• **SECTION 1. TITLE**

This Act shall be known and cited as the "Bismarck-Style Healthcare System and Interstate Compact Act."

**SECTION 2. PURPOSE AND FINDINGS**

(a) The purpose of this Act is to implement a Bismarck-style healthcare system, characterized by universal access to healthcare coverage via non-profit, regulated insurance providers, and a collaborative partnership between employers, employees, and the government.

(b) The People of Colorado find that:

1. The current healthcare system does not adequately address the needs of all Coloradans, particularly in terms of cost, access, and quality.

2. A Bismarck-style system, which blends elements of public oversight and private healthcare delivery, will provide a more equitable, efficient, and sustainable model for the state.

3. Interstate cooperation is necessary to ensure uniformity, efficiency, and the broad applicability of this system across state lines.

**SECTION 3. IMPLEMENTATION OF BISMARCK-STYLE HEALTHCARE SYSTEM**

(a) **Universal Coverage Requirement:**

1. All legal residents of Colorado shall be entitled to healthcare coverage under the Bismarck-style healthcare system.

2. Healthcare coverage will be provided by non-profit, private insurance companies that will operate under strict regulatory oversight by the state of Colorado, with premiums shared between employers, employees, and government subsidies.

3. Employers must provide a healthcare stipend to all full-time and part-time employees.

4. Individual mandates shall apply, requiring all legal residents to enroll in a healthcare plan unless they qualify for an exemption based on income or other state-defined hardship criteria.

(b) **Non-Profit Insurance Providers:**

1. All healthcare insurers operating under this system must be non-profit entities. Any surplus funds shall be reinvested into healthcare services or used to reduce future premiums.

- Administrative costs will be capped at 8% of income. 92% of income, at a minimum, must be spent on health outcomes.

2. Insurers will offer standardized benefit plans that meet state-approved essential health coverage guidelines, ensuring all residents have access to comprehensive healthcare services.

3. Private for-profit health insurance plans are permitted only for services not covered by the public framework.

(c) **Cost Sharing and Premiums:**

1. Premiums will be based on income, with cost-sharing mechanisms such as co-pays regulated by the state to ensure affordability.

- Co-pays will not exceed the average wage the bottom 90% of workers will earn in 1 hour of work. Premiums will not exceed 10% of annual income. Deductibles will not exceed 3 weeks of wages for the duration of coverage, and will be charged in alongside co-pays not to exceed a 60% increase at point of service cost.

2. The state shall provide subsidies for low-income individuals and families to ensure no resident is deprived of healthcare due to financial constraints.

3. Funding for this system will be supported by a combination of employer contributions via a tax free stipend, individual premiums, and state and federal funds.

(d) **services provided**

1. All non profit providers must cover:

- Preventive services

- Hospitalization

- Prescription drugs

- Mental health services

- Rehabilitative services

- Eye and Dental care

2. All insurers will be forbidden from dropping or denying care to anyone within their care.

3. There will be no healthcare networks. It is not for the insurers to decide where a patent seeks care. All insurers and all healthcare providers will operate under one network.

**SECTION 4. INTERSTATE COMPACT FOR BISMARCK-STYLE HEALTHCARE SYSTEM**

(a) **Authorization for Interstate Compact:**

1. The state of Colorado is authorized to enter into an interstate compact with one or more states to jointly establish and manage a regional Bismarck-style healthcare system.

2. The interstate compact shall allow for the sharing of resources, information, and regulatory practices among member states to ensure consistent implementation and oversight of the healthcare system.

3. The state of Colorado will seek to establish the interstate compact under Article I section 10 of the Constitution.

(b) **Interstate Health Insurance Pooling:**

1. Member states of the compact may create regional health insurance pools to increase the size of risk pools, stabilize insurance premiums, and expand access to care across state lines.

2. The compact may include provisions for shared data, collective bargaining with healthcare providers, and joint purchasing of pharmaceuticals and medical supplies.

**SECTION 5. INTERSTATE HEALTHCARE REGULATORY AGENCY**

(a) **Creation of an Interstate Regulatory Agency:**

1. The state of Colorado shall establish, in conjunction with other compact member states, an "Interstate Healthcare Regulatory Agency" (IHRA) responsible for overseeing the implementation and enforcement of the Bismarck-style healthcare system within the compact.

2. The IHRA shall have the authority to set standards for healthcare coverage, regulate insurers, manage cross-state healthcare access, and ensure compliance with both state and interstate healthcare regulations.

3. The Board of the IHRA will be made up of representatives of the member states Departments of Health, healthcare providers, and members of the public. Each group listed above getting equal representation on the board.

(b) **Powers and Duties of the Interstate Healthcare Regulatory Agency:**

1. The IHRA will have the power to audit healthcare providers and insurers, investigate complaints, and enforce compliance with compact regulations.

2. The IHRA will establish interstate guidelines for pricing transparency, billing practices, and consumer protection.

3. The agency shall work to harmonize healthcare regulations across compact member states, facilitating ease of access to healthcare for individuals residing or working in multiple states.

**SECTION 6. FUNDING AND BUDGET**

(a) The Colorado General Assembly shall appropriate funds for the creation and initial operation of the Bismarck-style healthcare system, as well as contributions to the IHRA.

(b) The system will be funded through employer and employee contributions, individual premiums, and government subsidies. The state will also seek federal waivers to redirect existing healthcare funds into this system.

**SECTION 7. SEVERABILITY CLAUSE**

If any provision of this Act, or its application to any person or circumstance, is held invalid, the remainder of the Act, or the application of the provisions to other persons or circumstances, shall not be affected.

**SECTION 8. EFFECTIVE DATE**

This Act shall take effect on January 1, 2027, following its passage by the voters of Colorado.

**END OF INITIATIVE**