In recent years, experimentation with single-payer and universal health care systems has largely taken place in the nation's governmental laboratories.

Most of us call them states.

Some states—most notably Vermont—have investigated building a single-payer system for health care consumers within their borders. However, the hurdles were too great to overcome in the Green Mountain State and Gov. Peter Shumlin had to put a halt to single payer due to a very high price tag in 2014. Fast forward to the 2016 presidential election cycle, and the issue again cropped up in the campaign of Vermont's own Bernie Sanders, who made universal health care a central plank in his socialist-minded platform. Sanders created a lot of exposure for the idea, and several states—up to 20 by some estimates—have opted to explore single-payer or universal health coverage in the past few years.

As the Sanders campaign relented to the presidential bid of Hillary Clinton, the center of the debate this election year has turned to the Rocky Mountains, where residents of Colorado will see a universal health care system proposed on their ballot in November. (It may not come as a surprise that Sanders won the state's Democratic primary handily.)

ColoradoCare

Like a few other states, Colorado has a ballot initiative process to bring questions directly to voters. Proponents of a universal system gathered 156,000 signatures—more than enough for the initiative to appear on the ballot—in support of adding what's known locally as Amendment 69 to the ballot. If passed, the measure would add a 12-page amendment to the state's constitution and create ColoradoCare.

In essence, Amendment 69 would create one large insurance group for the state that would be governed by ColoradoCare's elected board of 21 trustees. Proponents call ColoradoCare a universal plan because some payers, such as Tricare, Medicare and Medicaid, would remain in place. In these instances, ColoradoCare would act as a supplemental policy.

According to ColoradoCare's website, the system would cover primary and specialty care; hospitalization; prescription drugs and medical equipment; mental health and substance use 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; and palliative and end-of-life care.

Under ColoradoCare, there would be no deductibles and designated primary and preventive care services would have no co-payments. ColoradoCare would replace the state's health insurance exchange.

To pay for the program, Colorado would collect a 10 percent payroll tax—3.33 percent from the employee and 6.7 percent from the employer. Residents who are 65 years and older would see some of their retirement and Social Security income exempted from the tax, up to $46,000 for individuals and $75,000 for joint filers. While employers would still be able to offer their own health insurance plans to employees, the ColoradoCare tax would still be collected.

ColoradoCare would also have to apply for several waivers from federal programs—such as the ACA—and have the money redirected to the system. Owen Perkins, communications director for ColoradoCare, says that Colorado is the first state in the nation to apply for an ACA waiver.

“The ACA leaves roughly 6 percent of the population uncovered and roughly a fifth of the population underinsured,” says Perkins. “You wind up with a million people without realistic access to health care. It's people who are required to get health care under the ACA, but they're making too much for Medicaid and not enough for adequate care. They've got deductibles that make their health insurance inaccessible.”

The debate

ColoradoCare proponents see health care as a fundamental right, like education and fire protection. They believe the system would reduce the overall amount Coloradans spend on health care, while improving quality and providing coverage for everyone. The system's backers estimate that 80 percent of Coloradans will pay less under ColoradoCare.

According to ColoradoCare's projections, the savings would come from reduced administrative costs, while increased purchasing power would give the system the ability to more aggressively negotiate prices with drug and medical equipment makers.

However, opponents of Amendment 69 say that the measure is short on details. They also point out that passage of the amendment would mean an alteration to the state constitution—a remedy too severe for the problem.

“The promise that a simple solution like combining all buyers into one block will result in more affordable care for all—unfortunately, it isn't that simple,” says Joni Reents, president of the Colorado State Association of Health Underwriters and owner of the Reents Insurance Agency in Broomfield, Colorado. “And ColoradoCare is not the solution, but rather an experiment that will be embedded in our constitution.”

Reents also isn't convinced that ColoradoCare's savings will materialize over time. “When there isn't enough money to keep up with the demand for health care, ColoradoCare will either have to ration care, increase taxes, reduce reimbursement, or some combination of the three,” Reents says. “Rationing of care in a single-payer model is accomplished by limiting access, which results in longer wait times.”

Perkins says that the quality of health care would actually improve because networks would be eliminated. Under ColoradoCare, patients would be able to choose their primary care physician, while doctors could send patients to other doctors without restrictions.

“Everybody on ColoradoCare gets the same access and the doctors get the full reimbursement,” Perkins says. “It also eliminates an incredible amount of bureaucracy for doctors because you do away with narrow networks of choice, so the doctor can send the patient to the provider they think is the best one and provide the best care.”

Perkins also points to ColoradoCare's independence as a main benefit of the system. After attempts to push health care reform through the Colorado state legislature failed, architects of universal health care not only went with the ballot initiative process, they also proposed a system that's largely free from government and private industry. However, the state would be responsible for collecting start-up taxes and the full tax if Amendment 69 were to pass.

“It's not in the hands of the legislature, Washington politicians, or the corporate insurance industry,” Perkins says. “This takes it out of government hands, D.C. politicians' hands and away from the groups who are focused on profits and puts it into the hands of Coloradans. It removes that interference between them and their provider.”

Impact on benefits professionals