Summary of Amendment 69 ● 11-page Amendment ● Not a lot of details

Why now? The ACA has not worked very well Current system is expensive Many are still uninsured Many believe other international models work better

● Will appear on the November ballot ● Would changed the Colorado Constitution ● Would eliminate all private health insurance and workers’ compensation ● Creates a government-run healthcare system in Colorado ● Would create new taxes, giving Coouble the state budget ● Would create a 21-member board of trusteeo determine what is covered and what is not Will appear on the November ballot Would changed the Colorado Constitution Would try to obtain an “Innovation Waiver” under the ACA Would eliminate all private health insurance and workers’ compensation Creates a government-run healthcare system in Colorado Would cover every resident in the state Summary of Amendment 69 (cont.)

● Will appear on the November ballot ● Would eliminate all private health insurance and workers’ compensation ● Creates a government-run healthcare system in Colorado ● Would create new taxeate a 21-member board of trustees ● Authority to raise taxes annually ● Authority to determine provider reimbursements ● Authority to determine what is covered and what is not Would offer “Platinum” plan with no deductibles Would create new taxes, giving Colorado citizens the highest taxes in the country Would double the state budget Would create a 21-member board of trustees Authority to raise taxes annually Authority to determine provider reimbursements Authority to determine what is covered and what is not Summary of Amendment 69 (cont.)

● Creates a new political subdivision of the State to run a state-funded healthcare system which would take over administration of these existing sources of coverage: ● Medicaid and Children’s Health Insurance Program (CHIP) ● Individual and group plans ● Workers’ compensation insurance ● All other state and federal healthcare funds for Colorado would go to ColoradoCare if Innovation Exemption is approved Summary of Amendment 69 (cont.)

Proponents say… Will save money ($4.5 B per year)Benefits will be betterSystem will be easier to navigate

Another perspective… ● Colorado GDP (2012) $295.3 Billion ● Total State budget projected to be $27 billion in 2017 ● Would nearly double the state budget ● Not a true single payer; would still have Medicare, Tri-care (military) and other federal programs (will still be a fragmented system) ● 21 people would be responsible for nearly 10% of GDP and 50% of total tax revenues ● We give up subsidies ● Non-tax-deductible: Federal government subsidizes employer-sponsored health insurance by $500 billion per year, nationally. Colorado would lose it’s share. ● Unclear if Colorado would recapture the federal monies from Medicaid and premium subsidies through the exchange.

Huge tax increases ● Payroll Tax ● 6.66% employer paid ● 3.33% employee paid ● Other Taxes ● 10% non-payroll income (anyone with a K-1) ● Taxes may be increased every year without legislative approval! The new board would have the ability to raise taxes any amount they deem necessary with a simple majority vote ● Exempt from Tabor ● Will hurt people on fixed incomes ● Medicare recipients will be taxed (except first $33k)

What happens if there is a shortfall? ● Benefits will be “Platinum” level ● There are many assumptions to arrive at the projected savings ● True cost is uncertain ● Who will provide a back-stop if there is not enough money?

NO ACCOUNTABILITY Establishes a 21-Member Board of Trustees ● A “member-elected” board (Note: “Member” is a defined term meaning a beneficiary of the program who is at least 18 years old and has been a resident of Colorado for at least one continuous year) ● 3 Trustees from each of 7 districts for a total of 21 Trustees ● Trustees shall serve 4-year terms; eligible to serve 2 consecutive terms ● Trustees can be removed for cause by a majority vote of other Trustees, but are not subject to recall elections ● The elected board may modify the boundaries of the 7 districts once every 10 years, within 1 year after the decennial census figures are published.11 people to gain a majority A “member-elected” board (Note: “Member” is a defined term meaning a beneficiary of the program who is at least 18 years old and has been a resident of Colorado for at least one continuous year) 3 Trustees from each of 7 districts for a total of 21 Trustees Trustees shall serve 4-year terms; eligible to serve 2 consecutive terms Trustees can be removed for cause by a majority vote of other Trustees, but are not subject to recall elections Special interest groups (i.e., pharmaceutical companies, etc.) would only have to focus on convincing 11 people to gain a majority

A long history of guessing wrong… Medicare 1967 Projected cost in 1990 to be $12 billion Actual cost in 1990: $98 billion (off by 800%) Medicaid 1987 Projected cost in 1992 to be $1 billion Actual Cost in 1992=$17 billion (off by 1700%) Medicare 2015 Cost: $605 billion

Impact on Care Will pay physicians % of Medicare Most physicians cannot run their practice on this The most-skilled physicians won’t move to Colorado Lower reimbursements The 10% non-payroll tax will have a huge impact

Impact on Care (cont.) Little incentive for hospitals to invest in new technology Hospitals will invest in more profitable markets (states), leaving Colorado’s medical infrastructure in the past Medical innovation may slow in Colorado Teaching hospitals may struggle

An island among free market systems…

Vermont’s Failed Experience “In my judgment, the potential economic disruption and risk would be too great to small businesses, working families and the state's economy." - Vermont Gov. Peter Shumlin Promised Too MuchToo ExpensiveNo Savings Platinum level of benefits Determined it would require a 160% tax increase Determined cost savings were not going to materialize

How it will read… SHALL STATE TAXES BE INCREASED $25 BILLION ANNUALLY [1] IN THE FIRST FULL FISCAL YEAR, AND BY SUCH AMOUNTS THAT ARE RAISED THEREAFTER, BY AN AMENDMENT TO THE COLORADO CONSTITUTION ESTABLISHING A HEALTH CARE PAYMENT SYSTEM TO FUND HEALTH CARE FOR ALL INDIVIDUALS WHOSE PRIMARY RESIDENCE IS IN COLORADO, AND, IN CONNECTION THEREWITH, CREATING A GOVERNMENTAL ENTITY[2] CALLED COLORADOCARE TO ADMINISTER THE HEALTH CARE PAYMENT SYSTEM; PROVIDING FOR THE GOVERNANCE OF COLORADOCARE BY AN INTERIM APPOINTED 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 HEALTH CARE 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[3]; REQUIRING COLORADOCARE TO CONTRACT WITH HEALTH CARE PROVIDERS TO PAY FOR SPECIFIC HEALTH CARE BENEFITS; TRANSFERRING ADMINISTRATION OF THE MEDICAID AND CHILDREN’S BASIC HEALTH PROGRAMS AND ALL OTHER STATE AND FEDERAL HEALTH CARE 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[4] TO ESTABLISH A COLORADO HEALTH CARE PAYMENT SYSTEM; AND SUSPENDING THE OPERATIONS OF THE COLORADO HEALTH BENEFIT EXCHANGE AND TRANSFERRING ITS RESOURCES TO COLORADOCARE? [1] IN THE FIRST FULL FISCAL YEAR, AND BY SUCH AMOUNTS THAT ARE RAISED THEREAFTER, BY AN AMENDMENT TO THE COLORADO CONSTITUTION ESTABLISHING A HEALTH CARE PAYMENT SYSTEM TO FUND HEALTH CARE FOR ALL INDIVIDUALS WHOSE PRIMARY RESIDENCE IS IN COLORADO, AND, IN CONNECTION THEREWITH, CREATING A GOVERNMENTAL ENTITY[2] CALLED COLORADOCARE TO ADMINISTER THE HEALTH CARE PAYMENT SYSTEM; PROVIDING FOR THE GOVERNANCE OF COLORADOCARE BY AN INTERIM APPOINTED 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 HEALTH CARE 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[3]; REQUIRING COLORADOCARE TO CONTRACT WITH HEALTH CARE PROVIDERS TO PAY FOR SPECIFIC HEALTH CARE BENEFITS; TRANSFERRING ADMINISTRATION OF THE MEDICAID AND CHILDREN’S BASIC HEALTH PROGRAMS AND ALL OTHER STATE AND FEDERAL HEALTH CARE 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[4] TO ESTABLISH A COLORADO HEALTH CARE PAYMENT SYSTEM; AND SUSPENDING THE OPERATIONS OF THE COLORADO HEALTH BENEFIT EXCHANGE AND TRANSFERRING ITS RESOURCES TO COLORADOCARE?

Summary Too expensiveWill cost jobsMay lead to less access to care and lower quality of careLittle accountability and oversight