2018 MIDTERM ELECTION

Time: D H M S

Dear Media: CO's Single Payer ballot initiative is ENABLED/PARTLY FUNDED BY THE ACA.

There's a lot of news stories of late about Colorado activists managing to successfully place a statewide initiative on the 2016 ballot which, if successful, would make Colorado the first state to move to a new Single Payer healthcare model.

I haven't written a whole lot about this so far, partly because we're still a year out, partly because I'm swamped with current Open Enrollment Period developments (believe me, I'll have more to say about it after the end of #OE3).

However, there's one meme which keeps coming up in the news which drives me a bit insane:

Setting aside the biased wording of the fourth headline (it's from Investor's Business Daily, what do you expect?), do you notice a running theme? They all refer to the proposed new plan as "replacing" the Affordable Care Act. Many of the actual stories accompanying these headlines refer to Colorado looking to "scrap" or "abandon" the ACA, as if it was a big waste of time and money which is being flushed down the toilet.

This bothers me every time I see a headline like the above, and especially when I see wording in ACA-related articles like this one from yesterday's NY Times:

In Colorado, unhappiness with the law has added momentum to an effort to replace it with a government-run health care program that would largely cut private insurers out. The initiative qualified for the 2016 ballot this month after supporters submitted over 158,000 signatures.

State Senator Irene Aguilar, a Democrat, said frustration with rising premiums and deductibles had fueled disillusionment, as had the recent collapse of a nonprofit cooperative that was the most popular insurer on the Colorado exchange.

The new system would be expensive, raising $25 billion a year in revenue from a 6.67 percent payroll tax on employers and a 3.33 percent tax deducted from workers’ paychecks.

It's a good article overall, and as a single payer advocate myself, I'm rooting for the Colorado initiative to succeed on both the ballot and in practice...but the framing of it as "abandoning" the Affordable Care Act is incredibly unfair to the Obama Administration and those who wrote the law, and I wish both opponents and supporters of single payer would stop phrasing it that way. Doing so is just as bad as, for instance, Republican Governor Rick Snyder and the Detroit News praising the "Healthy Michigan" program without mentioning that it was created by and is funded by the ACA.

Assuming it's successfully enacted, the proposed ColoradoCare system would be very much enabled BY and partly financed BY the Affordable Care Act itself.

Don't believe me? Here's the official explanation booklet:

How would it be funded?

It would be funded with Affordable Care Act (ACA) waiver funds granted to states that can innovate with their own plans to achieve or surpass the goals of the ACA, by Medicaid waiver funds, and by a Health Care Premium tax on payroll and non-payroll income collected by the Department of Revenue.

The design and operation of ColoradoCare will be determined by existing legal and market conditions.

ColoradoCare requirements and powers are described in the Amendment. The Affordable Care Act (ACA) waivers require that ColoradoCare meet or exceed all the guarantees of the ACA.

How are the current health care market dynamics dysfunctional?

There is a well-known problem called “adverse selection” in health care insurance. A high-quality, accessible, and low-cost plan is unprofitable to insurance companies because it would attract people with high health care needs. In other words, a better product adversely selects for consumers who cost too much money. The Affordable Care Act addressed part of adverse selection by prohibiting pre-existing condition exclusions, but there are many ways to attract the healthy such as offering high-deductible policies. The adverse selection dynamic overpowers the incentive for high-quality, accessible, and low-cost plans.

The passage of the Affordable Care Act (ACA) in 2010 gave states an unprecedented opportunity to use an ACA Section 1332 waiver, which allows states that can meet or exceed ACA standards to use the ACA funds to design their own health care financing system. In 2010, Dr. Irene Aguilar was elected to the Colorado State Senate, and she introduced the Colorado Health Care Cooperative proposal, a universal health care proposal, into the Senate (SB11-168).

Have I made myself clear? Yes, most of the funding of ColoradoCare would be from new state taxes and from shifting funds currently going to Medicaid (apparently Medicare, VA and Indian Health Service enrollees would stay put but have their supplemental coverage provided for by COCare). However, a large chunk of it (around 1/3 of total funding, I believe) would be provided for by the funds currently going to the ACA's tax credit, cost sharing reduction and Medicaid expansion funds.

This, to me, is one of the most important, and least talked about provisions of the Affordable Care Act: It specifically and deliberately creates a pathway for the ACA itself to be "replaced" down the road...as long as the "replacement" is at least as good, if not better, at achieving the ACA's goals. And even then, assuming they use the route Colorado is pursuing, the ACA would still be in place as a funding, regulatory and guidance mechanism.

Frankly, between Republican politicians taking credit for Medicaid expansion in general, Kentucky trying to pretend that "kynect" is somehow separate from "Obamacare" and now this, I have to imagine that President Obama is feeling a little like Dustin Hoffman's character Stanley Motss from the film "Wag the Dog".