Colorado Lessons Learned from our Mistakes and Successes! Emily Arell Colorado Consumer Health Initiative January 27, 2007 Families USA Health Action 2007.

ColoradoLessons Learned from our Mistakes and Successes!

Emily Arell

Colorado Consumer Health Initiative

January 27, 2007

Families USA

Health Action 2007

Washington, DC

Colorado Timeline• 1992 TABOR (Taxpayer Bill of Rights) passed by voters

in Colorado• 2000 First attempt to pass tobacco tax in Colorado (effort

fails)• 2001 Recession begins, impact of fiscal restraints felt in

Colorado’s health care programs• 2004 Voters pass Amendment 35, Tobacco Tax,

increasing health care access to over 90,000 Coloradans• 2005 Voters pass Referendum C to suspend TABOR for

5 years• 2009 5 year TABOR time out ends

Landscape in Colorado:• Initiative state• Often times the testing ground for conservative policies• Colorado already had one of the leanest Medicaid

programs in the country

Colorado Voters:• Believe in the bootstraps mentality• Inherent mistrust of government and believe that

government bureaucracy is inefficient• Little to no understanding of tax law and budget• Underestimate the number of government services they

personally utilize (roads, etc)• Focus on Government fraud and abuse

TABOR

• Douglas Bruce and other “anti-tax crusaders”

• Attempt to limit the growth of government

• Limits state local and municipal government at all levels

What do you think you are getting if you vote YES?

Shall there be an amendment to the Colorado Constitution to require voter approval for certain state and local government tax revenue increases and debt; to restrict property, income, and other taxes; to limit the rate of increases in state and local government spending; to allow additional initiative and referendum elections; and to provide for the mailing of information to registered voters?

Voters pass TABOR in 1992 with 54% of vote

TABOR-the nuts and bolts

4 major provisions1. Voter approval of tax increases2. Revenue limits

– Formula: Population + inflation or 6% growth (whichever is less)

– If revenue exceeds these limits, must refund excess to voters

3. Spending limits-- Ratcheting Effect

4. Limitations on tax options

TABOR-Impact on Public Programs

Cuts to MedicaidMedicaid for legal immigrants

Cuts to SCHIP (CHP+ in Colorado)Cap on CHP+ enrollmentCut access for CHP+ for pregnant

moms

Disability servicescreated a wait list for services

TABORLessons learned from Colorado

• More of each state dollar is spent on Medicaid without expanding services

• Populations that could be served by Medicaid are not having their needs met because the state cannot afford to extend benefits to these groups

• Populations pitted against each other for funding• Advocacy Groups have been forced to turn to

ballot to raise funds for their programs• Colorado does not have a rainy day fund

Why you don’t want TABOR in your state

1992 2004

Low-income uninsured Children (CO)

16% 32%

Low-income uninsured children (Nation)

21% 18%

Low-income uninsured adults (CO)

31% 46%

Colorado Voters Acknowledge TABOR is Flawed (2005)

Referendum C– Bi-partisan legislative compromise– Allows the state to spend or save revenue it collects for

5 years– Revenue raised will fund three areas: Education, health

services and roads.– Allows state services to rebound after recession– Does not result in new taxes– Colorado taxpayer with median income will give up

less than $70 a year or .20 cents a day

Colorado voters pass 5 year TABOR time out

Referendum C– Passes 52 % vs. 48% (2005)– Broad coalition-460 organizations endorse– Message to voters—invest in a brighter future

• Protect BASIC government services

– Hard to quantify impact– What happens after 2009?

TABOR-coming to your state in the near future?

• Bad track record but continue to move into new states zealously

• 2005-primarily via legislation• 2006-year of the initiative

– Defeated in Maine (55% vs. 45%), Nebraska (70% vs. 30%), and Oregon (70% vs 30%)

Colorado remains the ONLY state with TABOR

• Message– – TABOR did not work in Colorado message works no matter what

sate you are in– Simply saying “No to TABOR” only goes so far

2005 TABOR Summary

W Y

W V

W I

W A

V T

V A

U T

T X

T N

S D

S C

R I

P A

O R

O K

O H

N Y

N V

N M

N J

N H

N E

N D

N C

M T

M S

M O

M N

M I

M E

M D

M A

L A

K YK S

I NI L

I D

I A

H I

G A

F L

D E

C T

C OC A

A ZA R

A L

A K

D CD C

T A B O R p u s h e d ( 2 3 )

Courtesy of Karen Lyons, Center on Budget and Policy Priorities

Courtesy of Karen Lyons, Center on Budget and Policy Priorities

W Y

W V

W I

W A

V T

V A

U T

T X

T N

S D

S C

R I

P A

O R

O K

O H

N Y

N V

N M

N J

N H

N E

N D

N C

M T

M S

M O

M N

M I

M E

M D

M A

L A

K YK S

I NI L

I D

I A

H I

G A

F L

D E

C T

C OC A

A ZA R

A L

A K

D CD C

O n b a l l o t ( 3 )

T A B O R p u s h e d ( 1 3 )

2006 TABOR Summary

Courtesy of Karen Lyons, Center on Budget and Policy Priorities

Trends in TABOR

• Tighten up “Colorado plan”– Override becoming more challenging 2/3 Leg plus

voter approval – Only allow 1 year timeout (due to Ref C)

• Efforts have been unsuccessful due to:– Fraud (out of state circulators)– Insufficient signatures– Legal challenges– Single subject rule violation– Successful Advocacy and coalition efforts

Take Home MessagesTABOR• Avoid the TABOR fight

• If TABOR comes to your state, tell the Colorado horror story

• Long term, there is a real need to educate voters about the role government plays in their lives

• Coalition collaboration has been successful in fighting off TABOR

Colorado seeks alternate revenue source to fund health care

Amendment 35 Tobacco Tax (2004)• First successful healthcare effort in Colorado to

raise taxes statewide since TABOR

• Raised tobacco tax from 20 cents/pack to 84 cents/pack

• Revenue expands health care programs and access

Lessons Learned from 2000

• Failed effort in 2000 to pass Tobacco Tax (40% vs 60%)

• Strong opposition from Tobacco Industry ($5 million to defeat)

• Lessons Learned– The initiative focused too narrowly on tobacco cessation

and not as a means to raise revenue for public programs– Polling showed:

• Health care link made sense to voters• Tell voters where funds would be spent

Steering Committee starts meeting in 2002

Coalition effort broadens beyond anti-tobacco advocacy groups

– Community Health Clinics– Children’s Hospital– Colorado Consumer Health Initiative– AARP– Colrado Children’s Campaign– AFLCIO and SEIU– American Heart Association– American Lung Association– American Cancer Society– Colorado Tobacco Education and Prevention Alliance

Guiding Principles

1. Money would be used to EXPAND access and funding for programs and not supplant existing funding

2. Impact—not an attempt to spread money thin to large # of programs

3. Politically viable 4. Maximize federal matching dollars5. The people most impacted by tax will see benefit

from expanded services

Where the Money Goes-46%Medicaid • Expand Medicaid eligibility from 33% to 60 % FPL • Restores Medicaid presumptive eligibility for pregnant

moms (restoration to TABOR cut)• Remove Medicaid asset test for Medicaid children• Restore Medicaid coverage to legal immigrants

(restoration to TABOR cut)CHP• Expand CHP+ (SCHIP) eligibility from 185% to

200% FPL (relief for working families)

Where the Money Goes, part 2• Tobacco education and cessation (15%)• Safety net clinics that serve the uninsured and medically

indigent (19%)• Prevention, detection for chronic diseases (15%)

– Cancer– Cardiovascular– Pulmonary

• Remove wait list for HCBS and child extension waivers• Funding earmarked for disparate populations

– Rural– Communities of color

Opposition

• Some criticism that Am 35 is a regressive tax

• Independence Institute – “Cheaper to let smokers die!!!!!!!”

• Anticipate your opposition and mitigate– Municipal and county governments were nervous they

would loose revenue with raise in tax• Hold harmless clause 5% (generous) to counties

Coalition Building-You will need lots of Friends

• Citizens for a Healthier Colorado– Business

– Faith

– Colorado Non Profit Association

– Focus on the Family

– Hospitals, providers

– SEIU and other labor groups

– CoPIRG

• Over 100 organizations endorsed

The Initiative Process-start early

• #68,000 signatures needed to place on ballot

• Timeline---2 years

• $3 million and significant staff time dedicated

Ballot Language- Clear and Concise

State taxes shall be increased $175 million annually through additional tobacco taxes imposed for health related purposes….to expand eligibility for and increase enrollment in the Children’s Basic Health Plan, to fund Comprehensive primary medical care through certain Colorado qualified providers, tobacco education programs, and prevention, early detection, and treatment of cancer and cardiovascular and pulmonary diseases……specifying that the appropriations of additional tobacco tax revenues shall be in addition to and not substituted for appropriations

• 64 Cent raise in tobacco tax (per pack) for total of 84 Cents (per pack)

Messaging-Learn it, love it and Repeat it!

Saving money and saving lives

• Colorado’s rank: 3rd lowest tobacco tax (above Virginia and Kentucky)

• Moderate tax increase that will make a big difference• Smoking costs the state• Raising the price of tobacco will protect generations of

Colorado’s kids from tobacco and help smokers quit• Constitutional amendment means money will be spent as

promised• This initiative is being supported by groups you know and trust

Opposition

• Tobacco Industry

• Independence Institute

Educating the electorate

• Voter education and outreach

• Literature drop

• Full time Communications Director

• Speakers Bureau---20 speakers

Over 90,000 Coloradans Gain Access to Healthcare

• Eric and Marc Stahlman gets off the HCBS wait list and access services in their home

2004: Voters approve Am 35 61 % vs. 38%Raises $175 million in revenue for health care

Our work is not Over

• Implementation dates varied from July 1, 2005 through July 1, 2006

• Am 35 monitoring project– Are the funds going where we promised the

voters?– Are sin taxes a long term strategy for funding

state health care programs?– If the cessation efforts are successful, what will

revenue source be in future?

What does it Take?

• Is your state ready to raise the tobacco tax?

• Resources---staff and financial ($3 million)

• Broad coalition involvement

• Not every state will have to go to the ballot

• What services will receive funding from the raised revenue?

Take Home MessagesTobacco Tax• Consider raising a sin tax to fund health care

programs in your state• Don’t give up if your first attempt to raise a

tobacco tax fails• Tie the tobacco tax to health care programs and

tell the voters how the revenue will be spent• The tobacco industry will not fight you if you are

well organized early in the campaign

Contact Info

Emily ArellColorado Consumer Health Initiative1536 Wynkoop St #101Denver, CO 80206(303) [email protected]

For more information on TABOR’s impact in Colorado:

Carol HedgesColorado Center on Law and Policy(303) 573-5699 X [email protected]