Health Care May Be Key To Win Colorado’s Senate Seat. What’s The John Hickenlooper Position?

Colorado Senate debate
Hyoung Chang/The Denver Post-Pool
The U.S. Senate debate between Republican U.S. Sen. Cory Gardner and Democratic former Colorado Gov. John Hickenlooper took place at the Denver7 studio in Denver, Colorado on Friday, October 9, 2020.

In terms of presidential politics, Colorado has lost a bit of its luster as a battleground state. That's not the case if you look at the contested race for the Senate. The winner of the contest between incumbent Republican Sen. Cory Gardner and his Democratic challenger, former Gov. John Hickenlooper, will most likely be the lynchpin for whoever gets control of the chamber.

You've seen the reasonably civil, but pointed, debates between the two, now you can get the backstory.

The Claim:

“He wants government-run health care. A public option will decimate our rural hospitals. A public option will result in government-run healthcare,” Gardner said of Hickenlooper at a recent debate. “It will lead to Medicare for All.”

Gardner also claims that Hickenlooper has supported the idea of replacing the Affordable Care Act, citing a health reform plan he released with Ohio’s Republican Gov. John Kasich.

The Backstory:

Throughout this election, Democrats have put unrelenting pressure on Republicans like Gardner over health care. In a recent debate, Gardner turned that around by questioning his challenger, Hickenlooper, about Democrats’ grand plans.

Hickenlooper said his goal is to achieve universal health care coverage, which he claims is possible through a “national public option.” A public option is a government-managed health plan, similar to Medicaid, that people could voluntarily choose to enroll in.

“It’s not going to cost a fortune, it’s not going to break any bank, and we can be like all the other industrialized countries in the world that have universal coverage,” he said.

The Republican senator contends that the introduction of a public option would effectively usher in government-run health care (which these days goes by the shorthand “Medicare for All”) by wrecking the private market.

Hickenlooper has been public in his opposition to any immediate move to Medicare for All, but he has left the door open to the country adopting such a system eventually. 

He opposed a 2016 ballot initiative that would have created a single-payer health care system for Colorado. And as a presidential candidate in 2019, he stood out in the field as an opponent of ‘Medicare for All.’

He said then that he preferred the public option to be “at people’s discretion.” But he also said that the situation could change if an expanded government option proves popular, saying the public option could be part of an “evolution and not a revolution” that leads to universal coverage. 

In general, he’s cast his views on health care as more about the ends than the means.

“It’s more important to be unified and say we want universal coverage. We are not going to stop until we get universal coverage,” he said during his failed presidential campaign. He also described himself as “agnostic” at a campaign event, saying “if this country wants to go to single-payer, I am happy to support it.’

Gardner has said that Democrats generally are pushing for “socialized medicine” and argues Hickenlooper’s proposals would drive private insurers out of the market and hurt rural hospitals. That claim is impossible to assess with certainty, in part because so many of the details of a potential public option haven’t been worked out.

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“Whether [the collapse of private insurance] scenario would happen depends on a lot of factors, including the public option benefit design and premium, how payment rates to providers are determined under the public option, whether providers must participate in the public option if they want to participate in Medicare, and enrollment/eligibility rules such as whether employers can opt into the public plan,” wrote Jessica Mantel, co-director of the Health Law & Policy Institute at the University of Houston, in an email to CPR News.

“So in theory a public option over time could result in single-payer, but this is by no means a given.”

One significant factor is that existing government health insurance programs like Medicare and Medicaid pay less money to medical providers for services compared to private insurance. The question is whether the government option would push insurers to lower their rates, saving all consumers money, or if it would unbalance the market altogether.

Here’s what the Kaiser Family Foundation said in a recent analysis: “A public option could strengthen incentives for private insurers to compete on value and cost. A new public option could offer consumers an additional plan choice, particularly in marketplace areas served by a single insurer. On the other hand, if private insurers are unable to compete effectively, the public option could draw substantial enrollment away from them and might become the sole option in at least some areas.”

Gardner has also tried to portray Hickenlooper as hypocritical in his defense of the Affordable Care Act, pointing out that Hickenlooper has tried to change the law too. Indeed, Hickenlooper joined Republican John Kasich on a plan in 2017 to revamp health policy.

Rather than repealing the ACA, as Republicans have attempted to do, that plan was based on the idea of keeping the law in place while stabilizing the individual insurance market by maintaining federal subsidies for low-cost plans and encouraging states to develop reinsurance programs to help with the most expensive patients. It did not gain traction in Washington.

As governor, Hickenlooper presided over Colorado’s implementation of the Affordable Care Act. He worked with Democrats and a few Republicans in the state legislature to create Connect For Health Colorado, the state’s insurance exchange. He also supported expanding Medicaid eligibility to people making up to 138 percent of the poverty line, an expense that is covered in part by a fee paid by the state’s hospitals

At the time, Hickenlooper criticized the ACA as needlessly complicated but was still supportive of it. “Even though I don't support it 100 percent and I'm not going to say that I think it's, you know, the world's greatest piece of legislation ever written, my goodness, we needed to do something,” he told CPR in 2011.

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Editor's Note: This story was updated to correct an editing error on the term national public option.