirectly, any person, agency or facility for the performance of any induced abortion, PROVIDED HOWEVER, that the General Assembly, by specific bill, may authorize and appropriate funds to be used for those medical services necessary to prevent the death of either a pregnant woman or her unborn child under circumstances where every reasonable effort is made to preserve the life of each.

Initiative 3 prohibited the state from providing women with funds to receive elective abortions. Women in Colorado need private healthcare insurance that covers elective abortions to have an abortion's cost covered.[35] Amendment 69 would allow individuals and families to continue purchasing private healthcare insurance in addition to receiving ColoradoCare. Furthermore, ColoradoCare Yes's lawyer claimed Amendment 69 would, despite Initiative 3, allow ColoradoCare to cover elective abortions.

Ralph Ogden, attorney for ColoradoCare Yes, wrote a memo on the amendment and elective abortion. He argued that the ColoradoCare Board of Trustees would be authorized to include abortion services in ColoradoCare coverage. He futher claimed that prior judicial precedent favors allowing ColoradoCare to cover elective abortions. Citing Brown v. American Family Mutual Insurance Company (1990), Ortega v. Industrial Commission (1984), City of Florence v. Pepper (2006), and Colorado State Board of Medical Examiners v. Jorgensen (1979), Ogden contended:[37]

“ Clearly, in the case of Amendment 69, the plain language specific intent was to grant the board unlimited power to authorize payment for other health care services other than those listed. It is thus inconsistent with Article V, section 50. The inconsistency cannot be resolved without placing a limit on the board’s power, and no such limit appears in Amendment 69. Thus, the language of Amendment 69 repeals by implication the effect of Article V, section 50 to the extent Amendment 69 gives the board power to authorize elective abortions with state tax revenues.[6] ”

State Sen. Irene Aguilar (D-32), a doctor who helped develop Amendment 69, also responded, "When we pass Amendment 69, every Coloradan — regardless of age, income, gender identity, or ethnicity — will have access to quality, affordable health care. All women in Colorado will have full access to comprehensive reproductive services without financial barriers."[26]

Karen Middleton, Executive Director for NARAL Pro-Choice Colorado, was not convinced. She said, "[Ralph Ogden] suggests it would be overturned because it was 30-plus years ago or because their definition of universal care might want to include abortion. But unfortunately, we're not willing to take that risk." She claimed that in other rulings, the Colorado Supreme Court did not determine that "more recent" laws overrode "less recent" ones.[35]

Campaign finance

Total campaign cash[38]
as of October 18, 2016[39]
Category:Ballot measure endorsements Support: $836,813.34
Circle thumbs down.png Opposition: $4,048,293.00

As of October 18, 2016, the support campaign for Amendment 69 featured one issue committee, ColoradoCare Yes, that received a total of $836,813.34 in contributions. The support campaign had spent $813,636.63.[40]

The opposition campaign for Amendment 69 featured two issue committees, Coloradans for Coloradans and Committee to Stop ColoradoCare, that received a total of $4,048,293.00 in contributions. The opposition campaign had spent $3,878,241.33.[40]

According to reports through October 18, 2016, the top donor in support of Amendment 69, Lyn Gullette, provided approximately 21 percent of the campaign's funds, contributing $168,034 in cash donations. The top donor in opposition to this initiative, Anthem, Inc., provided approximately 25 percent of the opposing campaign's funds, contributing $1,000,000.[40]

Support

Cash donations

The following issue committee registered to support Amendment 69 as of October 18, 2016. The chart below shows cash donations and expenditures current as of October 18, 2016. For a summary of in-kind donations received by each PAC, click here.[40]

Committee Amount raised[41] Amount spent
ColoradoCare Yes $820,859.39 $813,636.63
Total $820,859.39 $813,636.63

In-kind donations

As of October 18, 2016, the issue committee registered to support this initiative also received in-kind donations in the amount of $15,953.95. The top in-kind donor, Ivan J. Miller, contributed $4,672.78 in the form of printing services.[40]

Top donors

As of October 18, 2016, the following were the top five donors in support of this initiative:[40]

Donor Cash In-kind Total
Lyn Gullette $168,034.00 $0.00 $168,034.00
Ivan J. Miller $113,101.46 $4,672.78 $117,774.00
Ralph Ogden $57,496.00 $0.00 $57,496.00
Eliza Carney $43,670.00 $0.00 $43,670.00
Co-operate Colorado $39,000.00 $0.00 $39,000.00

Opposition

Cash donations

The following issue committees registered to oppose Amendment 69 as of October 18, 2016. The chart below shows cash donations and expenditures current as of October 18, 2016. For a summary of in-kind donations received by each PAC, click here.[40]

Committee Amount raised[42] Amount spent
Coloradans for Coloradans $4,048,293.00 $3,878,241.33
Committee to Stop ColoradoCare $0.00 $0.00
Total $4,048,293.00 $3,878,241.33

In-kind donations

As of October 18, 2016, the issue committees registered to oppose this initiative received no in-kind donations.[40]

Top donors

As of October 18, 2016, the following were the top five donors in opposition to this initiative:[40]

Donor Cash In-kind Total
Anthem, Inc. $1,000,000.00 $0.00 $1,000,000.00
KP Financial Svcs $500,000.00 $0.00 $500,000.00
United Healthcare Services, Inc. $450,000.00 $0.00 $450,000.00
Centura Health $250,000.00 $0.00 $250,000.00
HealthOne System Support $250,000.00 $0.00 $250,000.00

Methodology

In calculating campaign finance for supporting and opposing committees, Ballotpedia does not count donations or expenditures from one PAC to another since that would amount to counting the same money twice. This method is used to give the most accurate information concerning how much funding was actually provided to and spent by the opposing and supporting campaigns. Ballotpedia reports all in-kind donations reported by the state government.

Media editorials

Support

  • The Aurora Sentinel said: "It’s not magic, nor is it a myth, it’s just a system that works all over the world because the priority is access to quality and controlling costs — it’s the opposite of a system dictated by corporate profits and market control. ... Universal health care is as inevitable as was legalized marijuana, where Colorado also was courageous and wise enough to lead the way. What will cement Colorado Care’s success is when other states follow, creating a solid system that serves patients and not just profits. They will follow."[43]

Opposition

  • The Coloradoan said: "We, too, are frustrated with the rising costs of health care. We believe that under our current constricts, incentives are misplaced. We need more transparency in any and all solutions offered to paying members. We want a system that is first socially just and also fiscally responsible. ColoradoCare leaves too many critical questions unanswered."[44]
  • The Denver Post said: "We apologize to the proponents for such harsh criticism. They mean well, and we agree that the state of health care coverage is maddeningly frustrating and in many ways badly broken. And while we also agree that a public option at the national level would help force needed competition to bring down prices, trying such a plan locally would be a fool’s errand."[45]
  • Longmont Times-Call said: "This is a public policy experiment that comes before voters because the threshold for constitutional petitions is so low. If approved, the state would take over the administration of health care for all residents. While health care policy is fraught with challenges, this amendment is not the answer. A "no" vote is recommended."[46]
  • Loveland Reporter-Herald said: “While health care policy is fraught with challenges, this amendment is not the answer. A "no" vote is recommended.”[47]
  • The Tribune said: "We’re not thrilled with the notion our state would become the laboratory for such a test, and we’re particularly concerned about the price tag. It’s for these reasons we’re urging voters to cast their ballots against this risky measure."[48]

Polls

See also: 2016 ballot measure polls
  • In late August 2016, Magellan Strategies surveyed 500 likely voters on Amendment 69. Of the respondents surveyed, 27 percent supported and 65 percent opposed Amendment 69. Democrats were most favorable towards the measure, with 41 percent in support and 45 percent in opposition.[49]
  • Colorado Mesa University, Rocky Mountain PBS, and Franklin & Marshal College surveyed 540 registered voters in mid-September 2016 and found support for Amendment 69 around 30 percent.[50]
Colorado Amendment 69 (2016)
Poll Support OpposeUndecidedMargin of ErrorSample Size
Colorado Mesa University, Rocky Mountain PBS, and Franklin & Marshal College
9/14/2016 - 9/18/2016		30.0%56.0%14.0%+/-5.1540
Magellan Strategies
8/29/2016 - 8/31/2016		27.0%65.0%8.0%+/-4.38500
AVERAGES 28.5% 60.5% 11% +/-4.74 520
Note: A "0%" finding means the candidate was not a part of the poll. The polls above may not reflect all polls that have been conducted in this race. Those displayed are a random sampling chosen by Ballotpedia staff. If you would like to nominate another poll for inclusion in the table, send an email to editor@ballotpedia.org.

Background

See also: Healthcare policy in Colorado
Voting on Healthcare
Health care.jpg
Ballot Measures
By state
By year
Not on ballot
Local Measures

Affordable Care Act - Section 1332 Waivers

A section of the Affordable Care Act (ACA) allows states to create their own healthcare systems. Section 1332 of the ACA created State Innovation Waivers, which waive a state's requirements to create ACA components, such as benefit packages and healthcare exchanges. It also establishes how states can fund their healthcare reforms. If given a waiver, Colorado would be eligible to receive subsidies that would otherwise go to state residents, including cost-sharing reductions, premium tax credits and small business tax credits. This means that Colorado could receive federal funding that could go toward the healthcare system that would otherwise go to Colorado residents. For more information, the Centers for Medicare and Medicaid Services created a page dedicated to explaining Section 1332 waivers, found here.[51][52]

Vermont attempted a similar single-payer healthcare system reform, but state leaders concluded the tax raise might hurt their economy. “It is not the right time for Vermont," said Gov. Peter Shumlin.[53] On September 9, 2015, Hawaii was the first state to draft a potential Section 1332 waiver and posted it for public comment. However, the state proposed waiving certain sections of the ACA versus creating an entirely new healthcare system like ColoradoCare. The Hawaii proposal can be read in full here.

Senate Concurrent Resolution 2 (2013)

Sen. Irene Aguilar (D-32) introduced a bill in 2013 to create a universal, single-payer healthcare system similar to ColoradoCare. The bill would have raised taxes by 9 percent to create about $16 million to fund the system. Senate Concurrent Resolution 2 would have been referred to the ballot and decided by Colorado voters, but with no Republican support and concern that special interests would spend large amounts to defeat the bill at the ballot, Aguilar motioned to kill her bill. "I had hoped that I could move forward with this resolution and send it to a vote of the people. Unfortunately, I was wrong," she said.[54][55]

The ColoradoCare Concept

The Colorado Foundation for Universal Health Care, Co-operate Colorado, and ColoradoCare Yes collaborated to conceptualize ColoradoCare. The chart below shows the relationship between the three organizations:

ColoradoCare2015.png

Insurance coverage in Colorado

See also: Health insurance coverage by source

In general, employers have been the dominant source of health insurance for individuals since the late 1940s and 1950s. This can be at least partially attributed to the income tax exemption granted to employers for payments made toward health insurance for employees. The second major sources of health insurance are the state and federal governments, which jointly provide Medicaid for low-income individuals while the federal government sponsors Medicare for the elderly and disabled.[56]

In 2013, about 52 percent of Colorado residents were insured through their employers. Medicaid covered 12 percent of Colorado's population, while another 12 percent were enrolled in Medicaid. The state's uninsured rate was 13 percent, equal to the national rate.[57]

Health insurance coverage by source, 2013
State Employer Other private Medicaid Medicare Other public Uninsured
Colorado 52% 9% 12% 12% 3% 13%
New Mexico 38% 5% 20% 18% N/A 16%
Utah 58% 8% 10% 11% N/A 11%
Wyoming 49% 5% 11% 12% 5% 17%
United States 48% 6% 16% 15% 2% 13%
Source: The Henry J. Kaiser Family Foundation, "State Health Facts"

Healthcare costs in Colorado

See also: Total healthcare spending by state

In 2009, the most recent year for which state-level data are available, total healthcare spending nationwide was $2.5 trillion. In Colorado, total healthcare spending amounted to $30.1 billion, 12.3 percent of gross state product (GSP). Total spending came out to about $5,994 per person. Between 1991 and 2009, healthcare spending in Colorado experienced the slowest average annual growth rate among its neighboring states, 7.3 percent.[58][59][60]

Total healthcare spending*, 2009
State Total health spending (in millions) Percent of GSP Health spending per capita Avg. annual percent growth†
Colorado $30,060 12.3% $5,994 7.3%
New Mexico $13,350 17.9% $6,651 7.7%
Utah $13,990 12.5% $5,031 7.9%
Wyoming $3,833 11.2% $7,040 7.6%
United States‡ $2,505,800 17.4% $8,175 6.8%
* "Total Health Spending includes spending for all privately and publicly funded personal health care services and products (hospital care, physician services, nursing home care, prescription drugs, etc.) by state of residence. Hospital spending is included and reflects the total net revenue (gross charges less contractual adjustments, bad debts, and charity care)."
† 1991–2009
‡ Data come directly from the Centers for Medicare and Medicaid Services, "NHE Summary including share of GDP, CY 1960-2013"
Source: The Henry J. Kaiser Family Foundation, "State Health Facts"


Most of Colorado’s healthcare spending went towards hospital care costs. The second largest share of healthcare spending went towards physician and professional services, which was greater in Colorado than the national average.[61]

Reports and analyses

Colorado Health Institute

The Colorado Health Institute published a report on Amendment 69, outlining the basics of ColoradoCare. The institute determined that 4.4 million people or 82.6 percent of Colorado’s population would be eligible for health insurance coverage under the plan. The remaining 17.4 percent of the population would be covered by Medicare, military, or other federal government insurance.[2]

The reports concludes:[2]

“ If approved, ColoradoCare would launch the most far-reaching health care reform in any state since the ACA. In fact, its consequences would be even larger than the ACA in Colorado. While the ACA sought to increase coverage by funneling more people into the current systems of private or public insurance, ColoradoCare would create a new system, displacing both Medicaid and private insurance.[6] ”

The full report is available here.

Path to the ballot

See also: Laws governing the initiative process in Colorado and Amending the Colorado State Constitution

Supporters needed to gather at least 98,492 valid signatures by a deadline on August 8, 2016, for the measure to qualify for the 2016 ballot. Proponents submitted 156,107 signatures on October 23, 2015, and the state verified 109,134 signatures as valid on November 9, 2015, certifying Amendment 69 for the ballot.[62][34][63]

Amendment 69 was called Initiative 20 during circulation. The designated representatives of the initiative petition are Ralph Ogden and William Semple.

Cost of signature collection

Cost of signature collection:
Sponsors of the measure hired Kennedy Enterprises to collect signatures for the petition to qualify this measure for the ballot. A total of $283,250 was spent to collect the 98,492 valid signatures required to put this measure before voters, resulting in a total cost per required signature (CPRS) of $2.88.

State profile

USA Colorado location map.svg

This excerpt is reprinted here with the permission of the 2016 edition of the Almanac of American Politics and is up to date as of the publication date of that edition. All text is reproduced verbatim, though links have been added by Ballotpedia staff. To read the full chapter on Colorado, click here.


One summer day in 1893, Katherine Lee Bates, an English teacher at Colorado College, made her way by prairie wagon and mule up 14,114-foot Pikes Peak. Inspiration struck as she looked out over the spacious skies from the purple mountain’s majesty to the amber waves of grain on the fruited plain, and she wrote the first version of America the Beautiful. Set to music, her words have resonated ever since, even though more than 90 percent of Americans up through World War II lived east of the Rockies, which rise above Denver, Boulder and Colorado Springs on the mile-high plateau. Colorado, the centennial state admitted to the Union in 1876, with its magnificent and contrasting landscapes, has long had a hold on the American imagination. And Colorado, as it has developed over the years, has been at the front edge of economic, cultural and political change. For all its scenery, it is demographically an urban state, with nearly half its 5 million people in metropolitan Denver and four-fifths in the urban strip paralleling the Front Range. And it is a healthy state, with the nation’s lowest rates of obesity ... (read more)

Demographic data for Colorado
 ColoradoU.S.
Total population:5,197,580314,107,084
Land area (sq mi):103,6423,531,905
Gender
Female:49.8%50.8%
Race and ethnicity
White:69.4%62.8%
Black/African American:4%12.6%
Asian:2.8%5%
Native American:1%0.8%
Pacific Islander:0.1%0.2%
Two or more:3.5%2.9%
Hispanic/Latino:20.9%16.9%
Education
High school graduation rate:90.4%86.3%
College graduation rate:37.5%29.3%
Income
Median household income:$59,448$53,482
Persons below poverty level:13.1%14.8%
Source: U.S. Census Bureau, "American Community Survey" (5-year estimates 2010-2014)

Presidential Voting Pattern

The percentages below show Colorado voter preference in general election presidential races.

Colorado vote percentages

  • 2012: 51.5% Democratic / 46.1% Republican
  • 2008: 53.7% Democratic / 44.7% Republican
  • 2004: 47% Democratic / 51.7% Republican
  • 2000: 42.4% Democratic / 50.8% Republican

U.S. vote percentages

  • 2012: 51.1% Democratic / 47.2% Republican
  • 2008: 52.9% Democratic / 45.7% Republican
  • 2004: 48.3% Democratic / 50.7% Republican
  • 2000: 48.4% Democratic / 47.9% Republican


More Colorado coverage on Ballotpedia

Recent news

This section displays the most recent stories in a Google news search for the terms Colorado ColoradoCare Amendment 69. This list of articles is automatically generated from Google. Ballotpedia does not curate or endorse these articles; they are included to provide readers with the most recent news articles on the subject. Click here to learn more about this section.

Colorado Creation of ColoradoCare System, Amendment 69 (2016) - Google News Feed

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Related measures

Healthcare measures on the ballot in 2016
StateMeasures
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CaliforniaProposition 61, California Drug Price Standards 
NevadaNevada Medical Equipment Sales Tax Exemption, Question 4 
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See also

BP-Initials-UPDATED.png
 		Suggest a link

External links

Basic information

Support

Opposition

Footnotes

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Colorado Secretary of State, "Text of Initiative 20 (Amendment 69)," accessed October 27, 2015
  2. ↑ 2.0 2.1 2.2 Colorado Health Institute, "ColoradoCare: An Independent Analysis," April 2016
  3. ↑ Colorado Department of Revenue, "Pension/Annuity Subtraction," accessed July 15, 2016
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Colorado Secretary of State, "Ballot Measure Information Guide 2016," accessed October 10, 2016
  5. ↑ Colorado Secretary of State, "Results for Proposed Initiative #20," accessed October 27, 2015
  6. ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 Note: This text is quoted verbatim from the original source. Any inconsistencies are attributed to the original source.
  7. ↑ ColoradoCare Yes, "Homepage," accessed October 9, 2016
  8. ↑ The Guardian, "ColoradoCare: universal healthcare plan has Democrats divided," May 20, 2016
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 ColoradoCare Yes, "Endorsers," accessed October 10, 2016
  10. ↑ ColoradoCare Yes, "Senator Irene Aguilar, MD: “ColoradoCare is real progress, right now," August 19, 2016
  11. ↑ 11.0 11.1 Public News Service, "State senators make case for universal healthcare initiative," January 27, 2016
  12. ↑ 12.0 12.1 Public News Service, "Universal Health Care Ballot Initiative Wins Ally in Colorado," December 17, 2015
  13. ↑ Our Revolution, "Ballot Initiatives," accessed October 4, 2016
  14. ↑ The Colorado Independent, "In Colorado, Green Party’s Jill Stein won’t endorse the ColoradoCare universal healthcare ballot measure," August 27, 2016
  15. ↑ ColoradoCare Yes, "Know the Facts," accessed October 10, 2016
  16. ↑ The Colorado Independent, "Bernie Sanders: Colorado could “lead the nation” with its universal healthcare ballot measure," October 26, 2015
  17. ↑ The Denver Post, "Yes on Amendment 69: Coloradans should take back their health care," September 30, 2016
  18. ↑ Boulder Weekly, "Heath care: A right or a privilege?" October 6, 2016
  19. ↑ 19.0 19.1 Coloradans for Coloradans, "Homepage," accessed October 10, 2016
  20. ↑ 20.0 20.1 20.2 Denver Post, "No on Amendment 69: ColoradoCare would be too costly," April 1, 2016
  21. ↑ Coloradans for Coloradans, "Endorsements," October 10, 2016
  22. ↑ Akron News Reporter, "Stapleton stops in Akron to advocate against Amendment 69," August 3, 2016
  23. ↑ 23.0 23.1 23.2 23.3 23.4 Colorado Independent, "Sen. Michael Bennet comes out against ColoradoCare," April 21, 2016
  24. ↑ Daily Sentinel, "Club 20 concensus: No to ColoradoCare," April 2, 2016
  25. ↑ The Intercept, "Health care industry moves swiftly to stop Colorado's 'single payer' ballot measure," April 22, 2016
  26. ↑ 26.0 26.1 26.2 Denver Post, "Would Amendment 69 limit access to abortion in Colorado?" June 24, 2016
  27. ↑ BC Democrat, “NARFE Colorado chapter opposes ColoradoCare,” October 11, 2016
  28. ↑ Business Times, "NFIB: Colorado members oppose ColoradCare plan," June 22, 2016
  29. ↑ Daily Camera, "Boulder Valley chamber coalition supports measure 71, opposes 69," September 21, 2016
  30. ↑ 30.0 30.1 The Journal, "Planned Parenthood opposes health care proposal," September 12, 2016
  31. ↑ Fox 31 Denver, "Progress Now comes out against Colorado Care ballot measure," August 17, 2016
  32. ↑ 32.0 32.1 Daily Sentinel, "Coalition launches opposition to universal healthcare proposal," January 28, 2016
  33. ↑ The Gazette, "GUEST COLUMN: Amendment 69 is an unmitigated disaster for Coloradans," April 3, 2016
  34. ↑ 34.0 34.1 Denver Business Journal, "Universal-health-care advocates submit signatures for 2016 Colorado ballot measure," October 23, 2015
  35. ↑ 35.0 35.1 35.2 Mother Jones, "Here's Why Abortion Advocates Won't Vote for Universal Health Care in Colorado," September 12, 2016
  36. ↑ Colorado Office of Legislative Legal Services, "Colorado Constitution," accessed October 10, 2016
  37. ↑ ColoradoCare Yes, "Memorandum on the Conflict between Colorado Constitution Article V, Section 50 and Amendment 69 with respect to funding elective abortions with state tax monies," June 13, 2016
  38. ↑ Note: These totals may include in-kind donations as well as cash donations.
  39. ↑ Note: This date is the most recent date on which Ballotpedia staff researched campaign finance data. The actual date through which this information is accurate depends on the campaign finance reporting requirements in this state.
  40. ↑ 40.0 40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 Colorado Secretary of State, "TRACER Committee Search," accessed October 18, 2016
  41. ↑ Note: The totals listed below do not include in-kind donations, which are detailed in a separate section below.
  42. ↑ Note: The totals listed below do not include in-kind donations, which are detailed in a separate section below.
  43. ↑ The Aurora Sentinel, "Editorial: Vote ‘yes’ on Amendment 69 — Colorado Care is good medicine for everyone," October 11, 2016
  44. ↑ The Coloradoan, "Editorial: We need a better plan than ColoradoCare," October 7, 2016
  45. ↑ The Denver Post, "A resounding “no” on Amendment 69: Voters should reject ColoradoCare," October 14, 2016
  46. ↑ Longmont Times-Call, "Editorial: Choose 'yes' to shorten the Colorado ballot," October 1, 2016
  47. ↑ Loveland Reporter-Herald, “Choose 'yes' to shorten the ballot,” October 1, 2016
  48. ↑ The Tribune, "Tribune Opinion: We’re opposed to Colorado’s universal health care amendment, other constitutional measures; we support aid in dying, primary changes," October 14, 2016
  49. ↑ Magellan Strategies, "Amendment 69 / ColoradoCare Survey Findings," September 6, 2016
  50. ↑ Colorado Mesa University, "CMU-RMPBS Poll Results," September 18, 2016
  51. ↑ If approved, Amendment 69 would be approved before Colorado would be issued a Section 1332 waiver. The amendment would create an interim board of trustees that would apply after it was appointed by the governor and legislative leaders.
  52. ↑ Health Affairs Blog, "Section 1332 Waivers And The Future Of State Health Reform," December 5, 2014
  53. ↑ Politico, "Why single payer died in Vermont," December 20, 2014
  54. ↑ Denver Business Journal, "Aguilar kills her state-run healthcare measure," April 12, 2013
  55. ↑ Colorado Legislature, "Senate Concurrent Resolution 2," accessed October 10, 2016
  56. ↑ Health Affairs, "Employment-Based Health Insurance: Past, Present, And Future," November 2006
  57. ↑ The Henry J. Kaiser Family Foundation, "Health Insurance Coverage of the Total Population," accessed July 23, 2015
  58. ↑ The Henry J. Kaiser Family Foundation, "Health Care Expenditures by State of Residence (in millions)," accessed July 17, 2015
  59. ↑ The Henry J. Kaiser Family Foundation, "Health Care Expenditures per Capita by State of Residence," accessed July 17, 2015
  60. ↑ The Henry J. Kaiser Family Foundation, "Average Annual Percent Growth in Health Care Expenditures by State of Residence," accessed July 17, 2015
  61. ↑ The Henry J. Kaiser Family Foundation, "Distribution of Health Care Expenditures by Service by State of Residence (in millions)," accessed August 27, 2015
  62. ↑ Colorado Secretary of State, "2015 - 2016 Proposed Initiatives," accessed October 27, 2015
  63. ↑ Colorado Public Radio, "Universal Health Care Measure Certified For Colorado's 2016 Ballot," November 10, 2015
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