This November, Coloradans could decide to bring the first European-style health care system to the nation.
While other proposed initiatives scramble to make the ballot, a single proposal, Amendment 69, known as ColoradoCare, has been cleared for takeoff since late 2015. If voters pass it, ColoradoCare would amend the state Constitution to bring a tax-funded health insurance system to Colorado. Everyone not already covered under federal insurance like Medicare would be eligible for coverage, which would include copays for certain services but no deductibles.
While detractors and supporters cast the plan quite differently, this much is certain: ColoradoCare would be a financial giant. Its board members would handle some $38 billion a year and cover 4.4 million people.
Such a system has been proposed by other states. Vermont came close to implementing a plan until its one-time champion, Gov. Peter Shumlin, dropped it in 2014, calling it unaffordable.
According to Physicians for a National Health Care Program, "a non-profit research and education organization of 20,000 physicians, medical students and health professionals who support single-payer national health insurance," more than 15 states have introduced single-payer health care bills since the passage of the Affordable Care Act in 2010. And, of course, plenty of countries across the globe have single-payer systems.
But if Colorado voters pass Amendment 69, the state would be in uncharted territory as the first and only state to ensure that all its citizens have health care. Owen Perkins, spokesperson for the campaign to pass ColoradoCare, says that sounds just fine to him.
"It's not exactly an untested experiment at all," he says. "It's something that's been done in every [other] industrialized country in the world and has been shown to work. So we've studied that carefully and know that it's something that can work here. And it works — essentially this is something very similar to Medicare for all. So we know Medicare is one of the most popular and effective programs that the government is involved with."
But Sean Duffy, spokesman for the opposition campaign, Coloradans for Coloradans, says ColoradoCare is poorly written and offers more questions than answers. While he acknowledges many Coloradans are unhappy with their current health plans, he says Amendment 69 is not the answer.
"You don't want to get out of the lifeboat that you're in and get into one that's shot full of holes," Duffy says.
Of course, Colorado is known for taking risks. This is a state where voters often act as change agents at the ballot box. The reason: Colorado has what's called a direct initiative process, and it's relatively easy for a citizen with a big idea and a lot of persuasion to navigate. That allows big ideas to become big laws with relative ease, for better or worse.
Initiatives, and other direct-democratic reforms like referendums and recalls, exist in only about half of all states. They have their roots in the Progressive Party of the early 20th century, whose most famous member was President Theodore Roosevelt.
Joshua Dunn, associate professor and chair of the Department of Political Science at the University of Colorado at Colorado Springs, says the Progressives passed these laws hoping to combat "corrupt urban machines." As he puts it, Progressives believed, "If there's a problem with democracy then more democracy will cure it."
According to the National Conference of State Legislatures, 19 states allow a direct initiative process to change their laws, meaning citizens can petition proposals that go directly to the ballot (instead of passing through or being tied in some way to the state legislature). Of those, 16 states have a direct initiative process to amend their state constitutions, and 14 states have the same process to amend their state statutes. Colorado has both.
While requirements for reaching the ballot differ from state to state, in most states that allow initiatives, the new laws pass with a simple majority vote. But, the NCSL points out, some states are more strict.
In Nevada, initiatives must prevail in two consecutive general elections before they are officially adopted. In Nebraska, Massachusetts and Mississippi, initiatives must garner a certain percentage of the total votes cast. If enough voters skip the question altogether, the initiative will fail.
Many have long claimed Colorado's Constitution is simply too easy to amend, leading to the state becoming a "testing ground" for all sorts of laws, some of which may not be well-crafted. In fact, a bipartisan group called Building a Better Colorado has filed potential initiatives for the November election that, if passed, would make it tougher to amend the Constitution with an initiative in the future.
Joe Megyesy, spokesperson for the campaign to pass the reforms — called Raise the Bar, Protect Our Constitution — says those initiatives haven't met all the requirements yet for making it onto the ballot.
The group wants to require a 55 percent majority to amend the Constitution through an initiative, rather than a simple majority. It also wants to require that petition signatures for amending the constitution be gathered in all 35 state Senate districts. Currently, all the signatures can be gathered without leaving Denver metro area.
The initiative would also change the required number of petition signatures from 5 percent of the total votes cast in the last secretary of state election (currently 98,492 signatures) to 2 percent of registered voters in each state Senate district.
Megyesy says the current number of signatures needed is one of the lowest in the nation, and the change would create only a slightly higher threshold. The main point, he adds, is to make it harder to amend the state constitution than to pass a state statute. Currently, the requirements are the same, so initiatives tend to take aim at amending the constitution. Because legislators cannot tinker with laws in the constitution, that can create problems.
"There are a number of conflicting mandates in [the state constitution] that make it difficult for lawmakers to adequately do their job," Megyesy says, adding that over the past 20 years, initiatives have become more popular, which could lead to more problems.
A prime example is the tug-of-war between the Taxpayer's Bill of Rights and Amendment 23. TABOR, which impedes government growth and forces a vote on tax increases, was a voter-approved initiative. When it passed in 1992, it was considered quite innovative, and conservative groups like the Koch-backed Americans for Prosperity have advocated similar laws in other states.
But in 2000, voters also passed Amendment 23, which required the state's spending on K-12 education to increase by inflation plus 1 percent from 2001 to 2011, and by inflation after that. But when the Great Recession hit, the Colorado Legislature was hamstrung. Unable to raise taxes to pay for the increases, plus regular government services, it reinterpreted Amendment 23 in a way that allowed it to cut education funding.
Dunn says because of these kinds of problems, he's "not a big fan of direct democracy."
"Legislators are supposed to reconcile these competing objectives and demands from constituents and make the tough choices, or compromise between them, and the people don't have to consider those," Dunn says. "And it's not because people are stupid; it's because people have busy lives. ... It's not your job to consider all the unintended consequences."
Other changes brought on by the initiative process include the legalization of medical marijuana and recreational marijuana, which put Colorado on the leading edge of national cannabis debates.
Coloradans have also turned down several attempts to pass a so-called "personhood" amendment, which would have made a zygote a full-fledged citizen. It's no secret that the backers of those measures — who ultimately hope to pass personhood laws across the country — targeted Colorado voters repeatedly in part because of the state's simpler initiative process.
"I think a lot of people," Dunn says, "when they're looking to test out different initiatives, Colorado is an attractive test market for them."