Following two years in which it died on the Senate clock at the end of the legislative session, a bill to study converting Colorado to a Canada-style single-payer healthcare system passed the House on Wednesday and is now on its way to Gov. Jared Polis.
Senate Bill 45, sponsored by Democratic Sen. Janice Marchman of Loveland, would require the Colorado School of Public Health to analyze and suggest draft-model legislation for making this the first state to move away from privately funded health care. The bill outlines a 20-person collaborative that will help CSPH research and suggest a bill, which the group must present to the Legislature by the end of 2026.
One of the biggest obstacles that similar bills faced the past two years was a price tag to the state around $400,000 — a hurdle that sponsors overcame this year by replacing state funding with study funding that would be made entirely of gifts, grants and donations. Backers have said they don’t believe they will have any problem finding nonprofit funders for the study.
The other past issue for the bill was a slow movement through the General Assembly that let Republican Senate leaders demand the bill be set aside at the end of each session as a bargaining chip to let other bills that were higher priorities for Democrats to proceed. Backers overcame that this year by pushing SB 45 quickly out of the gate and getting even Democrats who might not be wild about the idea of single-payer healthcare to agree to back the bill because it is a study rather than a conversion to a new health system.
Questions surround proposed study
None of that lessened concern from business groups, insurers, Republicans and some medical providers that what backers called a study of the issue is nothing more than a fait accompli that supporters of single-payer health care will call the system the best option. The bill directs CSPH to present draft-model legislation for creating a single-payer system at the collaborative’s first meeting in July and begin the conversation from there, essentially looking to smooth out the bill rather than determine if it’s the best option, critics said.
“This idea requires analysis,” said Rep. Rick Taggart, R-Grand Junction. “That’s not a study. That’s not research. That’s not analysis. That is, in fact, a predetermined solution.”
Colorado state Rep. Rick Taggart speaks Wednesday against a bill to study conversion to a single-payer healthcare system.
If there is one thing that is predetermined, supporters said, it is that the current health system is not working. America spends twice per capita what other countries spend on health care and gets lesser outcomes, leaving too many people choosing between making themselves better or making themselves poorer, said William Semple, board president of the Colorado Foundation for Universal Health Care.
Cosponsoring Rep. Karen McCormick, D-Longmont, noted a high-level study commissioned by the Legislature in 2019 that suggested a single-payer system could save the state $5 billion over 10 years. As that study also suggested such a system could get more patients covered and potentially increase compensation for doctors, legislators owed it to constituents to investigate it further, she told the House Health and Human Services Committee last month.
What the single-payer study will examine
The study must analyze the one-, five- and 10-year costs for operating such a system, reimbursement rates necessary to retain healthcare providers, implications for hospitals and impacts on everything from behavioral health care to vision care to abortion access. The collaborative will include, among others, representatives from organized labor, the disabled community, homelessness advocates, advocates for historically marginalized communities and small and large business.
One group that does not have a designated spot on the board is the insurance industry — an industry that stands to get decimated if the state becomes the lone healthcare payer and that has experience in running a complex system of coverage. Rep. Brandi Bradley, R-Roxborough Park, attempted to add a representative to the board but was shut down in that request, as bill backers like Rep. Yara Zokaie, D-Fort Collins, said that sector’s influence at the Capitol has contributed heavily to the currently broken system.
Colorado state Rep. Yara Zokaie speaks Wednesday for a bill to study conversion to a single-payer healthcare system.
“What we are looking at is providing a prepaid system so that when care is needed, the question wouldn’t be ‘Will they impoverish me?’ but ‘What care do I need?” Semple told the House committee.
For all the talk about the current costs of health care, critics of undertaking the study said it’s been shown repeatedly that conversion to a single-payer system will require a tax hike the like of which Coloradans have never seen. A study done by similarly sized Oregon suggested implementation of a single-payer system there would require a $12.3 billion payroll tax and $7.6 billion income tax, noted Colorado Chamber of Commerce Senior Vice President of Governmental Relations Meghan Dollar.
A largely party-line debate
Bradley, a physical therapist, questioned too how Colorado could even contemplate running a healthcare system that is different from every other state’s when whole countries have issues with similar systems. In the United Kingdom, whose public health system often is held as a model, a report from early this year found that 3 million people were on waiting lists to see physicians that exceeded 18 weeks.
The final votes on SB 45 broke largely along party lines. The Senate passed it 23-10, with only Republican Sen. Cleave Simpson of Alamosa joining Democrats in their universal support, saying that the bill represents a study rather than a change of system. And the House passed it 39-25, with three Democrats — Reps. Bob Marshall of Highlands Ranch, Jacque Phillips of Thornton and Lesley Smith of Fort Collins — joining all Republicans in opposition and with Democratic Rep. Shannon Bird of Westminster excused from the vote.
It’s likely, that not assured, that Polis, a Democrat, will sign the bill. As a 10-year congressman, he was a supporter of single-payer healthcare, saying that it would take businesses out of the healthcare field and simplify the system with a single entity assigned to pay private doctors. However, when he ran for governor in 2018, Polis also added the caveat that such a system must be a national solution rather than one that’s left to each state to figure out.