The Colorado State Capitol in Denver, Colorado. (Photo: Jason Miller; Edited: LW / TO)

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Colorado’s efforts to become the first state to pass a public, universal health care system are facing stiff opposition from right-wing organizations, many of which are funded by or affiliated with brothers Charles and David Koch.

As expected, these moneyed interests are doing everything they can to stop the state from amending its constitution with a ballot referendum, Amendment 69, which would implement a statewide version of “single-payer” health care. If approved, ColoradoCare would cover every resident, regardless of employment or ability to pay. In October, organizers submitted enough signatures to put the amendment on the ballot. The vote will take place on Election Day this year.

“These groups spend so much money getting people to be afraid of their own government.”

If the opposition groups succeed, they would not only be depriving Colorado of universal health care, but also would be serving another destructive blow to single-payer activists across the country. The single-payer movement saw a similar effort in Vermont fail in 2015, and its activists were shunned by the White House during federal reform discussions in 2010.

These groups and their tactics demonstrate how progressive state policies are opposed — and often defeated — with the help of a vast and impressive network of free market groups in all 50 states. Many of these groups have ties to the billionaire Koch brothers, who have vigorously resisted health care reform in Washington and in the states. Opposition is also coming from the Denver Metro Chamber of Commerce and is expected from the health insurance and drug industries. Combined, these forces will be an extremely difficult obstacle for advocates of health care justice, who hope Colorado can create health care history.

Given the wealth and organization of the opposition, if Colorado is to become the first state to pass universal, guaranteed health care, it will require a massive effort: strong coalitions, lots of education and as many resources as possible, possibly including support from outside of the state. This is because if ColoradoCare becomes a reality, there is hope that it could create momentum for single-payer health care across the country — and this is exactly why the right is so rigorously opposed to these kinds of plans.

The Fight for ColoradoCare

As Truthout reported in October 2015, ColoradoCare is the name of a system that would be implemented in the state by amending the Colorado Constitution, if voters support it in a referendum on the ballot in November 2016. The state would use the state innovation provision in the Affordable Care Act (ACA) to implement the system without losing federal funds. The policy is not technically a true “single-payer” plan, since there would still be a few separate payers, most notably Medicare (which is why true single-payer is not technically possible in one state). But ColoradoCare is about as close as a state plan can get to a single-payer model, and it is rooted in the same principles — a public system that guarantees care for everyone. As a result, the boards of two important single-payer organizations, Health Care for All Colorado and Healthcare-NOW have both unanimously endorsed the campaign.

If it becomes law, ColoradoCare will be run not by the governor or state legislature, but by trustees who are elected by residents from each of the state’s seven congressional districts. The plan’s proponents say this would radically improve the lives of the approximately 603,000 Coloradans who remain uninsured. While the plan requires a significant payroll tax increase, the transition to ColoradoCare would ultimately save the state more than $4.5 billion per year in health spending, according to an economic analysis from Dr. Ivan J. Miller.

The website for ColoradoCareYES, the hub of the campaign to support the measure, features a calculator that demonstrates how ColoradoCare would impact specific individuals and businesses, to help them separate the truth of the situation from the fearmongering that the opposition has been using aggressively. The vast majority of Colorado residents would end up spending less money due to the out-of-pocket savings they would gain from a public health care system.

But, despite all of these benefits, winning the public debate will be a major task. “Advocates don’t have anywhere close to the same resources as their opponents. So financially they start with a large disadvantage,” said Wendell Potter, a whistleblower who used to work with health insurance company Cigna, in an interview with Truthout. “The plan will face formidable opposition. These groups spend so much money getting people to be afraid of their own government.”

The Illusion of Grassroots Discontent

While the ColoradoCare battle has been drowned out by all of the presidential election coverage, the organized opposition to universal health care in the state has been extremely active for some time. After the signatures were approved, opponents wasted little time in painting the proposal as a near-apocalyptic policy.

Americans for Prosperity, a right-wing advocacy group founded (and funded) by the Kochs that has spent hundreds of millions of dollars on conservative causes and candidates, has already produced hyperbolic negative ads. It has also created a website entitled “Amendment 69: A Prescription for Disaster,” which promotes misinformation and courts donations to oppose the initiative. This is in addition to their very active presence on social media sites like Twitter and Facebook.

Americans for Prosperity is just one of several well-funded right-wing organizations and business organizations that are already going after the referendum aggressively. The Independence Institute, Independent Women’s Forum, Coloradans for Coloradans, Advancing Colorado, the Colorado branch of the National Federation of Independent Business and the Denver Metro Chamber of Commerce have all been active in opposing the amendment, with a slew of videos, petitions, press releases, broadcasts and ads.

Many of these groups can be tracked directly to the Koch brothers or their major allies. Others do not disclose their donors and can’t be directly linked to the Kochs. But all of them are pushing nearly identical arguments and tactics against the policy.

The Koch’s 50-State Strategy

This massive outpouring of opposition groups in the state does not come as a surprise to Mary Bottari, the deputy director of the Center for Media and Democracy (CMD), a nonprofit investigative reporting group that monitors the funding and tactics of many of these groups on websites like SourceWatch.

“The Kochs operate on several tracks … On the state level, the Kochs have created a brilliant power play,” Bottari said. Whenever a major issue comes up in the states, she observes, the Kochs are able to use their massive infrastructure of affiliated lobbying groups and think tanks to organize quickly against or for a policy.

One such group is the State Policy Network (SPN), which CMD describes as an “$83 million right-wing empire.” The organization is a “sister organization” of the American Legislative Exchange Council (ALEC), the powerful “corporate bill mill,” which is closely connected to the Koch brothers, according to Bottari. SPN is a coalition of more than 60 free market think tanks and advocacy groups, located in all 50 states.

The Independence Institute is the SPN think tank in Colorado. While SPN’s think tanks are largely funded by a central source, they often present themselves as local groups, helping to provide the illusion of massive grassroots discontent with a policy. This tactic was widely observed during the birth of the Tea Party movement, which, according to Jane Mayer of The New Yorker, was covertly backed by Americans for Prosperity.

“It is important for Coloradans to understand this opposition is not organic.”

After groups create the illusion of grassroots discontent, Bottari notes, Koch-affiliated groups are there to help control the legislative process. Conservative legislators will often submit bills using “verbatim” language from ALEC proposals, and scholars from ALEC and SPN will then defend these ideas at hearings. Meanwhile, the local members of the State Policy Network contribute to the debate with what Bottari calls “cookie-cutter studies.” This multipronged approach can serve to shape a debate dramatically, skewed to the benefit of the Kochs, often before local constituents have uttered a single word.

“This kind of well-funded opposition is extremely difficult to overcome,” Potter said. “The other side does not have a comparable infrastructure or the resources to counter it.”

Of course, advocacy groups are free to support whatever policies they wish, regardless of where they get their money. But the problem is transparency: Many residents are unaware that the opposition to ColoradoCare is largely created from outside of the state by groups with very specific financial and ideological goals. “It is important for Coloradans to understand this opposition is not organic,” Bottari said.

The Kochs’ infrastructure can help them influence policy in virtually every state. The Center for Media and Democracy describes how these “textbook plays” were used in opposition to a “right to work” battle in Wisconsin. Koch-funded groups also played a major role in influencing the fight for single-payer health care in Vermont, a battle that dragged on for years. The Vermont chapter of the National Federation of Independent Business was among the most visible opponents of reform and is still fighting to repeal the law that would’ve led to single-payer in the state. The federation has close ties to Koch-funded groups, according to CMD. The Ethan Allen Institute, a think tank in Vermont that is a member of the State Policy Network, was also active in opposing the reform with attack ads and numerous policy briefs and position papers.

“There were groups that were trying to elect Republicans,” said James Haslam, who was the director of the Vermont Workers’ Center during the health care reform battle. “[They] aired negative ads, ran op-eds. The Koch brothers and those kind of forces probably had an impact.”

The “Vermont Example” is now being cited by Americans for Prosperity as fodder to attack ColoradoCare.

Fear and Persuasion

During the health care debates in Vermont, the Ethan Allen Institute aired an ad on radio stations around the state. The ad portrayed a sad elderly woman suggesting that Medicare would be put in jeopardy if health reform passed. The ad was certainly aimed at scaring senior citizens, and this tactic — using fear to help create opposition to any progressive policy — is being used in spades by organizations in Colorado. The most recent ad by Americans for Prosperity in Colorado is no less hyperbolic, and features an ominous voice warning that the “government takeover” is “worse than Obamacare” and will lead to “Coloradans suffering.”

The advocacy group Advancing Colorado, whose donors have not been disclosed, has called ColoradoCare “a killer and a moral outrage” as well as a “death sentence” on its website opposing the amendment.

Jon Caldara, president of the Independence Institute, compared ColoradoCare to the Canadian model and claimed he spoke to a Canadian who “slept in a chair for four years waiting for a hip replacement.”

Of course, Caldara did not bother to mention that, according to the Commonwealth Fund, the United States has much longer wait times than the United Kingdom and Australia, which both use single-payer systems. And this is just one example of many where the opposition spreads misleading information that lacks proper context.

Another example of this comes from the Independence Institute, which alleges ColoradoCare would make it so “all personal health care data will be deposited in a database for publicly available research.” Americans for Prosperity repeats this spurious allegation on its website.

“To put this delicately, they are not telling the truth,” said Owen Perkins, communications director of ColoradoCareYES, in an interview with Truthout. “There is no way that could be done legally or would be done at all.”

This particular attack, according to State Sen. Irene Aguilar, who spearheaded ColoradoCare, is a distortion. “They have medical records and payment databases confused,” she told Truthout. “In Colorado, we have an All Payer Claims Database at CIVHC [the Center for Improving Value in Health Care] that allows you to do research on the utilization and cost of services. No private medical information is released.”

Another falsehood is that the plan would leave residents with “no choice,” when in fact the plan would allow beneficiaries to “choose their primary care professionals.”

Opponents are also always quick to point out the large tax increases that are indeed required for this kind of reform. “It is always the first point they make when I do public debates about the program,” Perkins said. But when they mention the new taxes, they do so without explaining how they are offset by out-of-pocket expenses. This is a common tactic that has also been used to attack Bernie Sander’s single-payer plan in the presidential election.

“This is the big challenge. [Single-payer] requires an increase in taxes,” Potter said. “So it is a formidable challenge to get people to understand that they will save money. I wish them the best.”

Reasons for Optimism

So how does one counter all of these organizations and respond to the fear tactics? “The short, simple answer is the truth,” said David Sabados, a general consultant for ColoradoCareYES. “We have done polling and engaged in debates, and one thing we have learned is that the more educated people are about the plan, the more likely they are to support it.”

And despite the challenges organizers face, there are some reasons for optimism. The enthusiasm behind the Democratic presidential primary — and specifically Bernie Sander’s advocacy for a Medicare for All, single-payer program — has served to excite and inform many voters, especially young people.

“No matter how the primary turns out, it is really raising awareness. Especially with Senator Sanders and his impact on young people,” Sabados said. Sanders won the Colorado caucus in early March. “Millennials understand they are unlikely to keep the same job for most of their lives. They understand the need for a new system.”

Organizers hope they can use this momentum to empower their growing coalition. “We’re building a great coalition: The League of Women Voters, Health Care for All Colorado, Public Citizen and, most importantly, a growing group of health care providers, small business owners and community leaders,” Sabados said.

While to date the vast majority of support for ColoradoCare has come from within the state, the referendum could become a bigger national story in the coming year. Many single-payer advocates have long argued that if one state could pass a public, universal health care system, it would be a major advance for the whole movement.

The Canadian health care system started when one province passed universal hospital care. In light of this, many single-payer advocates from across the country are invested in the results of the health care fight in Colorado.

Walter Carpenter, a grassroots activist in Vermont who pushed hard for universal health care in his state, says he is now doing whatever he can, even from afar, to help support ColoradoCare.

“The single-payer community, and people in all 49 [other] states, should do whatever they can to see that ColoradoCare becomes a reality,” he said.