In its first year of operation, the proposed ColoradoCare statewide health care program would either have a $2 billion surplus or a $253 million deficit.

Voters now have separate financial analyses that resulted in those two opposite conclusions to consider when they fill out their Nov. 8 general election ballot and decide whether they favor or oppose Amendment 69.

Starting in 2019, ColoradoCare would provide comprehensive health care to every Coloradan, with no insurance premiums or deductibles for health care, and no co-pays for primary care. Funding for the program will primarily come through a 3.33 percent payroll deduction for employees and 6.67 percent for employers.

Supporters of ColoradoCare held a news conference and conference call Tuesday, Aug. 30, to promote their analysis that shows the $2 billion surplus, and to point out why an earlier Colorado Health Institute analysis that predicts a $253 million deficit, was flawed.

Backers said the CHI analysis overlooked three critical sections of Amendment 69 that ensure its economic viability.

“Amendment 69 requires the state to maintain its current funding of Medicaid, including the state match for Medicaid expansion and (Child Health Plan Plus, public, low-cost health insurance for certain children and pregnant women),” said Ivan Miller, executive director of the ColoradoCareYES campaign. “The federal government matches all state funding sources for Medicaid. In the case of the expansion, the federal government provides a 9:1 match.”

The CHI also failed to include the impact of Amendment 69’s requirement that the state legislature revise statutes and ensure the preservation of Medicaid funds, backers said.

ColoradoCare is designed to utilize federal waivers, and language in Amendment 69 protects it from budget deficits that would result without the federal funding, bakers noted. If the federal waivers are not granted during the build-up to the program’s start in 2019, the amendment requires ColoradoCare to “shut down operations and restore unused funds” to taxpayers.

Backers cited analyses from economists Dr. Gerald Friedman (University of Massachusetts), Dr. Anders Fremstad (Colorado State University) and Dr. Jeff Helton (Metro State University) to counter the CHI study conclusions.

CHI stands by their study

Michele Lueck, president and CEO of the Colorado Health Institute, said the organization stands by their analysis and findings.

“We have identified a structural gap in the financing of ColoradoCare,” she said. “Simply put, revenue will not cover expenses. Our analysis is based on the best evidence and the most realistic assumptions. We looked at the most reliable research and data and applied our best thinking to formulate our projections.”

Lueck noted that when CHI, a nearly 15-year-old independent, non-partisan organization, started their examination of ColoradoCare’s financial structure, “we had no idea whether the bottom line would be positive or negative.”

“It is worth noting that while Amendment 69 calls for a full transfer of Medicaid funding to the state, the federal government is not required to follow state amendments,” Leuck’s statement continued. “Our policy experts advise that only some Medicaid funds will be available to finance ColoradoCare. This is based on years of analyzing when and how federal grants and waivers are awarded.”

“Our findings also revealed that even if ColoradoCare received all the Medicaid funding that the campaign anticipates, there is still a long-term structural gap that will result in a deficit in future years without actions such as tax increases or cuts to benefits or payments.”

Lueck also said the institute does not take policy positions.

“We have not and will not take a position on Amendment 69,” she said. “But we are clear in our belief that it is crucial to have an independent organization examining the most important health policy discussions in our state.”

In an interview with The Colorado Statesman, Amy Downs, the lead researcher on the CHI study and a vice-president of the organization, said it’s not guaranteed that all the federal funds due Colorado from a waiver of Medicaid and other programs would be allowed.

“The federal government makes that decision and they trump whatever a state constitution might say,” Downs stated. “If the feds surprise us and do approve the waiver for the full amount, that’s good for ColoradoCare. But we have to go by what the amendment says, not by what some people aspire to.”

ColoradoCare supporter and former Democratic state Sen. Jeanne Nicholson said the federal government has been very supportive of state innovation in health care. She said eight other states are in the process of expanding their Medicaid program, as Colorado has done, and all had been supported by the federal government.

Miller noted that legislation proposing health care programs similar to ColoradoCare, which helped serve as the foundation for the proposed amendment, had been introduced in the Colorado legislature three times.

“And each time, state attorneys reviewed the language and found no problems,” he said.

Miller said a conflict with the language in state statues regarding hospital provider fees would be required to be changed if the amendment is approved.

ColoradoCare spokesman Owen Perkins added that as long as a state program provides the same level of health care as offered by the Affordable Care Act, and at comparable or less cost, federal waivers will be granted.

Fremstad noted that both the CHI analysis and the ones cited by ColoradoCare found the program can result in reductions to waste and corporate insurance profit, which means lower health care costs to consumers.