* add health care choice as a constitutional right;

* prohibit the state from requiring or enforcing any requirement that a person participate in a public or private health coverage plan; and

* restrict the state from limiting a person's ability to make or receive direct payments for lawful health care services.

Summary and Analysis

Amendment 63 adds health care choice as a right listed in the bill of rights in the Colorado Constitution. The measure specifies that the right to health care choice limits the ability of state government to either require health insurance or any other type of health care coverage, or to restrict direct payments for health care services.

Health care coverage requirements. Colorado law does not require a person to have any type of health care coverage. A person may purchase coverage from a private insurer; participate in an employer-provided health plan; choose to enroll in a public program such as Medicaid and Medicare, if eligible; or have no coverage. If a person does not have health care coverage, or if his or her plan does not cover a specific service, services may be paid for out-of-pocket.

In March 2010, a package of federal health care laws was adopted by the United States Congress and signed by the President. Beginning in 2014, most people are required to provide proof of acceptable health care coverage to the Internal Revenue Service. Persons without coverage are subject to a federal tax penalty.

Payments for health care services. Currently, health care services can be paid for by health insurance companies, the government, patients, or some combination of these sources. When an individual has coverage, a third party, such as an insurance company or the government, negotiates with the provider to establish a price for health care services. Direct payments refer to when a person pays a provider directly, without seeking approval or reimbursement from a third party. No state or federal law prohibits a person from seeking services outside of a health care plan and paying a provider directly.

Effects of Amendment 63. Amendment 63 does not change current health care coverage requirements, but it places restrictions on what the state may require in the future. For example, the state may offer new health coverage plans but, under Amendment 63, could not require a person to join a plan. The measure prohibits the state from: requiring a person to obtain health care coverage, regulating direct payments, or penalizing a person for either participating or not participating in any particular plan. The measure does not apply to workers' compensation insurance or mandatory emergency medical care.

Amendment 63 also prohibits the state from enforcing health care coverage requirements at the direction of the federal government. However, the measure does not impact the federal government's ability to enforce the coverage requirements created by federal health care laws. Coloradans are still required to have acceptable coverage under federal law beginning in 2014.

Estimate of Fiscal Impact

Amendment 63 is not expected to affect state or local government revenue or spending.