transcript

Speaker 1:
[00:00] Support for Purplish comes from the Colorado Hospital Association. Almost 7 in 10 Colorado hospitals are at risk financially. Increased costs and a growing number of uninsured patients are among the many challenges. Learn more at cha.com.

Speaker 2:
[00:17] You know, every day on Up First, NPR's Golden Globe-nominated Morning News podcast, we bring you three essential stories. At the heart of each story are questions. What really happened? What really mattered? What happens next? At NPR, we stand for your right to be curious and to follow the facts. Follow Up First wherever you get your podcasts and start your day knowing what matters and why.

Speaker 3:
[00:42] Colorado's primary election is about six weeks away. By now, Democratic and Republican ballots are pretty much set. For many candidates, securing their slot required winning support of party activists.

Speaker 4:
[00:57] On the Democratic side, candidates put President Donald Trump, as well as protecting Little D democracy, and standing up to billionaires and their businesses front and center.

Speaker 5:
[01:08] When you're up against a lawless bully, do you accommodate or appease? Or do you fight for what you believe in?

Speaker 6:
[01:16] We are living in a country led by people who want us to believe that cruelty is what makes us strong, that violence is normal, and that corruption has no consequences.

Speaker 7:
[01:30] I will take on the goliaths, the big tech, the private equity, the monopolistic bros. Because I know that if we use the law boldly and courageously, we can take down these goliaths, and I want to be the David on your shoulder when we do.

Speaker 8:
[01:44] Republicans argued that it's time for the end of one-party rule in Colorado. GOP candidates made the case that they might be the one to finally turn the tide on a decade of their party's Colorado losses.

Speaker 9:
[01:56] This is our year. This is the year we're going to do this. I'm going to reclaim parenthood and childhood for all Coloradans.

Speaker 10:
[02:03] We do not need a senator with a steep learning curve. But when he gets to Washington, DC in January, we need one who's already stood toe-to-toe with the Democrats.

Speaker 11:
[02:12] We need a leader, someone with the experience of doing what other people say can't be done. We've longed too well for so long as Republicans, and this year it changes.

Speaker 3:
[02:25] Both parties recently held their state assemblies in Pueblo, high-stakes gatherings in this high-stakes election year. The top offices in Colorado are all open. Governor, Secretary of State, Attorney General, Treasurer.

Speaker 4:
[02:39] The assemblies also set up some intriguing congressional primaries. Democrats will have a choice for US Senate and choose a candidate to try and unseat Colorado's most vulnerable Republican congressmen, races that pit moderate Democrats against more progressive candidates. On the Republican side, a freshman representative gained an 11th hour challenger.

Speaker 8:
[03:00] Yes, the general election isn't until November, but the decisions voters make in June have the potential to shape the state for years to come. In a lot of races, just because of the voting trends in Colorado, the primary will likely decide who holds these offices starting next year.

Speaker 3:
[03:23] This is Purplish from CPR News and the Colorado Capitol News Alliance, a show about Colorado politics and policy. I'm Bente Birkeland, and we have CPR's Washington, DC correspondent, Caitlyn Kim, on the line with me. She's back on the East Coast, but was just here in Colorado to attend the assemblies in Pueblo. Hey, Caitlyn, thanks for joining us.

Speaker 4:
[03:48] Hi, what can I say? Any excuse to have some sloppers?

Speaker 3:
[03:51] I had my first slopper in Pueblo and it was delicious.

Speaker 6:
[03:55] I know, I was there.

Speaker 3:
[03:58] And we have Jesse Paul with the Colorado Sun joining us. He also covered the assemblies.

Speaker 8:
[04:03] Apparently, I get invited to Purplish, but not the slopper party.

Speaker 4:
[04:07] Next time.

Speaker 3:
[04:12] So a quick civics lesson. Colorado has a few ways of getting on the primary ballot. A candidate can collect voter signatures or they can rally support through the caucus and assembly process.

Speaker 8:
[04:25] I want to note that the assemblies bring together the most progressive Democrats on the one hand and the most conservative Republicans on the other. I like to describe it as who would be left if you boiled the major parties down for 24 hours. So it's really the most committed and often most partisan members of the parties that are at these assemblies.

Speaker 4:
[04:43] Yes, party members go to local caucuses and volunteer to be a delegate to the state assembly. And it definitely takes a lot of time out of someone's daily life. So these voters are really active in the party and invested in candidates.

Speaker 3:
[04:58] To win support, candidates have to show that they embody what the party wants right now and that they're the right choice to sell that vision to a wide range of voters. And it can be a hard tightrope to walk.

Speaker 8:
[05:11] One of the big functions of this process is to winnow down the field. It's pretty simple to file paperwork to run for office in Colorado, but to get on the ballot through the caucus and assembly route, you need at least 30% of delegates to support you. So when you do the math, that's three candidates, max, per race, getting on the ballot this way.

Speaker 3:
[05:29] So, civics lesson over, let's get to it. The Democrats held their assembly first. This was at the end of March. And when we were there talking to delegates, we heard a lot of concerns that were pretty national in scope.

Speaker 12:
[05:57] I think the American people have been really clear that they do not want us to engage in foreign wars. They want us to be focused on issues here at home.

Speaker 13:
[06:06] I'm focused on democracy and preservation of democracy.

Speaker 14:
[06:12] I am for affordability.

Speaker 12:
[06:16] That's like the main issue right now.

Speaker 3:
[06:19] A lot of delegates also talked about the war in Gaza, political PAC money, and taking a stronger stand against Trump than against ICE.

Speaker 4:
[06:29] Because many of these delegates tend to come from the far ends of the political spectrum, assemblies can pose a risk for candidates whose politics tend more towards the center, especially in this cycle when people are unhappy with the status quo.

Speaker 8:
[06:42] Yeah, the assemblies can just be a real crap shoot. Fail to win 30 percent of the people in this one auditorium, in this one place, at this one time, and it's the end of the line for your campaign. What happens if some of your supporters ate bad shellfish the night before? Or what if they just had something better to do on a Saturday?

Speaker 4:
[06:59] It's also though a time saver to gather signatures. If you're a member of Congress running for re-election, those incumbents are in DC during the week. That's why a lot of them tend to go the petition route to get on the ballot.

Speaker 8:
[07:11] It is very pricey though. So for candidates who don't have that much money, the caucus and assembly process is the way to do it.

Speaker 3:
[07:19] Yeah. What's interesting this year is there's a bit of a trend in some of the Democratic races where you see one candidate going the signature route, and then kind of leaving the assembly wide open for their opponent. So that was the case for the governor's race. Senator Michael Bennet got signatures, and then Attorney General Phil Weiser swept the assembly.

Speaker 4:
[07:39] Yeah. And it was also the case for the US Senate. John Hakenlooper went with petitions, while state senator Julie Gonzalez won over the delegates at the assembly. And in CD8, the same thing. Former state lawmaker Shannon Bird and veteran Evan Munsing went the petition route, state representative Manny Ruttenell the assembly route.

Speaker 3:
[07:58] But we did see in some key races that the main candidates did go through assembly. So the race for secretary of state, two candidates, Jesse Danielson, a state senator, and Amanda Gonzalez, a county clerk, they both made the ballot. In the attorney general's race, three candidates went through the assembly process, David Seligman, Jenna Griswold, and Michael Doherty. And a fourth candidate is expected to make it on via petitions, Heddle Doche.

Speaker 4:
[08:25] Given the recent voting trends in the state, it's very likely that whoever wins the Democratic primary will have a smooth glide path to the state office.

Speaker 8:
[08:32] Democrats definitely have the most at stake in this year's primaries. A lot of ambitious Dems hope to climb the political ladder this year. So it's not surprising that all of these races have primaries. Maybe it's even a little surprising that the fields aren't larger.

Speaker 3:
[08:46] Gosh, yeah, that would be a lot. I mean, the benefit to winning an assembly is that you do get your name first on the ballot. So during the primary, it's listed top billing.

Speaker 8:
[08:57] But winning assembly and getting top line on the primary ballot doesn't mean you're actually going to win the primary. Sometimes when you're first year last, as the great Ricky Bobby said, the only reason I'm here today is that I was promised that I would get to rant about all of this later.

Speaker 4:
[09:12] We are very much looking forward to that.

Speaker 3:
[09:21] Before we get to Jesse's much-anticipated rant, I want to talk about maybe the biggest surprise in the Democratic field, Diana DeGette. She's the dean of Colorado's delegation, and she came close to not making the ballot. She was significantly outperformed by Maylock Quiroz, a first-time candidate, a self-described Democratic socialist.

Speaker 4:
[09:42] I wasn't surprised DeGette got through in the end. Yes, it was close. You know, DeGette got around 33% of the vote at the CD1 assembly. And a few points lower, and she would have been out of luck.

Speaker 3:
[09:53] I mean, Jesse, how big of a deal is it that Quiroz did so well on this congressional district assembly?

Speaker 8:
[09:59] As tempted as I am to start my rant now, the bottom line is that you can't draw any conclusions from it.

Speaker 3:
[10:05] Quiroz is a political newcomer. Could she really upend this race?

Speaker 4:
[10:10] You know, it's not out of the realm of possibility, but look, it's going to be tough for her. Denver is a deep blue district, and whoever wins the primary will be on a glide path to the House. But it's important to remember, primary voters are not as progressive as the people who go to assembly, and there are more unaffiliated voters in the district who will get a say in the primary race.

Speaker 8:
[10:33] Okay, you guys are just like tempting me to start my rant now. I'm going to close my mouth.

Speaker 3:
[10:38] I do want to mention that this could end up being a three-way race for CD1. We're waiting to see if another DeGette challenger, CU Regent Wanda James, has enough signatures to qualify. But what does it say about the Democratic electorate after these three decades that DeGette is facing some pretty significant challenges?

Speaker 8:
[10:59] This is not the first time that DeGette has faced a primary challenge, and she's fended off a lot of challengers before. But polling does show that Democrats are unhappy with their party and its leaders, so this primary could be telling on that front.

Speaker 4:
[11:11] Yeah, you know, it goes towards this larger theme of people being sick of the status quo and wanting change.

Speaker 3:
[11:17] Well, that's kind of the mood among Democrats, but next up, we're going to talk about Republicans who are just hoping to get a seat at the table. This is Purplish from CPR News and the Colorado Capitol News Alliance.

Speaker 1:
[11:35] Support for Purplish comes from the Colorado Hospital Association, almost 7 in 10 Colorado hospitals are at risk financially. Increased costs and a growing number of uninsured patients are among the many challenges. Learn more at cha.com.

Speaker 15:
[11:52] You love podcasts to keep up with the news. Now there's an easy way to find out what's happening in Colorado every day. The Colorado Today podcast is new from the same trusted source that brings you Purplish. You'll get the top stories, on the ground reporting and moments of curiosity. Follow Colorado Today for the statewide news you need each weekday on Apple, Spotify or wherever you get your podcasts.

Speaker 3:
[12:22] This is Purplish from CPR News and the Colorado Capitol News Alliance. Colorado Republicans have been pretty rudderless for the last few years. Deep, deep divisions about the direction the party should take. Policy divides, arguments about who is a true Republican, calling people rhinos, support for President Trump or not. And there were a lot of questions about Republicans even being able to pull off a successful state assembly.

Speaker 8:
[12:54] Yeah, and whether it was a success or a suffer fest probably depends on whether you were there for the 12 plus hour event. Success in the sense that yes, they chose some candidates, not so much of a success in the bureaucratic or efficiency sense. The backdrop here, party chair Britta Horne got hit with a no confidence vote earlier in the year and promised to step down right after the assembly.

Speaker 3:
[13:15] A lot of distressed going into the assembly. People weren't sure delegates would even believe the outcome of the vote with Horne and her supporters in charge. And as you both know, Republicans have been calling for hand counts and paper ballots in elections. So some delegates were upset that the party wasn't counting everything by hand.

Speaker 4:
[13:37] You know, as someone who was there though, given how long everything took, I think in the end, everybody was happy that they weren't waiting hours for a hand count. That said, and I hate to say this because I know the people working there were really trying, but the GOP assembly was a mess and definitely bore out some of the concerns people had. You know, it started hours and hours late and was plagued by disagreements throughout. And then once the votes were in and counted, organizers found out they had more votes than credential delegates.

Speaker 8:
[14:09] That's right, the Party of Election Integrity had about 80 more votes than credential delegates. And everyone was so tired of being there that at the end of the day, they just said, the heck with it, and accepted the clearly flawed results.

Speaker 3:
[14:21] That's not something I would have predicted ahead of the assembly. When we talk to Democratic delegates, a lot of folks concerned about affordability. That was top of mind for Republicans too, as well as social issues like transgender rights, parental rights, and trying to unify as Republicans.

Speaker 16:
[14:41] I work hard for my money, and yet I feel like it's not actually being put to use how it should be. I can't afford to live on my own. I have to live with roommates. And then after a while, I have to move back home with my parents.

Speaker 17:
[14:53] The education and the parental rights that are being taken away from our kids in school.

Speaker 14:
[14:58] Are we going to come together and be in a divided party? And like people said, don't bring snacks. We eat our own. That's the joke.

Speaker 3:
[15:15] Let's look at who made it onto the Republican primary ballot, starting with the governor's race.

Speaker 4:
[15:20] Yeah, this is where you really see the power of the assembly to bring some order out of chaos, especially a huge field of candidates. There were 18 gubernatorial candidates that went the assembly route.

Speaker 8:
[15:33] So many speeches. My favorite was from Kelvin K. Mann Wimberley, never heard of him before, who spent his entire speech trying to persuade a delegate just to nominate him. And he was successful, he got a nomination.

Speaker 4:
[15:45] Thankfully, not all of these 18 showed or even spoke. But of those 18, only two came away with their names on the ballot.

Speaker 8:
[15:53] That's pastor and Marine veteran Victor Marx, who got just under 40 percent of the vote, and state representative Scott Bottoms, a fellow pastor who got 45 percent of the vote. Sadly though, K. Mann came up well short, but just a handful of support.

Speaker 3:
[16:07] Covering the legislature, Scott Bottoms is a pretty familiar figure. He's definitely one of the most conservative lawmakers at the state capitol, especially a cultural conservative. But outside of political circles around Denver, Victor Marx is probably less familiar. Jesse, what should people know about Marx?

Speaker 8:
[16:28] Victor Marx is definitely someone I hadn't heard of when this whole process started. He is running his first race for elected office. Marx said he started putting down roots in Colorado about 15 years ago. He's got a massive social media following a lot of it from his national profile. He says he spent his career trying to rescue women and children from exploitation. We know that Marx has a focus on the family connection. That's the big evangelical church down in Colorado Springs. This is his first campaign for office, as I mentioned, but he's got a who's who of backers, including Lauren Boebert. Yep.

Speaker 4:
[16:58] Boebert was there in the back waving a sign for him. I will say Marx promised if elected that he would release former Mesa County Clerk Tina Peters on quote, day one.

Speaker 8:
[17:08] That's not if current Governor Jared Polis beats him to it.

Speaker 3:
[17:11] Bottoms and Marx won't likely be the only two Republicans in this primary race, though. State Senator Barbara Kirkmeyer from Weld County, she's run for Congress before, she submitted signatures to petition on.

Speaker 8:
[17:26] Yeah, she's still very conservative, but she's not cut from the same cloth as these Republican assembly delegates. So it's not really a surprise that she sat out the assembly.

Speaker 3:
[17:37] Let's talk about some of the other statewide races. What stood out there?

Speaker 8:
[17:41] Well, one theme is that Republicans won't have a ton of choices for statewide office on their primary ballots. They'll see one candidate for US Senate, that's State Senator Mark Basely, one candidate for Secretary of State, one candidate for Treasurer, and two for Attorney General.

Speaker 3:
[17:55] Jesse, people may be surprised that even if there's only one candidate for Republicans, let's say US Senate, it's still listed on the primary ballot.

Speaker 8:
[18:03] That's right. You got to fill out that bubble and get carpal tunnel syndrome even if there's only one candidate. Technically, the reason why is that if a candidate drops out once their name is already on the primary ballot, there have to be some votes for that person so that a vacancy committee could be formed to fill that person's spot.

Speaker 3:
[18:19] We know how much you love covering vacancy committees.

Speaker 8:
[18:22] Yeah.

Speaker 3:
[18:22] Thank you for that tidbit. Moving down the Republican ballot, one thing that makes the assembly process pretty interesting is that it does allow a candidate to pop up at the 11th hour, make a splash, because you can get nominated from the floor. And that's what happened for Congressional Districts 3. This is the seat that covers Western and Southern Colorado.

Speaker 4:
[18:43] That's right. And to be clear, this happened during the Republican assembly. Incumbent Representative Jeff Hurd, you know, he had already fended off a primary challenger, Hope Sheppleman, with the help of President Trump, no less. But he gained another at the district assembly, former state representative Ron Hanks. It essentially means a rematch of the 2024 GOP primary, where Hurd beat out Hanks and others. You know, Hanks pulled off this floor nomination following a speech criticizing some of Hurd's votes, like overturning Trump's tariffs on Canada and his collaboration on a public lands bill with Colorado's two Democratic US senators.

Speaker 18:
[19:21] If I had an audience with the president, I would go in and say, Mr. President, what more can I do to forward the America First agenda?

Speaker 4:
[19:33] Now, Hurd secured his spot on the ballot via the petition process, so unlike DeGette, he wasn't ever at risk of getting knocked out at the assembly. But he did show up to talk to delegates, a legislative update, and reminded them that this district is not solidly red, which means electability matters.

Speaker 19:
[19:51] This is not about personality. It's not about noise. It's about results. It's about effectiveness, and it's about keeping Colorado's third district in Republican hands. I'm proud of the work that we've done, but we're not finished.

Speaker 3:
[20:05] Remember, this is the seat that Congresswoman Lauren Boebert almost lost. Then she moved across the state to rent in the reddest congressional district.

Speaker 4:
[20:13] That's right. This time, Boebert, as well as incumbent representatives Jeff Crank and Gabe Evans, will also not have to face any primary challengers.

Speaker 8:
[20:21] But you'll still have to fill out those little bubbles.

Speaker 3:
[20:28] We talked a bit earlier about why a candidate might choose to go the assembly route versus collecting petitions. But it's also interesting to ask what succeeding at the assembly process means for a candidate's chances in the primary. Jesse, you've been putting in some time trying to answer that question. Yes.

Speaker 8:
[20:47] This is my moment. Let's do this. Leroy Jenkins. Oh my God.

Speaker 18:
[20:57] Okay.

Speaker 8:
[20:57] The reality is that while party activists put a lot of weight on the caucus and assembly process and the candidates who win it, there is often a reverse correlation between who wins at the assembly and who wins in the primaries.

Speaker 3:
[21:09] So unpack that a little bit more.

Speaker 8:
[21:11] Lots of candidates who win their party's assemblies in Colorado have gone on to lose in the primaries. In 2018, for instance, former state treasurer Kerry Kennedy won nearly 62 percent of the delegate vote at assembly, easily beating then US representative Jared Polis. But if you haven't figured it out by now, Kennedy went on to lose the primary to Polis and by a very wide margin.

Speaker 4:
[21:33] Yeah, and we've seen this in both parties. Former Parker Mayor Greg Lopez won the biggest share of the delegate vote for governor at the 2022 Republican State Assembly. But he went on to lose the primary to Heideginal, who ultimately lost to Polis in the general election.

Speaker 8:
[21:49] There are examples of this up and down the ballot and with both parties. Of course, there are people who win at the assembly and in the primary. But the point I'm trying to make here is that the popularity at assembly does not automatically mean voters will like you when the primary ballots arrive. It often in fact means the opposite.

Speaker 4:
[22:06] Yeah, and I think people need to keep in mind that the state assemblies are attended by about 1500 to 2000 delegates. That is a small, small fraction of the roughly 4 million registered voters in Colorado, most of whom are unaffiliated and not even partisans.

Speaker 8:
[22:22] Take that first congressional district democratic assembly that we talked about at the top, where DeGette almost didn't make the ballot. It's not to say that Mila Kyrgios or Wanda James won't beat Diana DeGette in the primary. That could definitely happen. It's that you can't make that conclusion because of what happened at the assembly. The point is just that these assemblies are not representative of the electorate. It's like a poll. The results are only as good as the data. And that data needs to be randomized and representative to be worth anything. Okay, rant over.

Speaker 4:
[22:57] Preach, Jesse, preach. You know, you could be on the Republican ballot for governor at this rate or Democratic ballot.

Speaker 8:
[23:02] Well, it's too bad I'm unaffiliated like the majority of the electorate and can't participate in any of this assembly stuff.

Speaker 3:
[23:18] What are the implications when candidates who succeed at assembly often struggle with a larger electorate when you have Republicans potentially on the verge of dropping their primary altogether? So that means Republicans would only use the assembly process to pick candidates for the general election.

Speaker 8:
[23:36] Yeah, this is a good moment to talk about that. There's a faction of Republicans who have long sought to stop their party from participating in Colorado's primaries, mainly because they don't like that unaffiliated voters are allowed to cast ballots in them. And they received a major boost late last month when a federal judge concluded that rules in the state about how a party can opt out of Colorado's open primary system are unconstitutionally high.

Speaker 4:
[23:58] Now, as a reminder, Colorado voters overwhelmingly supported letting unaffiliated voters participate in partisan primaries when they voted on it about a decade ago. They could choose either their Republican ballot or the Democratic ballot. But the law allows the parties to opt out of the primary if 75% of their essential committee votes to do so.

Speaker 8:
[24:18] Democrats to be clear have not tried to opt out, but a faction of Republicans has tried every election cycle in recent memory. However, they've been unable to reach that 75% threshold. They've gotten a majority, but not that magic three quarters number.

Speaker 3:
[24:32] That's right. And in 2023, the Republican Party sued in federal court, and they claimed that the 75% threshold was too high.

Speaker 8:
[24:42] And now Republicans have partially won their case. This is a big development. The judge agreed that the threshold is too high, but he didn't set a new threshold. But if it's lower, there is a very good chance that the Central Committee will reach it.

Speaker 3:
[24:55] Would this affect this year's Republican primary election?

Speaker 8:
[24:59] It's a bit of a tough question, but the answer is probably not. It's kind of too late for that. But there is a very strong likelihood, as I mentioned, that Republicans will vote to opt out of the primaries in 2028 and possibly beyond.

Speaker 4:
[25:12] And that would mean not only that unaffiliated voters would be blocked from helping pick the Republican general election candidates, but also that only party insiders would get to weigh in. And I will say, that is a rant from me for another day.

Speaker 8:
[25:26] Preach, girl.

Speaker 3:
[25:27] There are Republicans, and as we've mentioned, Democrats as well, who really do think it's important for unaffiliated voters to participate in the primary.

Speaker 8:
[25:36] And that makes sense. Unaffiliated voters make up more than half of the state's electorate. But remember, unaffiliated voters, you can only vote on one party's primary ballot, not both. Don't fill out those extra bubbles, people.

Speaker 3:
[25:57] Since taping this episode, we have confirmation on some more names you can expect to see on those bubbles. In the Democratic race for Attorney General, Heddle Doshi and Michael Doherty both successfully petitioned on. A quick aside, Doherty qualified for the ballot through the assembly and by gathering signatures. State Senator Barbara Kirkmeyer has officially qualified for the Republican gubernatorial ballot. And in the congressional races, for CD3, Republican Congressman Jeff Hurd's petitions were accepted. And in CD1, CU Regent Wanda James will join Congresswoman Diana DeGette and Maylock Quiroz on the Democratic ballot. That's it for this episode. Purplish is a production of member-supported Colorado Public Radio and the Colorado Capitol News Alliance.

Speaker 4:
[26:50] The CCNA is a collaboration between KUNC News, Colorado Public Radio, Rocky Mountain PBS and the Colorado Sun with support from news outlets throughout the state. Startup funding for the Alliance was provided in part by the Corporation for Public Broadcasting. I'm Caitlyn Kim.

Speaker 8:
[27:07] I'm Pastor Jesse Paul.

Speaker 3:
[27:08] And I'm Bente Birkeland. Our producer is Stephanie Wolf. Sound design and engineering by Shane Rumsey. Our theme music is by Brad Turner. Megan Verlee is our executive producer. Additional reporting in this episode from Briana Heaney.

Speaker 8:
[27:24] Purplish will be back in your feeds next week. Subscribe now so you don't miss an episode.

Speaker 3:
[27:34] This is Purplish from CPR News and the Colorado Capitol News Alliance. And by the way, we didn't catch it when he said it, but if you did, yes, Jesse's Talladega Nights quote was a bit off.

Speaker 10:
[27:51] If you ain't first, you're last.

Speaker 6:
[27:53] You know what I'm talking about?

Speaker 10:
[27:54] That phrase is trademarked, not to be used against the British, but Ricky Bobby Ains.

Speaker 1:
[27:58] Support for Purplish comes from the Colorado Hospital Association. Almost 7 in 10 Colorado hospitals are at risk financially. Increased costs and a growing number of uninsured patients are among the many challenges. Learn more at cha.com.