Amendment 63 is a Jon Caldera Independence Institute initiative to prevent the State of Colorado from developing any health care policy which includes an individual mandate.
The amendment will not affect federal healthcare reform because the constitutional issue is already being argued in federal courts and will likely get a final disposition in the US Supreme Court. If the courts find the Patient Protection and Affordable Care Act (PPACA) constitutional, federal reforms will be implemented, because federal law trumps state law. If the PPACA is unconstitutional, Colorado will have to solve its health care dilemma at the STATE level. If Amendment 63 passes, Colorado will not be able to establish a public health insurance option which includes an individual mandate.
Prohibits Colorado State Individual Mandate
Without an individual mandate, more and more individuals will choose to “play the odds” and remain uninsured. There are 750,000 uninsured in Colorado and this number will surely increase. When the uninsured get sick, their bills usually exceed what they can pay, even if they declare bankruptcy, and their unpaid charges are passed on by way of higher premiums and co-insurance to those who have insurance. This vicious cycle hurts everyone.
Amendment 63 would put a stop to managing care and auto-enrolling children and adults into safety net programs, and might prohibit managed care for prisoners. Unmanaged care means uncontrolled costs, and taxpayers would pay the difference.
Protects Direct Pay to Doctors
Amendment 63 has a second extreme and far-reaching clause. It establishes a protection for any person (not health care provider) to receive direct payment for any lawful health service. This provision is unrelated to federal healthcare reforms, since there is nothing in PPACA that prevents direct payment. It is surprising that third party payment (insurance) is not protected in this amendment. So, what’s the intent here?
Perhaps Caldera imagines that if we returned to the 1920’s system of direct pay when Uncle Walter paid the doctor with cookie jar money and a bag of potatoes, the free market would fix everything. Well, that’s a nostalgic notion worth thinking about, for a second.
The problem is we don’t live in 1920. We can now diagnose Uncle Walter better, treat his illnesses with more advanced biomedical technology, and offer him multiple treatment options. Medical progress is wonderful, but expensive. Most of us need insurance to pay for the health advances of the past century. That’s why other state initiatives protect third party payers. It’s curious that Amendment 63 does not.
Constitutional protection of direct pay may also block limits on provider charges. Most insurer-provider contracts limit the pay a provider can receive for his/her services. Billing more than insurance pays (balance billing) is illegal in Colorado, but Amendment 63 may render that law, or the very common insurance-provider contracts unconstitutional.
Finally, the direct payment protection clause could have the extreme consequence of nullifying state regulation of the quality of health care as well as the discipline and licensure of health care professionals. If any person’s right to receive payment is constitutionally guaranteed, how can disciplinary boards or regulatory agencies keep unscrupulous or incompetent persons from practicing medicine?
Broad Language Guarantees Multiple Lawsuits at Taxpayer Expense
Although 9 other states have ballot initiatives similar to Colorado’s Caldera Amendment 63, none is so vague and broad. Most others protect current practices, but not Amendment 63. Only Workman’s Compensation and (strangely) ER care are exempted from the Amendment’s effects. This broad-stroke approach and its many legal ambiguities make it the most extreme anti-health reform ballot initiative in the country.
This doesn’t sound like the good-old days to this doctor. It sounds like chaos for Colorado.
Carol Blackard, M.D., lives in Centennial. EDITOR’S NOTE: This is an online-only column and has not been edited.
