Report on State-Level Initiatives for Universal Healthcare and Alignment with Sustainable Development Goals

A new coalition, One Payer States, has been formed to pursue fundamental healthcare reform in the United States. The group’s activities and objectives align closely with several United Nations Sustainable Development Goals (SDGs), primarily SDG 3 (Good Health and Well-being), but also touching upon SDG 1 (No Poverty), SDG 10 (Reduced Inequalities), and SDG 16 (Peace, Justice and Strong Institutions).

Strategic Approach to Achieving Universal Health Coverage (SDG 3.8)

Proponents argue that national-level reform is obstructed by the political influence of the pharmaceutical and insurance industries. In response, One Payer States has adopted a state-by-state strategy to achieve universal health coverage, a key target of SDG 3.

H3: Multi-State Ballot Initiative Strategy

The core strategy involves placing single-payer healthcare initiatives on the ballot in approximately ten states during the same election cycle. This approach is designed to achieve the following:

• Dilute the financial resources of opposition groups, which heavily outspent proponents in past efforts, such as Colorado’s 2016 Amendment 69 campaign.
• Create a “domino effect,” where successful implementation in a few states encourages others to follow, similar to historical movements for women’s suffrage and child labor laws.
• Establish stronger, more accountable public institutions for health financing, directly contributing to SDG 16 by creating a system less susceptible to private industry lobbying.

The Proposed Model and its Connection to SDG Targets

The proposed model aims to establish a state-run, nonprofit, publicly financed health insurance system that would compete with private insurers. This system is designed to advance specific SDG targets through its operational structure.

H3: Key Features of the Proposed System

1. Universal Access: The state agency would offer coverage to all residents up to age 65, with seniors remaining on Medicare. This directly addresses SDG 3.8 (Achieve universal health coverage) and SDG 10 (Reduced Inequalities) by ensuring access regardless of income or employment status.
2. Financial Risk Protection: By eliminating premiums and deductibles, the model aims to end medical bankruptcy. This is a critical component for achieving SDG 1 (No Poverty), as it protects households from catastrophic health expenditures.
3. Increased Efficiency: Proponents estimate the administrative costs of a state-run plan at approximately 5%, compared to 18-20% for private insurers. This efficiency would allow more funds to be directed toward care, supporting the overall goal of SDG 3.

Challenges and Stakeholder Opposition

The initiative faces significant skepticism and opposition from key industry and business groups, who question its feasibility and potential impact.

H3: Arguments from Opposing Stakeholders

• Colorado Association of Health Plans: Argues that a state-by-state approach risks fragmenting care, creating patient uncertainty, and duplicating federal efforts. They advocate for building on the existing multi-payer system.
• Colorado Hospital Association: Opposes a single-payer model, stating that a multi-payer system provides greater choice, fosters innovation, and better supports diverse community needs.
• Denver Metro Chamber of Commerce: Believes a single-payer model would worsen the business climate and healthcare system challenges.
• Political Feasibility: Critics, including those who opposed the 2016 ColoradoCare campaign, deem the state-by-state approach impractical and politically unrealistic, especially in light of recent federal budget changes impacting healthcare.

Current Status and Path Forward

Recent developments in Colorado indicate a continued interest in exploring alternative healthcare models, driven by concerns over rising uninsured rates and federal funding cuts to programs like Medicaid.

H3: Legislative and Research Efforts

The Colorado legislature has authorized the Colorado School of Public Health to analyze draft legislation for a single-payer system. This study, which requires $750,000 in private funding, represents a critical step toward evidence-based policymaking, a principle of SDG 16. The findings are intended to inform public debate and a potential ballot initiative in 2028.

H3: Addressing a Growing Need

In 2023, approximately 265,000 Coloradans (one in 20) lacked health insurance. This number is expected to rise following federal budget cuts. Proponents like Lydia Guzman of Health Care for All Colorado argue that this growing crisis makes systemic reform urgent to prevent deaths and bankruptcies, reinforcing the core mission of SDG 3 and SDG 1.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being

   • The entire article is centered on healthcare reform, with the explicit goal of providing “health care for all.” This directly aligns with SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. The mission of the group “One Payer States” is to “win high-quality, cost-effective health care for all,” which is the core principle of this goal.

2. SDG 1: No Poverty

   • The article connects the lack of affordable healthcare to financial hardship. It mentions that under the current system, “people are getting bankrupt.” The proposed single-payer system aims to ensure “no more medical bankruptcy.” This relates to SDG 1, as high healthcare costs are a significant driver of poverty.

3. SDG 10: Reduced Inequalities

   • The article highlights inequalities in access to healthcare. It notes that federal cuts to programs like Medicaid and new work requirements will disproportionately affect “low-income adults.” The push for a universal system is an effort to reduce these inequalities by ensuring everyone has coverage, regardless of their economic status. The goal is to “provide health care for everybody,” directly addressing the inequality of access.

4. SDG 16: Peace, Justice and Strong Institutions

   • The article discusses the political and institutional barriers to healthcare reform. It mentions that “Congress is owned by the insurance companies and Big Pharma,” referencing the influence of lobbying on policymaking. The strategy of using state-level ballot initiatives is a form of participatory decision-making aimed at creating more responsive and inclusive institutions (a state-run health agency) to deliver healthcare.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

   • The article’s central theme is the push for “health care for all” and a “universal health-care payment system.” This directly corresponds to achieving universal health coverage (UHC). The proposal aims to cover “all residents” and eliminate premiums and deductibles, which addresses financial risk protection. The promise that “there would be no more medical bankruptcy” is a key aspect of this target.

2. Target 1.3: Implement nationally appropriate social protection systems and measures for all, including floors, and by 2030 achieve substantial coverage of the poor and the vulnerable.

   • A universal, state-run healthcare system as described in the article is a form of a social protection system. The article notes that federal cuts are endangering programs like Medicaid, and the proposed state plan is a response to protect citizens, especially the vulnerable, from the financial and health consequences of being uninsured.

3. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard.

   • The article points out that new federal policies, such as work requirements for Medicaid, create unequal outcomes for low-income populations. The proposed state-level legislation for universal coverage is an action intended to reduce these inequalities by ensuring that access to healthcare is not dependent on income or employment status.

4. Target 16.7: Ensure responsive, inclusive, participatory and representative decision-making at all levels.

   • The strategy of using ballot initiatives (“Ten states put a ballot initiative on the ballot the same election day”) is a direct example of participatory decision-making. It is presented as a way to circumvent a political process in Congress that is seen as unresponsive to the general public due to the influence of lobbying from the pharmaceutical and insurance industries.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicators for Target 3.8 (Universal Health Coverage):

   • Proportion of population with health coverage: The article provides specific data, stating that “one in 20 Coloradans, around 265,000 people, lacked health insurance in 2023.” It also tracks the change over time, noting the uninsured rate dropped “from nearly 16 percent in 2011 to below 5 percent in 2023.” This is a direct indicator of health coverage.
   • Proportion of population with large household expenditures on health as a share of total household expenditure or income: This is implied by the mention of “medical bankruptcy.” The goal to have “no more medical bankruptcy” serves as a qualitative indicator for measuring financial risk protection.
   • Health system efficiency: The article provides a metric for efficiency by comparing administrative costs: “Their [private plans] administrative costs run to 18, 20 percent. State-run plans are about 5 percent.”

2. Indicators for Target 16.7 (Responsive and Inclusive Decision-Making):

   • Lobbying Expenditures: The article provides concrete data on the financial influence of special interests on government, which is a barrier to responsive decision-making. It states: “the pharmaceutical industry is first, spending nearly $227 million. Insurance companies have spent $90 million and hospitals have spent almost $77 million.”
   • Use of Participatory Mechanisms: The entire strategy of using “ballot measures in multiple states” is an indicator of citizens attempting to engage in participatory decision-making.

4. SDGs, Targets, and Indicators Table

Source: cpr.org