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On Election Day, Colorado voters will decide whether to implement the nation’s first universal healthcare plan.

Amendment 69 would establish ColoradoCare, a healthcare financing system that would provide medical coverage to all Colorado citizens without copays, coinsurance, or deductibles. Upon full implementation, the state would pay for the plan with a 10 percent payroll tax. About 6.67 percent of the tax would be paid by employers and 3.33 percent by employees. The state taxable portion of non-payroll income, such as capital gains, rental, or pension income, would also be subject to the full 10 percent tax paid via the personal income tax. Colorado citizens who receive healthcare from Medicare, the Veteran’s Administration, Federal Employee Health Benefits Plan, TRICARE (for military and dependents), and Indian Health Services, would maintain their current coverage. ColoradoCare would replace Medicaid and the state-run ACA marketplace. Citizens could opt out of ColoradoCare and purchase private insurance, but they would still be subject to the payroll tax.

A grassroots collaborative that ultimately formed Universal Health Care for Colorado initiated the ballot initiative. Proponents argue the plan will provide comprehensive care at a lower cost not only by reducing administrative costs, fraud, and duplication, but also by increasing purchasing power for bulk drugs and medical equipment.

Opponents are more skeptical, particularly of the financing method. Many who oppose the measure argue the payroll tax is insufficient to cover rising healthcare costs and could leave the state with significant unfunded liabilities. The Colorado Health Institute estimated that the proposal would amass an $8 billion deficit after 10 years that would continue to grow. Some groups that support universal healthcare, including the Colorado Fiscal Institute (CFI) oppose Amendment 69)due in part to the unsustainability of the tax.  Opponents have also cited concerns about the lack of gubernatorial or legislative oversight of the 21-member Board of Trustees that would make plan decisions, and lack of coverage for elective abortion care.

A  CFI analysis found that ColoradoCare could result in lower healthcare costs even for those currently without insurance who pay nothing in premiums; however, low-wage earners currently receiving Medicaid could end up paying more if tax credits are not made available. Further, it is unclear if the 10 percent payroll tax would be a sufficient long-term revenue source for financing healthcare, particularly since healthcare costs have grown faster than wages and inflation.