1. Insurer Aetna lays out concerns about ACA exchange business
2. Blue Cross Blue Shield reports ACA enrollees tend to be sicker

The latest battle over the Affordable Care Act demonstrates what some have predicted all along – the ACA is merely one step toward a single-payer health care system. Colorado, disappointed that the ACA doesn’t go far enough and is a financial train wreck, will soon vote on whether to adopt a true single-payer system.

“One of the most detailed plans to replace Obamacare this year comes not from a Republican critic, but from a group in swing-state Colorado that is proposing to scrap it for a single-payer model long sought by liberals,” Politico reported. “Supporters, who won approval this week for a 2016 ballot measure after securing nearly 110,000 signatures deemed valid, will sell the overhaul as an Obamacare replacement plan designed in Colorado, instead of in Washington.”

The way the ACA (also known as Obamacare) works is that all Americans are required to get health insurance, and all the big employers are required to offer it. For those Americans whose employers don’t offer insurance, or those who can’t afford it, there’s Medicaid or ACA exchanges.

The theory is that if everyone pays into the health care pool, then there will be plenty of money in it to take care of those who are sick.

But it hasn’t worked that way. For one thing, not as many healthy young people have signed up as was hoped, and lots more sick people with pre-existing conditions have signed up. The proportions don’t work; more money goes out than comes in.

Also, insurance companies have hiked deductibles. That means many Americans have less access to health care – because they can’t afford the higher deductibles, and they put off seeing a doctor.

So the next step is for the government to step in and run the whole system. That’s how it works in countries such as Canada and the United Kingdom. They have a single-payer system; the single payer is the government.

But it’s expensive. The Colorado plan will cost more than $25 billion per year, paid for with a payroll tax increase.

“Colorado is an unlikely place for the battle over providing universal health care to residents, an approach far to the left of the Affordable Care Act,” Politico noted. “It was expected that a ‘Medicare for all’ push would take hold in a state like liberal Vermont, which was the most visible trailblazer until Democratic Gov. Peter Shumlin pulled the plug on his plan last year because of cost.”

Colorado supporters said the proposed system isn’t truly single-payer, because private insurance companies would be allowed to offer competing plans, if they deem them profitable (but they won’t).

The Heritage Foundation’s Dr. Robert A. Book said single-payer will hurt both patients and the health care system itself.

“This concentration of government power over health care would have a profound impact on all Americans, especially members of the medical professions,” he wrote recently. “Such government control would result in substantially lower payments to physicians and other health care providers, compared to a multiple-payer system.”

And as single-payer systems in other countries prove, health care rationing is inevitable.

Coloradoans could soon learn this.