Nation in Limbo, but Colorado Is Solidly Blue. What Does It Mean for Health?

Americans woke up this morning without knowing the winner of the presidential race.

While our collective attention and anxiety remain fixated on that outcome, most of Colorado’s results are in — and this formerly “purple state” appears to be a deep shade of aquamarine, its official gemstone.

Coloradans faced a long list of consequential races and ballot measures. Voters participated in record numbers: over 3.2 million ballots were returned, easily surpassing the record 2.86 million ballots cast four years prior.

At the top of the ticket, the state’s distaste for President Trump grew as Joe Biden captured nearly 56% of Colorado’s vote, compared to 48% for Hillary Clinton in 2016. The blue wave of 2018 grew stronger, turning the state’s U.S. Senate representation from purple to blue and maintaining the grip of Democrats on state government. The only solace for conservatives came from two ballot measures, including a drop in the state income tax rate, and the high-profile race for the 3rd Congressional District, where Lauren Boebert beat former state legislator Diane Mitsch Bush.

What do these results tell us about Colorado, and what do they mean for health policy in the years to come?

U.S. Senate

Former Gov. John Hickenlooper cruised to victory against incumbent Sen. Cory Gardner, with major networks calling the race for Hickenlooper shortly after Colorado’s polls closed at 7 p.m. The race was an important one nationwide for Democrats’ effort to wrestle away control of the Senate, which appears unlikely. Tens of millions of dollars were spent on TV ads, with more than half of spending coming from out-of-state groups.

Hickenlooper’s decisive win came despite campaign missteps and the need to defend against strong ads and debate performances from Gardner, who chaired the National Republican Senatorial Committee from 2017 to 2019. Hickenlooper was buoyed by widespread name recognition among Coloradans and an apparent desire to rebuke Trump’s party. While parts of Colorado remain deeply conservative, Hickenlooper’s win — in conjunction with the votes for president — should place the state solidly in the blue column for the foreseeable future.

While Democrats held onto the majority in the U.S. House of Representatives, their failure to take the Senate has implications for health policy at a national level, from the hope of major insurance reform to reacting to an upcoming Supreme Court decision on the legality of the Affordable Care Act. Of course, the president is a key part of this policy puzzle — and we don’t yet know who that is.

State Legislature

While votes are still being counted, a scan of state legislature results shows that nearly all incumbents held onto their seats. Possible exceptions are Sen. Bob Rankin (R-Carbondale), a moderate Republican who sits on the Joint Budget Committee; Sen. Kevin Priola (R-Henderson), another moderate Republican who has frequently bucked his party on issues such as behavioral health; and Rep. Bri Buentello (D-Pueblo), a moderate Democrat who has faced recall attempts in a district previously represented by a Republican. A full list of vote totals and pending races is available here.

For the 2021 and 2022 legislative sessions, Democrats will maintain firm control of the state House and a smaller margin in the Senate. Losses by Rankin and/or Priola would grow their lead there. Combined with Gov. Jared Polis, whose first term is halfway over, this means Colorado can expect to see additional progressive health policies enacted over the next two years. From a renewed attempt at creating a public insurance option (included in Polis’ just-released budget request) to tackling hospital, insurer, and pharmaceutical company profits, Democrats’ main constraint will be money, not votes. The COVID-caused economic recession put a large hole in the state budget, and voters’ decision to cut income taxes will make the hole even larger. Expect bills with large price tags to struggle at the Capitol in 2021.

Ballot Measures

Voters delivered a strongly progressive set of results on Colorado’s crowded list of ballot initiatives.

Coloradans approved a new paid family and medical leave program; higher tobacco taxes and a new tax on nicotine products; and a repeal of the Gallagher amendment, which was choking off property tax revenue for local governments. All had seemed to face uphill battles given Colorado’s fiscally conservative past. And voters soundly defeated a measure to restrict abortions and appeared to support a move to a national popular vote compact. Proposition EE, the tobacco and nicotine tax measure, is particularly notable for health policy. An attempt to increase the tobacco tax failed in 2016, but this year it won by a 2-to-1 margin — perhaps due to the inclusion of nicotine products and stories about Colorado’s highest-in-the-nation teen vaping rate.

However, in typical Colorado fashion, the combination of some results is perplexing. Some voters who gave a thumbs up to Gallagher repeal, raising cigarette taxes, or enacting paid family leave — liberal fiscal priorities — also voted to cut the state income tax rate from 4.63% to 4.55%, which will remove millions of dollars from the already hobbled state budget, and approved limits on legislators’ ability to create new enterprise programs, which are funded through fees and have offered some flexibility given Taxpayer’s Bill of Rights (TABOR) constraints. It’s hard to turn down a tax cut, and it’s likely the enterprise fee approach wasn’t well understood by many. But these results show that while Colorado is increasingly socially liberal, state residents are still mixed on their fiscal policy stances. (The state often defies easy categorization; think back to 2016, when voters approved a minimum wage increase, rejected new tobacco taxes, supported medical aid in dying, and overwhelmingly rebuffed a universal health care system.) TABOR and other budget restrictions remain a fixture of Colorado politics and budgeting, though yesterday’s results loosened their grip a bit.

What Comes Next?

Everything pales in comparison to the presidential race. Until that’s decided, a full understanding of Colorado’s results and how they’ll affect policy will have to take a backseat. Look for additional commentary from CHI when we know who will spend the next four years in the White House.

We’ll be diving deeper into all of these results and Colorado’s health policy forecast at our annual (and virtual) Hot Issues in Health conference on December 11. We hope you’ll join us. Registration is free.

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Photos by: Gage Skidmore; Brian Clark for CHI