DENVER - Going door to door isn't easy – and healthcare reform is hardly a quick sell especially in an election season when armies of volunteers spread out to pitch everything from presidential candidates to voter registration drives to ballot initiatives.

Two months out from Election Day, Julie Perla has the unenviable task of knocking on strangers’ doors in a Denver neighborhood, asking them to wait while she explains the nation’s complex, flawed healthcare system, a proposal to fix it and why the TV ads from opponents that run constantly on local channels are wrong.

Perla is pitching ColoradoCare, a citizen-sponsored amendment that would make Colorado the first state in the country to opt out of the Affordable Care Act in favor of an unproven experiment in a statewide, single-payer healthcare system.

Voters in the battleground state of Colorado will play a key role in swinging the Presidential election but the yes or no decision on ColoradoCare will impact the long-term financial health of their state budget and the physical health of every one of its residents.

Converting no to yes



ColoradoCare is deeply important to Perla, who experienced the struggle to insure the sick firsthand when her 19-year-old daughter developed a blood clotting disorder that made her a liability for insurers.



That experience inspired Perla to go back to school for a Master’s in public health and she now devotes all of her time to the cause as a regional organizer for the Amendment 69 campaign. But even Perla acknowledges the citizen-driven effort will be an uphill battle to Election Day.

“We have such opposition from corporations and billionaires who are opposing this, we are relying on grassroots efforts,” she says.

Six years after President Obama signed the Affordable Care Act into law following a contentious national debate, Amendment 69 volunteers are targeting millennial voters using innovative efforts like a volunteer-built app and YouTube-friendly media events like flash mobs to reach voters. But the bulk of the work is still done the old-fashioned way – through door-knocking and informational meetings.

Today, Perla knocks on the door of a woman who has decided to vote no in November after seeing TV ads that raise the possibility of long waiting lines for doctors and high taxes.

By the time they’re done talking, Perla has not only changed the voter’s no into a yes – she’s signed her up as the newest Amendment 69 volunteer.

Seven-year battle

“If we speak to people – they get it,” explains Colorado State Senator Irene Aguilar. She has just wrapped up a ColoradoCare presentation for a neighborhood association meeting in her district. The fight for Amendment 69 largely exists because of Aguilar, who is also a doctor and saw the costs of healthcare first-hand working at a safety net clinic.

“Unfortunately, I saw people all the time who were choosing between the necessities of daily life and medical care,” says Aguilar. She notes that many of those patients ultimately would end up going on Medicaid and Medicare programs once their conditions worsened, ultimately costing the government more money than early intervention and preventative care would have cost.

The problem inspired Aguilar to run for the state senate, where she led four ultimately unsuccessful attempts to pass a statewide system into law. She then joined other supporters of healthcare reform in promoting Colorado’s citizen ballot initiative, collecting enough signatures to get the measure up for consideration on the ballot in November.

Aguilar says ColoradoCare’s estimated $25 billion cost replaces the $30 billion Coloradans spend on healthcare costs now, while addressing the needs of 350,000 uninsured people and 870,000 underinsured in the state of Colorado. Opponents argue ColoradoCare’s cost would double the state’s budget and cripple small businesses with additional payroll and income taxes.

“We’re talking about something that’s literally saving half the population’s ability to live a productive life and have health,” she says, “and they’re just dismissing it out of hand because they don’t understand the complexities of healthcare.”

Imperfect plan

But in the small mountain community of Silverthorne, Colorado, Dr. Erin Sain understands the complexities of healthcare costs all too well. She’s carrying out her own form of voter education about ColoradoCare – writing editorials against the amendment for the town newspaper and talking to patients at the dental practice she started five years ago.

As one man waits for a routine checkup at her dental practice, he asks her about “the ad on TV about the health insurance thing.” She tells him there are many unknowns behind Amendment 69.

The problem is not so much the intention behind ColoradoCare but in its execution, says Sain. Even with a statewide system, she argues, Colorado would still run up against the realities of the overall high cost of healthcare and pharmaceuticals nationwide as well as the purchasing power of insurance companies.

Paying ColoradoCare’s 6.6% employee payroll tax combined with the 10% income tax, Sain would not be able to sustain her six-person business. Additionally, her dentistry could suffer under the amendment’s still-unclear medical reimbursement rates, a proposal she says is “kind of like asking somebody to apply for a job without knowing what your compensation is going to be.”

Sain says it’s not easy to come out in opposition to any proposal that would fix flaws in the way insurance companies do business and address concerns that have emerged since the implementation of the Affordable Care Act.

“We all want the same thing,” says Sain, “We all want quality, affordable healthcare. The problem I see with ColoradoCare is that it does not address enough of the reasons why our healthcare is expensive.”

Slim chance of passing



That debate is certain to continue in Colorado well past Election Day, when polls show voters will likely reject turning ColoradoCare into law. Back in the Denver neighborhood, Julie Perla acknowledges the possibility that all of her grassroots door-knocking and organizing may not translate into enough votes.

“Even if we’re not successful in November,” she says, “We’re moving the ball forward and we’re effecting change and people are going to become more and more aware of healthcare reform.”