A proposal which could see a universal healthcare system for all of Colorado’s residents would have a budget larger than the ACA in the state according to independent analysis; but it would almost certainly hit insurers’ revenues.

Voters will decide in November whether to adopt Amendment 69 which would create the new system would be a US first and generate revenue of $38 billion according to the Colorado Health Institute (CHI). That would be a larger income than McDonald’s and just behind New York Life Insurance.

ColoradoCare would use private providers of healthcare for everyone and, although private insurance companies would still be able to operate in the state, the CHI report notes that the market is expected to be much smaller.

Under the plan, Medicaid and CHP+ clients would be transferred to ColoradoCare and the state’s healthcare marketplace would be shut down. Both proposals would require Washington’s approval. Federal and state money would be diverted to ColoradoCare along with a new tax, to fund the program.

If voters decide they like the proposal it could be a blueprint for others states; which could mean more pain for private health insurers.