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Bernie Sanders and the Battle for Universal Healthcare in Colorado

Last week, Bernie Sanders endorsed a little-known campaign in Colorado that could have far-reaching effects on America's struggling healthcare system.

Bernie Sanders during this year's Democratic National Convention. Photo by Jeff J Mitchell/Getty Images

In his June non-concession concession speech, before grimacing in support of Hillary Clinton at the Democratic convention, Bernie Sanders called on his followers to take their "political revolution" to state and local races. "I hope very much that many of you listening tonight are prepared to engage at that level," he said. It wasn't clear what form the continuing revolution would take—amid allegations of dysfunction around Our Revolution, his new organization—but last week, Sanders indicated at least one measure he was backing: a little-noticed ballot initiative to bring universal healthcare to Colorado.

In November, Colorado's voters will be asked whether the state should increase taxes by $25 billion a year—nearly doubling the entire state budget—for a program that would provide every resident with health insurance. The proposal, which would become Amendment 69 in Colorado's constitution, would direct the state to begin creating an entity called ColoradoCare. This organization, with its own elected board, independent of the legislature, would then implement the first statewide universal healthcare regime in the country. Colorado would opt out of Obamacare—using a provision for state innovation in Obamacare itself—and those receiving care through Medicare or the Veterans Administration would keep the coverage they had. In exchange, Coloradans would be hit with a steep income tax hike—10 percent divided between employees and employers. But in the end, in theory, most people would end up paying less for better coverage than they get now, and every state resident would be covered.

It's not surprising that Sanders would support this measure—he mentioned it during his primary campaign, which made universal medical coverage a signature issue, and he won Colorado. But ColoradoCare also brings him into conflict, once again, with the Democratic powers that be.

Amendment 69 earned its place on the ballot thanks to a grassroots campaign that, among other tactics, collected petition signatures at Sanders rallies. It's no surprise that Republicans oppose this new government program funded with a new tax, but many of Colorado's top Democratic politicians are also against it. The opposition group, Coloradans for Coloradans, is co-chaired by a former Democratic governor, Bill Ritter, and has raised more than $3.5 million, much of it from the medical industry, compared to a few hundred thousand for the yes campaign. (This is despite the ColoradoCare endorsement in this year's state Democratic Party platform.) Those opponents who aren't worried about the business models of the Healthcare Establishment, or allergic to tax hikes, shudder at the consequences of searing the whole 11-page proposed amendment into the state constitution.

With the forces against them mounting, ColoradoCare advocates are looking to Sanders as a chance to turn their fortunes. They began calling on Sanders, once the primary was over, to turn his attention to their cause. "As his presidential campaign comes to an end, his campaign for a decent healthcare system can continue," TR Reid, chairman of the Colorado Foundation for Universal Health Care, told VICE at the time. Reid and his team appear to have succeeded.

"It is absurd, it is beyond belief, that here in America we remain the only major country on earth not to guarantee healthcare to all people," Sanders said during his rally in Vermont last Wednesday announcing Our Revolution. "If that proposal can win in Colorado, I believe that idea will spread around the country." The Our Revolution website includes ColoradoCare among "our ballot initiatives," alongside state measures limiting the rights of corporations and abolishing the death penalty.

ColoradoCare is not the single-payer solution that many healthcare reformers long for, since it keeps existing public-insurance programs in place and allows those who so choose to buy their own insurance if they want, instead or in addition—though they still pay the hefty income tax. (That's the stated reason that kept Green Party presidential candidate Jill Stein from endorsing Amendment 69 until she changed her mind over the weekend.) It's like public schools for medicine; part of the deal is that some people will have to pay for services they don't use so all their neighbors get covered. Its appeal for progressives is far than certain, however, because the program may be unable to provide coverage for most abortions, thanks to an amendment to Colorado's constitution that voters approved in 1984 banning state funds for such procedures. Whether the ban would apply to ColoradoCare's para-governmental entity remains unclear; it would need to be decided in court.

"Because Amendment 69 can't provide guarantees to affordable abortion access, it isn't truly universal healthcare," NARAL Pro-Choice Colorado's director, Karen Middleton, told the Colorado Independent in June.

The very ballot-proposal process that makes Amendment 69 possible may be its undoing. ColoradoCare's inventive structure itself is an attempt to work around conservative-backed constitutional amendment that voters passed in 1992 restricting the state legislature's ability to increase taxes. Such past amendments are cautionary tales. If voters approve Amendment 69, that's language nobody—not the legislature, not the program's elected board, not even voters—will have an easy time changing. These kinds of voter-suggested-and-approved amendments can do brave things that legislators facing reelection might be too careful to try, like the one in 2012 that legalized marijuana. But they can also have unexpected consequences.

Then again, Americans are unusually prone to trepidation when it comes to giving up a broken medical system. As Sanders has often pointed out, universal healthcare is something just about every wealthy country in the world got it long ago, and few of those countries' citizens are complaining. But now what hangs in the balance with Amendment 69 has to do with more than taxes and healthcare. It's a test of Sanders and his allies' ability to fight—and win—the local battles that they deem so important.

Nathan Schneider is the author of God in Proof and Thank You, Anarchy. His website is TheRowBoat.com, and he tweets here.