In recent weeks, a national campaign has aired hundreds of advertisements and sent countless mailers to Coloradans in an effort to defeat a bill that doesn’t even exist yet.
They’re aiming to defuse a sweeping effort by Gov. Jared Polis and some legislative Democrats to reform the health care system.
The state’s Democratic legislators haven’t yet introduced an expected “public option” bill, but the advertisements already warn about government interference that could kill jobs and hurt hospitals.
The latest round of mail has already arrived in communities from the Western Slope to the Front Range, according to Rep. Dylan Roberts, who will sponsor the bill.
“This is probably just the opening gambit,” he said at the Capitol on Tuesday, later describing it as a "dark money" campaign with little transparency about its funding. “But I’ll keep working through. It doesn’t intimidate me, and it doesn’t intimidate my co-sponsors on this legislation.”
The campaign is run by Colorado's Health Care Future, part of a new advocacy group called Partnership for America's Health Care Future. It's a sign of just how quickly Colorado has inserted itself into the national debate about health care. Until now, the Partnership had largely focused on fighting Medicare for All and other federal proposals by Democratic presidential candidates.
“They will be pouring a lot of money into Colorado to keep this from happening. They don’t want other states to look at Colorado as an example of something that might work,” said Wendell Potter, the former vice president of communications for CIGNA who later became a health care reformer with the group Medicare for All NOW!
“It’s going to be quite intense. They’ve been known to spend enormous amounts of money to keep legislation or ballot initiatives from succeeding.”
Who’s behind it?
Gov. Jared Polis has accused Colorado hospitals of funding the ads in order to protect their bottom lines.
“We know there are powerful special interests who have a financial stake in preserving the current system,” he told a joint legislative session. Hospitals on the Front Range, he said, are “using those profits from overcharging patients to run ads against legislation that could save families money.”
Julie Lonborg, a spokesperson for the Colorado Health Association, contested the governor’s accusations.
“He believes that this is being funded locally. I think he’ll be surprised to find out that it may not be,” she said. “I don’t know which if any of our members may be involved.”
It’s impossible to say with certainty who is funding the Partnership for America ads, or even the amount that the group is spending. The campaign has spent close to $130,000 on Facebook and broadcast ads in Colorado, according to disclosures from Facebook and the Federal Communications Commission.
But the group may not have to report its full spending — including the cost of the mailers — because they don’t directly relate to an election or a call for action, said Matt Arnold, whose company Campaign Integrity Watchdog advises candidates on campaign finance compliance and files complaints against perceived violators.
And when it comes to donors, as a nonprofit, Partnership for America likely isn’t required under state or federal law to disclose their names or the amount they donated.
PFA did not directly answer questions about how much it is spending in Colorado, but a spokesperson for the group said it is composed of “doctors, nurses, clinicians, community hospitals, health insurance providers, business organizations, and biopharmaceutical companies committed to working together to ensure access to affordable, high quality coverage.”
Polis hasn’t called any companies out by name, but Partnership for America has named dozens of supporters, including HCA Healthcare — which operates facilities in Colorado, including Rose Medical Center, Swedish Medical Center and five other Denver locations.
HCA supports the campaign because the state government option would “not protect patient choice” and “would dramatically impact care for rural Coloradans,” according to a statement forwarded by a spokesperson.
Also included in the alliance is the Federation of American Hospitals, a group of investor-owned hospitals that includes the operators of about 3,000 hospital beds in Colorado.
Colorado in the crosshairs
Only one other state, Washington, has passed a law on the scale of what Colorado is considering, according to Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. Washington lawmakers approved a similar “public option” law in 2019.
“I think there’s a real concern that if Washington and Colorado are successful, it could set a precedent — more states will follow,” she said.
To be clear, the Colorado proposal would not replace private insurance, as Bernie Sanders and some other Democratic primary candidates have proposed.
“Colorado’s idea is to almost double down on the role of private health insurance,” said Joe Hanel, spokesman for the Colorado Health Institute.
The Colorado plan would create a new “state option” health insurance policy that insurers would be encouraged — or forced — to make available to businesses and the public. It also would limit the costs that hospitals can charge under that policy. That’s triggering a strong response, in part, because it’s targeting the industry’s income.
Corlette believes the states are on the right track, especially in trying to control prices and she thinks hospitals will fight “tooth and nail” against that idea because it puts most of the risk and costs on the private providers.
And while Colorado isn’t a comparatively large state, it’s one of the most likely to approve major legislation.
“What Polis is after is lowering costs in health care. And when you have a chief executive who has a pretty single-minded focus like that, and a legislature that is kind of champing at the bit to get at this for several years, big things are going to happen,” Hanel said.
The Partnership ads portray ideas like Medicare for All and the public option as a government intrusion.
"The proposed state government option is not designed to compete with private insurance plans — it’s designed to force as many Coloradans as possible into a new government-controlled health insurance system over time. It would shift $1.5 billion in costs to those with private insurance and studies show similar systems could force rural hospitals, serving thousands of Coloradans, to close," the group's statement claimed.
The $1.5 billion figure comes from a study by the Colorado Hospital Association, while the claim about rural hospitals comes from REMI Partnership, a group of business interests. Both reports came out weeks before the state's own report on the details of a potential state option.
Instead, PFA and its backers say legislators should focus on the tools in the Affordable Care Act, also known as Obamacare, as Politico reported. State Rep. Roberts counters that a public option was part of the original ACA debate, although it didn’t make it into the final law.
Some of the state’s largest health organizations told CPR News that they weren’t involved in the PFA campaign — but all who responded expressed strong concerns.
“If we don’t know the unintended consequences, I worry,” said Margo Karsten, CEO of Banner Health in Northern Colorado. “In fairness to whoever’s running the ads, they’re trying to alert people. Stay alert.”
The proposal would put Colorado at “the leading cusp,” she said. “I’m not convinced that we’ve done this in the collaborative fashion, including the insurance industry and pharmaceuticals, to make sure whatever gets put in place will truly reduce the cost to the patient and the community members.”
The Colorado Hospital Association will run its own campaign on the public option, too, but it will bear the organization’s name and will be much smaller than the Partnership for America effort, Lonborg said.
Roberts, the sponsor, said that the idea is grounded in years of research, including a report commissioned under a state law passed in 2019. That report sets a template for the bill to come — but a lot can change in the four months of the legislative session. In Washington, the health care industry won concessions including higher prices, as The New York Times reported.
In particular, Hanel said, the bill could live or die by the question of how it will affect some of the state’s smaller and less profitable hospitals.
And while the idea clearly has Polis’ support, other Democratic leaders haven’t spoken up so strongly yet. Senate President Leroy Garcia is open to considering “all ideas and options,” but won’t take a position until he has seen the bill, a spokesperson said.
House Speaker KC Becker is “open to considering a number of options that would lower health care costs, including the governor's public option proposal,” a spokesperson said, calling for collaboration.
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