Q&A: US Senate candidate Andrew Romanoff wants health reform sooner rather than later

It seems that a realignment is underway in Colorado, the product of which might be Andrew Romanoff. The youngest Speaker in the history of Colorado’s House of Representatives, Mr. Romanoff is running a progressive campaign for the United States Senate, seeking to build off of his local legislative experience.

During and after his ascension to the Speakership in 2005, he’s had a front row seat to watch Colorado shift from a state which helped send President Bush back to the White House in 2004 to a state that has since elected consecutive Democratic governors and went for Bernie Sanders in the 2020 Democratic Primary. If there has been a shift, Romanoff exemplifies it through a platform that includes Medicare for All and a Green New Deal.

After retiring from the state house in 2009 due to term limits, Romanoff ran for federal office twice unsuccessfully before serving four years as the President and CEO of Mental Health Colorado. Departing in 2019 to run for the Senate, Romanoff is challenging two-term governor and short-lived presidential candidate, John Hickenlooper. After winning the Colorado Caucuses last month by a wide margin, Romanoff has proved to be a formidable challenger.

The US Senate seat held by Republican Cory Gardner is the Democrats’ top target in 2020, but Romanoff has more on his mind than just painting the seat blue. I called Romanoff recently to hear about his ideas for enacting systemic health reforms, improving mental health outcomes, and what he thinks lies at the root of Colorado’s shifting political landscape.

Michael Goldberg: Can I just start by asking what it’s like to be a candidate at a time like this? March was obviously a big month for your campaign after winning the Colorado Caucuses and I’m sure you were eager to build on that momentum with rallies, canvassing, and other in-person events. What is it like to be a candidate during this pandemic?

Andrew Romanoff: Political candidates are probably the least essential workers right now, so campaigning is not considered an essential activity. Democracy is though, so the election is not going to be postponed. We’re intent on, as you said, building on our success at the caucuses last month. We won by almost two-to-one, we captured almost every county assembly since then and I expect we’ll win the state virtual assembly when it takes place later this month. Obviously we shifted those tactics. We sent our staff home last month, we replaced our events with Zoom meetings, we’ve had a series of virtual town halls and we’ve attracted a lot more interest. Where we used to get hundreds on virtual town halls, we’re now getting thousands because a lot of folks are home and probably going a little stir crazy. We’re trying to connect people with resources, so we’ve had health professionals, mental health providers, and other experts on. We’re trying to do the same in our texts, emails, and phone calls. Our first priority is making sure people get the help they need. At the same time, we’re trying to make the case that recovering from this pandemic and rebuilding our economy will require more than incremental reform.”

MG: Campaign finance reform has been a key issue in each of your campaigns. You’ve consistently rejected taking PAC money dating back to your first senate campaign in 2010. I’m wondering if you could speak to the particular issues that might arise from taking money from the insurance industry or pharmaceutical companies. I know that might sound like a simplistic question, but one refrain we’ve heard, particularly throughout this primary season is, ‘well if candidate X can take money from the Koch brothers or the oil industry, then what’s the problem with candidate Y taking money from a health insurance company? So, I’ll just ask you: what in particular is the problem?

AR: One of the reasons we haven’t gotten the reforms we need in health care or the climate crisis, or any major priorities, is because the nation’s most powerful corporate interest groups are bankrolling Congress and blocking reform. You don’t have to be a conspiracy theorist, you can follow the money and connect the dots. Ask yourself, when it comes to climate action for example, why does Exxon subsidize members of the Senate Energy and Natural Resources Committee – like Cory Gardner? It’s because the company gets something in return, and we get the bill. Cory has voted to gut environmental laws, block climate action, and do the bidding of the nation’s biggest polluters. I think the same dynamic is at play when it comes to health care. The insurance industry has demonized not only plans like Medicare for All, which I support, but also the Public Option. As I’m sure you know, the insurance companies, drug companies and other big players formed a front group called Partnership for America’s Health Care Future. They are hell bent on continuing this campaign of disinformation so that Americans will be scared to embrace the kind of reforms that might actually cut costs and expand coverage. And it’s not a new tactic by the way. I know Medicare for All has borne the brunt of the attacks, not just from Republicans, but from Democrats like John Hickenlooper who are parroting their talking points. The same attacks came against Medicare itself more than 50 years ago. If you go back to the time in which Harry Truman was proposing universal health care, you can see the same scare tactics being deployed. These fights are going to be hard to win no matter what, but it will be impossible to enact the reforms we need if we have to fight not only Republicans but Democrats as well and the industries that bankroll those politicians.”

MG: You ran Mental Health Colorado for four years, where one of your priorities was to “decriminalize mental health conditions.” This involved advocating for a new transportation alternative for people in a mental health crisis so that when they need to go to a health care facility they are not transported by law enforcement. This policy initiative, at least in part, seems to be aimed at improving outcomes for people who are moving between public institutions. The correctional system is a major provider of health care, particularly mental health and substance abuse. In many areas, what you might call the institutional health care sector is disconnected from the civilian health care sector. With respect to mental health care, can you talk about what can be done to create conditions that are conducive to better outcomes for people who are moving between different public institutions?

AR: First, we have to recognize that most people with mental illness are not violent. In fact they’re more likely to be the victims of crime rather than the perpetrators. Turning the criminal justice system into a warehouse for people with mental illness and substance abuse disorders is the single most expensive and least therapeutic decision we could make. I’m glad that Colorado ended the use of jails as places where you could confine people on emergency holds. Colorado has a law like most states that allows people to be held against their will for 72 hours if they are found to present an imminent danger to themselves or others. The catch in Colorado is that we didn’t have a lot of therapeutic facilities to hold people. We still don’t have enough. So, the state was using jails instead. We ended that practice but we still don’t have enough resources to take care of folks who are experiencing a mental health crisis. In fact, we rank in the bottom quartile in the nation for the number of psychiatric beds per capita – probably only half of the psychiatric beds as we need. There are a thousand things we ought to do to improve care, but I’ll just mention a couple. One, we need to put a much greater emphasis on prevention and early intervention. We know that the first signs of mental illness appear during adolescence and yet there’s a gap between the onset of the symptoms and the arrival of treatment – a gap that lasts on average for about 8-10 years. One of the priorities that I pursued at Mental Health Colorado, and the same priority I’ll bring to the Senate, is to get more schools, parents, pediatricians, child care providers, and other folks who serve kids equipped with the resources they need to spot some of the early warnings signs of mental health disorders and then make sure there are adequate resources in place to provide kids with the help they need. I think ultimately the best way to solve this problem is to integrate mental health into the primary care system. Right now, those systems are segregated. We send you to one place to treat your body and another place to treat your brain. Well, your brain is part of your body, so of course we should be treating you in the same place. I think that segregation contributes to the stigma we see and also just presents a logistical obstacle. So, integration is one of the most important policy developments in this field, and one we need to accelerate.”

MG: I think one of the main appeals of Medicare for All is its simplicity, at least in message. It rests on the central idea that health care is a human right. When you start with a fundamental premise like that, it seems that you might avoid ending up with a complicated plan that most people don’t understand, and that leaves a significant number of people out. Can you speak to the role simplicity – or a rejection of complexity for the sake of it – plays in this conversation?

AR: I agree with that premise. No one would design the system we have now if you started from scratch. It’s not actually a system at all in a rational sense, it’s just a patchwork of laws and programs that we’ve cobbled together over time. I think one of the best examples is the link we’ve got between insurance and employment. It’s not a law of nature, it’s just an accident of history; the product of decisions that were made by the federal government in the 1940s to freeze wages and make benefits tax free. That’s really where this nexus took hold and there’s nothing particularly logical about it. In my view, your ability to get health care should not depend on your employers willingness or ability to provide it or your ability to keep the same job. It should not change based on your age, income, and zip code. I met a woman in Greeley, Colorado who needed spinal surgery when she was 64. She couldn’t afford it so she decided to wait until she was old enough to qualify for Medicare. She rolled the dice and waited a year. She ended up getting the surgery and thank goodness, she’s fine. But what if she had been 63 or 62, or 26. This is a really crazy quilt that we’ve created and that’s why I think the simplicity that you’re describing is a much more rational approach and a much more economical approach, since we’re spending almost twice as much as other industrialized countries for health care that is definitely not twice as good. To some extent, we’ve already made the decision to provide universal health care, we just picked the most expensive place possible: the emergency room. In 1986, President Reagan signed a law called EMTALA that says, ‘if you’re a hospital that wants Medicare dollars, you’re going to have to accept anybody who comes in and needs emergency care. I think that was the right decision for a moral society to make. But if you agree, you’ve got to think, ‘well wouldn’t it be smarter, cheaper, and healthier if we helped people get the care they need before they end up in the emergency room? I think the answer to that is clearly yes.”

MG: This is a tough week for many voters in the left wing of the Democratic Party. I think there’s long been a perception that Colorado is a purple state, but that state elected back-to-back Democratic governors and Bernie Sanders did win the Colorado primary by a fairly comfortable margin. Do you think that the electorate in Colorado has actually become more progressive, and if so what do you think accounts for that shift?

AF: Yes, I think the voters here have undergone a shift because people are seeing too many of their neighbors and loved ones lose too much. While at Mental Health Colorado, I spent four years traveling across the state meeting with families who had lost their jobs, homes, savings, and in some cases their loved ones; not just to mental illness, but often to the indifference of an insurance industry that bases its profits on its ability to exclude as many sick people and deny as many claims as possible. That’s a great business model for the insurance companies. It’s a pretty lousy model for the rest of us. What I think you’ve seen in Colorado and across the country is an appetite for change, a desperation really. When you allow one quarter of the population to go uninsured or underinsured, when you send half a million families into bankruptcy each year, when you watch 35,000 people die because they can’t afford to see a doctor, you have to recognize the system is in crisis. The system was in crisis even before this pandemic hit. I think that set of problems has driven a lot of people in my state to embrace plans like Medicare for All. In the last survey I saw, a majority of Americans now – including almost a third of Republicans – are in favor of this single payer plan. At a certain point this debate will no longer be political, it’ll just be mathematical. When you can’t devote a sixth of your economy, when the country spends twice as much as other industrialized countries, when health care costs are the single biggest source of bankruptcy in the United States; when you do the math you recognize that you’re going broke. There’s another survey that shows a majority of small business owners in America would like to get out from under this burden. It’s not what they signed up for, and it leaves them at a disadvantage. I also found this when I was trying to hire folks; we couldn’t always compete with bigger companies that offered more generous benefits. So, we need to forge a coalition of business leaders, community activists and health care providers; consumers themselves who want a different model. I’d just like to get there sooner rather than later.”

This conversation has been edited for clarity and length.