The revamping of the U.S. health care system appears to be shifting from the federal arena to states, with fall ballot issues in Colorado and California challenging the status quo.

According to The New York Times, both ballot issues bear the indelible stamp, and have earned the endorsement of ex-presidential candidate Bernie Sanders. The Colorado ballot issue would bring to that state the single-payer health plan championed by Sanders during his bid for the Democratic nod. Californians will be asked to vote on whether to control the prices of certain prescription drugs, another issue Sanders has raised.

Under the terms of Amendment 69, the Colorado health plan would be funded in part by a new 10 percent state payroll tax and a 10 percent “nonpayroll income” tax that would create a health insurance fund of some $38 billion. The money would be used to provide health insurance to all Coloradans, according to the website Ballotpedia. Early polling has indicated the measure has strong support among young voters.

As the Times notes, the state health care industry has mounted an aggressive campaign to defeat the measure. But the $3.6 million raised by opponents in Colorado pales in comparison to the nearly $70 million poured into the anti-Prop. 61 campaign in California, most of it from insurance company war chests.

Prop. 61 would, says Ballotpedia, cap certain prescription drug prices at the prices set by the U.S. Department of Veterans Affairs — prices often far lower than drug companies are accustomed to receiving.

“This initiative was designed to restrict the amount that any state agency could pay for drugs [and] would apply in any case in which the state ultimately provides funding for the purchase of drugs, even if the drugs are not purchased directly by a government agency,” Ballotpedia says. “The measure only applies to the purchasing of drugs by state agencies and does not apply to purchases made by individuals.”

According to experts interviewed by the Times, the California measure is the more likely of the two to be approved by voters, despite the millions being spent to oppose it. “Of the two, I probably think the prescription drug piece, because people have so much anger and antipathy toward the pharmaceutical industry,” said John McDonough, professor at the Harvard T.H. Chan School of Public Health.

While two state ballot initiatives hardly constitutes a major trend, the Times reported that movements are under way in a number of states to introduce elements of health care reform at the local level that weren’t part of the federal legislation.

An Ohio initiative similar to California’s Prop. 61 didn’t make it onto the ballot this fall, but supporters are rallying to try to get it in front of voters next year. Other measures that could still appear on state ballots this fall would raise tobacco taxes, expand the applications of medical marijuana and add another state to those that allow physicians to assist patients who are terminally ill to end their lives.

But even the two measures that have made it to the ballot are yet another indication that referring to a presidential candidate like Sanders as “unsuccessful” may be a misnomer. Sanders’s backing of the issues was prominently referenced in the Times article, putting him in the enviable position of being able to take credit for reform without having to actually oversee its implementation.

Instant Insights /

California, Colorado voters put health care reform on the ballot

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