Backers of ColoradoCare — the state ballot initiative that would establish universal health care in Colorado — think they have the perfect job for former presidential candidate Sen. Bernie Sanders.

With the Democratic National Convention in Philadelphia behind him, Sanders “comes to Colorado and campaigns for single-payer — and we win,” says T.R. Reid, one of the architects of ColoradoCare. The initiative aims to provide every resident of Colorado with affordable health insurance. Sanders made universal coverage one of the cornerstones of his presidential bid.

The proposal comes with a $38 billion annual price tag — to be paid by a tax on workers and businesses. The program would eliminate the need for insurance premiums and deductibles, and proponents claim it would save the state and individuals a lot of money.

Reid says the backers of ColoradoCare have pitched Sanders’ team, hoping he will campaign on behalf of the measure that will come before voters in November.

Sanders has already championed the issue in the state — he pushed for a single-payer system during his Democratic primary campaign in Colorado. It was one of his key health care positions, and it got thousands of his supporters cheering at an event in Denver in February.

“I believe that health care is a right, not privilege,” Sanders told cheering crowds.

He also beat that drum during a TV appearance with MSNBC’s Rachel Maddow in May. Sanders pointed out that Canada started what would eventually become its nationwide system of universal health care by persuading lawmakers in each province — one province at a time.

“So if you’re asking me, do I think if a major state — whether it’s Colorado or California or whatever — goes forward and it works well, [will] other states say ‘Hey, you know, I got a brother over there in Colorado and he’s getting health care, great health care and it’s less expensive than the current system,’ ” Sanders said. “Yeah, I think that is one possibility.”

The whole concept of ColoradoCare — or Amendment 69, as it will appear on the ballot — appeals to Andrew Kleiman, a 35-year-old Sanders supporter from Grand Junction.

“I think we’re just at such a tipping point,” Kleiman says. “The momentum of Bernie’s campaign carried over into something like this would be a perfect fit and pretty necessary.”

Kleiman says if Sanders actively backed the proposal in Colorado it would help motivate millennials like him to vote.

Reid agrees. “The last poll showed 60 percent of millennials support ColoradoCare,” he says. “Those are Bernie people and if he can turn them out to vote, we win.”

But a coalition of opponents, including conservatives, insurance firms and business groups, has come out against the initiative, which is expected to draw big money from both sides.

“I don’t think the economics of it work out,” says Nina Anderson, a small business owner in Grand Junction. She says the proposed program would be too expensive for small businesses and employees.

Colorado has been on the cutting edge of some other big policy changes, like legalizing recreational pot. Anderson says she’s not ready for the state to take the lead on a huge government-run health care system, and does not think Sanders should jump in.

“That is the scary part, I think, about being in Colorado and being on the forefront of anything that is attempting to move to socialized care,” Anderson says. “You do get everybody with outside interests coming in and playing in your sandbox.”

Cody Belzley, who served as senior health policy analyst to former Democratic Gov. Bill Ritter, opposes the proposal and says she’s not sure what difference Sanders would make — if he did come.

“It’s such a strange political year,” Belzley says. “I think it’s really hard to know what’s going to impact Colorado voters or the outcome of Amendment 69. I think this is a decision to be made by Colorado voters, based on what’s going to be best for them and their families.”

Colorado voters haven’t passed a general tax increase in years. Obamacare cut the state’s uninsured rate in half, but many residents still struggle with high premiums and deductibles.

Belzley, who works for a group opposing the amendment, Coloradans for Coloradans, urges voters to look at the details. “I think when folks look at that,” she says, “they come to understand this is just too risky a proposal.”

Sanders’ presence in Colorado could motivate voters on both sides, says Seth Masket, a political science professor at the University of Denver.

“That’s kind of the mixed message of initiatives,” Masket says. “They can really draw out both sides, depending on how passionate people are on the subject. The key for supporters of this initiative would be to translate passion for Sanders into passion for this initiative. Sanders is probably the best equipped to actually make that case.”

A representative from the Sanders campaign, Michael Briggs, says the topic is something that “interests Bernie very much. We don’t have a trip scheduled yet, but he has been keeping a close eye on this.”

This story is part of NPR’s reporting partnership with Colorado Public Radio and Kaiser Health News.

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In a big hotel conference room near New York’s Times Square, six doctors huddle around a greasy piece of raw pork. They watch as addiction medicine specialist Michael Frost delicately marks the meat, incises it and implants four match-sized rods.

“If you can do it well on the pork, you can easily do it on the person,” Frost tells his audience.

Frost consults for Braeburn Pharmaceuticals, the company behind the newly FDA-approved treatment Probuphine, and is teaching doctors how to use it. They are learning to implant it in pork so they can later implant it in patients’ arms.

Although addiction specialists welcome Probuphine, which delivers a constant dose of the drug buprenorphine over six months, at this early stage it’s complicated for physicians to add it to their repertoire. Because physicians who treat addiction don’t necessarily have experience with surgery or access to sterile spaces, some are having to learn a new skill and develop new systems.

Probuphine is unlike any other addiction treatment on the market. It promises to be life-changing for people already stable in recovery using medication-assisted treatment, who would otherwise need a daily dose of a similar drug to stay free of cravings and withdrawal pains.

Patients using Probuphine were 14 percent more likely to stay opioid-free compared to those using a daily sublingual version of buprenophine, according to a study published this month in JAMA, the Journal of the American Medical Association. Patients in this study had been stable on buprenorphine for an average of three and a half years beforehand. The authors do caution against generalizing these findings. Most participants, they note, were white, employed, had at least a high school education and were previously addicted to prescription opioids rather than heroin.

“They don’t have to be dependent on taking something every day. It takes the choice out of that,” says Ella Leers, a doctor who treats substance abuse at the Carnegie Hill Institute in Manhattan.

The FDA approved Probuphine under the condition that physicians are trained and tested before implanting or even prescribing the treatment. There are three kinds of certification: implanter, prescriber or both. If doctors can’t perform the implanting themselves, they need to coordinate with another doctor who can.

To date, over 1,800 healthcare practitioners have been certified — 27 have implanted dozens of patients, according to a representative for Braeburn Pharmaceuticals, Probuphine’s maker.

Gloria Baciewicz, chief of addiction psychiatry at the University of Rochester Medical Center, says using the new treatment will take some adjustments. But, she adds, there need to be as many effective treatments as possible for opioid use disorder.

“Now with Probuphine, we have to take it up to a whole different level because we have to have either agreements with implanters or a room where we can implant. We have to get the equipment. There will be a lot more to do,” she says. Her team was already planning on moving to another space, which will have the facilities they need to conduct minor surgery.

Prescribing Probuphine may also call for a new approach to the counseling and behavioral therapy that is typically recommended for those on medication-assisted treatment.

“If you’re implanting something that can be there for six months, you want to make sure that the patients are still coming in to get the other types of support that they can use because of their addiction issues,” says Leers.

There are also questions about insurance coverage. Billing codes are still being established. For now, doctors need to buy the Probuphine kits that run almost $5,000 themselves, and then bill patients or insurance companies.

Braeburn has offered to help physicians verify if an insurance plan would reimburse any of the cost. According to the company, Blue Cross Blue Shield and United Healthcare approved reimbursement for a few patients who have implants. Medicare, Medicaid and the VA have Probuphine in their formulary and are required to cover it if deemed medically necessary.

Despite having to get certified and the other hurdles, many doctors welcome the treatment option. Opioid drug overdoses have reached epidemic levels — roughly 78 Americans die every day from opioid overdose, according to the Center for Disease Control and Prevention.

So it’s good to have a another way to deliver medication-assisted treatment, says Richard Rosenthal, medical director of addiction psychiatry for the Mount Sinai Health System. Rosenthal was one of two principal investigators on a Probuphine clinical trial.

“Everybody is waking up to the fact that we’re in the midst of an opioid epidemic,” says Rosenthal. “There are actually very few medications for addiction of any kind. Given the addiction treatment system in the United States, most of the treatment that’s given is psychosocial. There’s very little use of FDA-approved medications.”

Probuphine made a difference, says Scott Jernigan of Jacksonville, Fla. He was in recovery for almost a year, taking another medication, when he signed up for a Probuphine clinical trial. He said Probuphine freed him from weekly doctor visits and pharmacy runs, and from fears of how sick he’d feel if he missed a dose or forgot to take his medication.

“[It] meant that I could become more of what my normal is going to be,” Jernigan says.

Some specialists recommend patients stay on medication-assisted treatment for years, or even indefinitely. For now, Probuphine can only be prescribed for two runs of six-month use and is meant for people already stable on 8 mg or less of a medication like buprenorphine.

Authors of the JAMA study suggest further investigation of Probuphine to gauge issues often associated with buprenorphine, such as diversion or pediatric exposure.

This story is part of a reporting partnership with NPR, Side Effects Public Media and Kaiser Health News.

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As he takes the stage Wednesday night at the Democratic National Convention in Philadelphia, vice presidential nominee Tim Kaine is firmly in Hillary Clinton’s camp — and his party’s — on the big health care issues. Now a U.S. senator from Virginia, Kaine supports the Affordable Care Act and pushed its Medicaid expansion. He also worked to overhaul the mental health system when he was governor of Virginia.

Here are highlights and a few flashpoints of controversy from Kaine’s health policy record:

Mental health

A defining moment in Kaine’s tenure as governor was the 2007 mass shooting at Virginia Tech, where 33 people, including the gunman — a student at the school — died.

Almost exactly one year later, Kaine signed a $42 million legislative package to overhaul the state’s mental health system. The money was used mostly for emergency mental health services, children’s mental health services, increased case managers and doctors and jail diversion projects, according to the Virginia Office of the Attorney General.

“Somebody shouldn’t be imprisoned because we won’t provide funding for community mental health,” Kaine said at a mental health conference in 2008, shortly after the bills were signed, according to the Virginian-Pilot in Norfolk.

The package of laws made it easier for authorities to commit someone having a mental health crisis into treatment involuntarily. They no longer had to prove the patient was in “imminent danger.” Instead, the new standard only required authorities to demonstrate a “substantial likelihood” that the person could cause serious harm to himself or others.

Together, Kaine and the state’s General Assembly made a down payment on longer-term reforms for the delivery of mental health and behavioral health services in Virginia, says Peter Cunningham, a professor of health behavior and policy at Virginia Commonwealth University.

Abortion

As a Catholic who worked with Jesuit missionaries in Honduras in 1980, Kaine says he opposes abortion personally but supports a woman’s right to choose for herself. His stance has drawn criticism over the years.

“Personally, I’m opposed to abortion and I’m opposed to the death penalty,” he said on NBC’s Meet the Press in June. “The right thing for government is to let women make their own decisions.”

That was a change from Kaine’s position in 2005, when he supported parental consent laws and bans on “partial birth” abortions, causing the Virginia chapter of NARAL Pro-Choice America to withhold an endorsement in his gubernatorial campaign. As governor, he signed a bill creating “Choose Life” license plates in Virginia, which he said was an issue of free speech.

Since then, Kaine has actively supported Planned Parenthood and opposed abortion restrictions.

In 2013, Kaine cosponsored legislation to improve access to contraception.

Affordable Care Act

Kaine did not mark himself as a health care reformer when he was Virginia’s governor, but his 2006-2010 term overlapped the recession when little change was happening anywhere at state or national levels, Cunningham points out.

“He was probably pretty typical of the middle-of-the-road Democratic governors in sort-of-purple states,” Cunningham says. “When the recession hit, that precluded any other major health reform effort that he might have contemplated.”

Kaine supported Obamacare when he ran for Senate in 2012 and has since cosponsored bills to improve the law. Kaine has pushed for Medicaid expansion in Virginia and cosponsored legislation to incentivize expansion in other states as well. Like Clinton, Kaine has proposed adjusting the federal health care law to include some low-income families that aren’t currently covered — fixing the so-called family glitch. This year, he cosponsored a bill to require more businesses to provide benefits under the ACA.

Public health

Kaine has occasionally incited controversy, as in 2007 when Virginia became the first state to require all girls to get the human papillomavirus vaccine (protection against a virus that can cause cervical cancer) before enrolling in high school. In 2009, he backed a bill that banned smoking in bars and restaurants in the tobacco-producing commonwealth.

Opioids

Since his election to the Senate four years ago, Kaine has cosponsored bills that would establish an advisory committee to help the FDA approve new opioids, reform guidelines for the VA regarding the prescription of opioids, protect first responders from lawsuits when they administer emergency drugs to counteract an overdose, and create a drug monitoring program for Medicare.

Many of those bills were rolled into CARA — the Comprehensive Addiction and Recovery Act of 2016, which was signed by President Obama in July. The bill bore Kaine’s name as a cosponsor.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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