2016 Colorado Amendment 69

2016 Colorado Amendment 69

November 8, 2016
Creation of ColoradoCare System
Results
Choice Votes % Yes 568,683 21.23% No 2,109,868 78.77% Total votes 2,678,551 100.00%
County results No   >90%   80–90%   70–80%   60–70%   50–60%

Amendment 69 was an initiated constitutional amendment that appeared on the November 8, 2016, ballot in the state of Colorado. The measure aimed to create a universal healthcare scheme for state residents by establishing ColoradoCare, which would be paid for through the introduction of a 10% payroll tax.^[1]

The amendment received bipartisan opposition and was rejected by Colorado voters in a landslide, failing to pass in each of the state's 64 counties.^[2]

Amendment 69 was a citizen-initiated constitutional amendment that would have established ColoradoCare, a statewide program to provide universal healthcare coverage for state residents. It was placed on the November 2016 ballot after receiving 156,000 signatures in support, meeting the minimum of 99,000.^[3][4] ColoradoCare would have operated as a cooperative, with members^[a] electing 21 trustees to oversee operations and vote on tax increases to allocate additional funding to the program.^[1][5]

ColoradoCare would have been primarily funded through the introduction of a 10% payroll tax, with two-thirds paid by employers and one-third paid by employees. Provisions in the Affordable Care Act mean that Colorado could have received federal funding towards the universal healthcare system.^[6][1] A portion of Social Security and retirement income — up to $33,000 for individuals and $60,000 for couples — would have been exempt from the ColoradoCare tax. High-income earners would have only paid ColoradoCare taxes on income below $350,000.^[5]

In 2013, over half of Colorado's population were insured through their employers, while another 12% were covered by Medicaid. The state's uninsured rate was identical to the national rate of 13%.^[7] The introduction of ColoradoCare would not have prevented residents from purchasing private health insurance,^[1] and the Colorado Health Institute estimated that 83% of Colorado's population, or around 4.4 million people, would have been eligible for primary health insurance coverage through the system, while the remaining 17% would be covered by Medicare, military, or other federal government insurance.^[1][5]

The campaign in favor of Amendment 69 was primarily led by the organization ColoradoCare YES.^[8] State senator Irene Aguilar, who The Guardian called the "chief architect" of ColoradoCare, claimed that a "disconnect" existed between "the powers that be and the people" in relation to healthcare coverage.^[8] Aguilar defended the proposal against economic concerns, pointing out that residents already pay $25 billion yearly – the estimated cost of ColoradoCare – in the form of a penalty tax for not having a healthcare plan, much of which is used to fund ObamaCare subsidies.^[9][10]

Bernie Sanders was the lone U.S. senator in support of Amendment 69, telling The Colorado Independent that the state could lead the way to improve healthcare, adding that the United States was "the richest nation on earth" and should therefore make healthcare a right for all citizens.^[9]

After the Colorado Health Institute conducted a study estimating deficits of over $8 billion after a decade of ColoradoCare,^[5] the Colorado Foundation for Universal Health Care came out in support of the program and stated that the Health Institute's study failed to include revenue from Medicaid or account for the slowed growth of health care inflation from a single-payer system.^[11] The foundation conducted their own study, concluding that ColoradoCare was financially feasible and would result in a net positive impact on the state's economy.^[12] The ColoradoCare YES campaign also released an analysis, which estimated the state would save $6.2 billion in administrative costs while residents would see a $4.5 billion reduction in expenses.^[4]

Boulder-based newspaper The Daily Camera described efforts to understand the effects of Amendment 69 as "a little like looking at the outline of a novel and trying to imagine the finished book."^[13] Nonetheless, the paper's editorial board narrowly voted to endorse the measure, urging Colorado residents to cast a protest vote in support of a better healthcare system. In their endorsement, the board said that voting "no" implies approval of the current healthcare system.^[13]

Amendment 69 received opposition from national and state politicians from both major parties, with the group Coloradans for Coloradans (also referred to as No on 69) leading the opposition campaign.^[1] ColoradoCare YES claimed most of Coloradans for Coloradans' funding came from corporations. Sean Duffy, a spokesperson for Coloradans for Coloradans, told The Guardian that the group had spoken to numerous companies who have said that the amendment would hurt their ability to operate.^[8]

Opponents, including hospitals and insurers, raised more than $5 million, significantly overshadowing the $900,000 raised by supporters of the amendment.^[1][14] Health insurance provider Anthem (now known as Elevance Health), spent over $1 million opposing Amendment 69.^[15]

Coloradans for Coloradans hired the Democratic consultant firm Global Strategy Group, who were simultaneously working with Priorities USA Action, a super PAC associated with Hillary Clinton's presidential campaign.^[8] Clinton briefly mentioned Amendment 69 at a 2015 campaign rally in Boulder, but didn't explicitly make a case for or against the measure.^[8] In October 2016 as part of the Podesta emails, WikiLeaks released email correspondence between Clinton campaign staffers warning against mentioning ColoradoCare in speeches. Campaign manager Robby Mook purportedly wrote that the campaign were "avoiding ... [healthcare coverage] because of the single payer referendum,"^[16] to which deputy communications director Kristina Schake responded, "[Clinton's state campaign manager] Brad [Komar] asked us not to do health care tomorrow in Colorado because of the ballot initiative. Said it won't be helpful there."^[16]

Despite the Colorado Democratic Party's 2016 platform featuring support for Amendment 69,^[17] many of the state's prominent Democrats, including governor John Hickenlooper and senator Michael Bennet, opposed the measure.^[18][19] Abortion rights group NARAL Pro-Choice, now known as Reproductive Freedom for All, also opposed Amendment 69.^[20] While the organization reiterated their support for universal healthcare, they argued that a 1984 constitutional ban on the use of public funds for abortions would prohibit ColoradoCare from covering the procedure, limiting access for low-income earners.^[20] The Rocky Mountains chapter of Planned Parenthood endorsed against the measure for the same reason.^[21] ColoradoCare YES criticized this position, claiming that Amendment 69 would supersede the 1984 ban, which was enshrined in the state's constitution.^[22][23]

An August 2016 poll by Magellan Strategies found broad opposition to Amendment 69,^[63] with the ballot measure failing to gain net approval from any age group, gender or political affiliation.^[65][63]

Amendment 69

Choice	Votes	%
No	2,109,868	78.77
Yes	568,683	21.23
Total votes	2,678,551	100.00
Source: Colorado Secretary of State

Amendment 69 failed in each of Colorado's 64 counties,^[67] including the 22 counties won by Hillary Clinton in the concurrent presidential election.^[2][66] The ballot measure performed best in San Miguel County, with a 44.93% "Yes" vote, though Clinton carried the county by 45 points.^[2] Washington County recorded the highest "No" vote at 93.66%, outpacing Donald Trump's performance by almost 10 points.^[66]

The public policy think tank Third Way partially attributed the landslide defeat of Amendment 69 to public opposition to ColoradoCare from prominent Democratic politicians, including governor John Hickenlooper, Michael Bennet, and former governor Bill Ritter.^[67] They noted an August 2016 poll that showed 41% of Democrats supported Amendment 69, while 45% opposed it.^[67][65]

Irene Aguilar, a lead supporter of Amendment 69, responded to the results by saying "[w]in or lose, the issue of guaranteed access to healthcare for everyone without financial barriers was finally brought before the voters." Lyn Gullette, a ColoradoCare YES staffer, promised to continue campaigning for universal healthcare,^[14] while the group's spokesman Owen Perkins criticized the language used to describe Amendment 69 on the ballot, arguing that it omitted their estimates that ColoradoCare would save money long-term.^[14] He also said that the "Yes" campaign was defeated by some of "the biggest multi-billion dollar corporations in the country."^[68]

The Colorado Hospital Association said it was pleased that Amendment 69 was rejected by voters. "It was too risky, too uncertain and unaffordable for Colorado," the association wrote in a statement.^[14] Dr. Katie Lozano, president of the Colorado Medical Society, who largely opposed ColoradoCare, clarified that the amendment's failure does not show approval for the state's current healthcare system.^[14]

Journalist T. R. Reid, who supported Amendment 69, attributed the landslide loss to lopsided campaign spending, and told Colorado Public Radio that supports of ColoradoCare were "viciously outspent by the insurance companies",^[48] referencing large donations to the "No" campaign by insurance companies UnitedHealth, Anthem, Kaiser and Cigna.^[48]

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