Supporters of single-payer health care hope third time is charm for advancing study bill

For the third year in a row, Colorado Democratic legislators have begun to advance a bill to study the impact of implementing a single-payer health-care system, though this year’s version of the legislation would carry no cost to the state itself.

The Senate Health and Human Services Committee on Thursday advanced Senate Bill 45 on a 6-3, party-line vote to the Senate Appropriations Committee. The bill’s supporters include medical professionals, local government leaders and the Colorado PTA, while business groups and the health-insurance industry are heading up the opposition.

SB 45, from Democratic Sens. Sonya Jaquez Lewis of Longmont and Janice Marchman of Loveland, tasks the Colorado School of Public Health with analyzing implementation of a government-funded universal health system in Colorado and suggesting a bill to do that. This investigation would be led by a 20-member collaborative of health-care officials, advocates for various interest groups and two employer representatives, and the report must be submitted to the Legislature by the end of 2026.

All those details mirror provisions in bills that died in the Senate the past two years — proposals that were tripped up partly by their expected $400,000 price tags and partly by Republican threats to filibuster them at the end of each session. One big difference between SB 45 and its predecessors is that the study and the collaborative in this year’s proposal would be funded entirely by gifts, grants and donations to CSPH and that the work could not begin until all the needed money has been raised.

Same song, different year?

Opponents reminded committee members that statewide voters in 2016 rejected by a 4-to-1 margin a ballot initiative that would have implemented a single-payer system in Colorado at a cost of $36.2 billion. And Meghan Dollar, senior vice president of government relations for the Colorado Chamber of Commerce, noted that a similar study conducted in Oregon said such a system there would require implementation of a $12.3 billion payroll tax and a $7.6 billion income tax.

But Democrats and bill supporters said that they believe the current health-care system is broken, pointing to the rising costs of care, the struggles of practitioners to comply with insurance requirements and the millions of Americans that have no health insurance. Several emphasized that the study is just a low-cost method to allow experts to study whether there is a better way to offer health care and does not commit the state to further changes if the bill passes.

“We can’t keep sticking our head in the sand about affordable, accessible health care. The committee is going to be made up of a lot of people with knowledge of health care,” Jaquez Lewis said. “This is going to dig into what we can do to lower costs for Coloradans of health care. We deeply need this.”

The study comes as small businesses in particular complain about annual double-digit percentage increases in the cost of health insurance — hikes blamed by different groups on government mandates, soaring pharmaceutical costs and rising hospital bills. It also comes as some 70% of hospitals within the state are operating with operational margins under 4%, a level that is considered unsustainable and that puts their ability to offer some services in jeopardy.

Details of proposed study

SB 45 would require CSPH to analyze whether a government-funded and privately operated universal health-care system could achieve the goals of “better, more affordable and fairer health care for all Coloradans” and propose legislation to implement such a system. That system, according to the bill, must, among other aims:

• Provide comprehensive physical, dental, hearing, vision and mental-health benefits at least at the level of public-assistance programs like Medicaid and Medicare;
• Be funded by premiums that are determined by an individual’s ability to pay, with no deductibles or copayments, and allow state residents to choose from among all providers in the healthcare system;
• Ensure “fair drug and hospital prices, as well as fair payments to providers,” with the caveat that provider reimbursement should be at 120% of current Medicare reimbursement rates; and,
• Prioritize benefits and access to care for patients while preventing “barriers to care that are imposed for the purpose of increasing profits.”

The analysis also would have to estimate the impact of implementing such a system on development of specialty and rare-disease pharmaceuticals, the price of pharmaceuticals and the ability for various socioeconomic groups to get care. Plus, it would task CSPH with assessing the impact on health-care facilities, private health insurers and the Colorado Option health plan, which requires insurers to offer certain plans at a lower cost.

Health insurers push back

Kevin McFatridge — executive director of the Colorado Association of Health Plans and representative of a sector that could disappear under a single-payer plan — said he is concerned the collaborative is skewed to favor a positive report in favor of such a system. Beyond that, though, the bill’s fatal flaw is that it does not require CSPH in its study and draft bill to consider the actual cost of running such a system or the operational burden it would have on participants.

“This bill creates a study that could be wrought with biases, potentially leading to a massive, government-run model,” McFatridge said.

Jaquez Lewis, however, said she believes that the study would have to answer a range of questions that otherwise would not be contemplated, including what reimbursement rate would be needed to retain providers and whether this would shut down research on drugs.

That seemed to lead to backing even from Democrats who have not expressed the same vocal support as the bill’s sponsors for the concept of a Canada-style, single-payer system. Sen. Kyle Mullica, a Thornton Democrat and emergency-room nurse, said: “I’m going to be a ‘yes’ because I don’t think there’s harm in a study and academia studies a lot of things.”

Would proponent accept results of study?

But Republicans and bill opponents noted that the issued has been studied — and been rejected by voters — and questioned why even state personnel resources through CSPH should be dedicated further to it. In one exchange, Sen. Lisa Frizell, R-Castle Rock, asked Clear Creek County Commissioner George Marlin, a bill supporter, what would happen if the study came back to show the cost of such a system to be prohibitively high and required limits in services.

“We’re going to have to keep turning over rocks, because this is not a problem we can accept,” said Marlin, speaking on behalf of the organization Counties & Commissioners Acting Together.

“The voters have spoken. They have said ‘no.’ We have studied and studied and studied,” Frizell said later in emphasizing her opposition to SB 45. “Are we going to keep studying this until we get the answer that a subset of in the state of Colorado wants?”

Senate leaders have not set a date yet for the next hearing for the bill.