Colorado clinics, mental health providers see more uninsured people

Health clinics in Colorado are seeing more uninsured patients than they have since the Affordable Care Act took effect a decade ago, and some of their leaders believe the state must prepare for a future where more people lack coverage. .

Colorado, like most states, has largely completed the process of ending Medicaid coverage for people who are no longer eligible. During the COVID-19 public health emergency, states suspended the process of making recipients prove they still had low enough income to qualify.

Most of the half a million people who lost their Medicaid coverage in Colorado did not return their paperwork or otherwise failed to complete the process. So far, the state has no data on whether these people have found other insurance.

After the ACA was passed in 2010, states and the federal government assumed the uninsured rate would continue to fall, and that’s what generally happened, said Phyllis Albritton, managing consultant for the Colorado Safety Net Collaborative, which represents clinics that were serve mostly uninsured people and receive no federal funding.

That led governments and nonprofits to put less resources into serving the uninsured and focus more on things like meeting the economic and social needs of patients, she said.

“The grand scheme of the policies has been, everybody is going to have coverage, so we don’t have to worry about the uninsured,” Albritton said. “We have to accept that there are going to be uninsured people in Colorado.”

Despite public perceptions that everyone can get affordable coverage through the individual market, people often find they can’t pay their own out-of-pocket costs if they get sick or injured, said Dr. Bebe Kleinman, CEO of Doctors Care in Littleton, which treats the uninsured and those covered by Medicaid.

She estimated that about 20% of her clinic’s patients don’t have insurance — the highest rate since key provisions of the ACA went into effect in 2014.

“It’s been a strange ride from where I thought I was going to shut this country down” because the number of uninsured people was supposed to drop dramatically under the ACA, Kleinman said.

An analysis of the nationwide employer-based insurance market found that the average worker had a $1,735 deductible for single-person coverage, with people employed by smaller companies generally paying higher deductibles. In contrast, about half of all Americans could not pay a $500 medical bill right away, and roughly one in five reported that they could not pay one even with a payment plan or the ability to borrow money from family. according to the non-profit group KFF. .

Some of the newly insured patients may still be eligible for Medicaid coverage but filled out the paperwork incorrectly or couldn’t find help in a language they understood, Kleinman said. Others are former Medicaid recipients who now earn too much, or new immigrants who don’t know how to buy insurance, even if they are eligible and can afford it, she said.

“It becomes so overwhelming that you stay uninsured,” she said.

Other low-income clinics that don’t receive federal funding are also seeing a higher percentage of uninsured patients than they were before the ACA, when about 15% of the population had no coverage, Albritton said. Clinics that receive that funding, known as federally qualified health centers, have also reported budget struggles as some of their patients drop out of Medicaid and become uninsured.

Colorado’s uninsured rate had hovered around 6.5% between the passage of the ACA and the COVID-19 pandemic, before hitting a low of 4.6% in 2023 due to the pandemic’s freeze on Medicaid disenrollments.

Colorado’s Medicaid eases after the public health emergency largely ended in April, though some people with disabilities have extra time to show they’re still eligible. People who have lost coverage can regain it through an expedited process if they renew within 90 days, so some could return to Medicaid this summer. Those who have passed the 90-day deadline can register again, but the process is more onerous.

As of March, Medicaid enrollment decreased by about 514,000 people from May 2023, or about 29%. At the same time, enrollment in the marketplace increased by just under 16,000 people and enrollment in Children’s Health Plan Plus increased by more than 38,000. There is no data yet on how many people joined employer-sponsored health plans or became uninsured.

Steps the state can take to help

The state could help offset the increased cost of care for uninsured people by finding a more stable source of revenue for its primary care fund, which currently gets most of its money from tobacco taxes, it said. Albritton. Since fewer people smoke, that means less money is available to be shared among safety-net clinics based on the number of appointments they provide to uninsured people, she said.

Health policy was not the focus of this year’s legislative session, although lawmakers approved a one-time appropriation to help Denver Health, the state’s only urban safety net hospital.

Lawmakers also appropriated funding for county and state agencies to increase staffing so they can help people renew their Medicaid coverage or find an alternative source of insurance, Rep. Shannon Bird, a Westminster Democrat and chair of the Joint Budget Committee.

The state has already taken additional steps, such as automating enrollment for eligible children in Child Health Plan Plus, which has a higher income maximum than Medicaid; trying to make re-registration as easy as possible; and working with partners to guide people to insurance options, she said.

Most people probably have an affordable coverage option available, but they may not know what it is or how to enroll in it, Bird said. The budget committee will keep an eye on the problem between legislative sessions and take action if it determines agencies need more resources to help people navigate their insurance options, she said.

“I hope that all the good work that the Department (of Health Care Policy and Financing) is doing will help reverse this trend and help people who haven’t found an insurance home,” she said.

No one knows yet whether the number of uninsured patients will continue to rise, hold steady or decrease as people learn they’ve lost coverage. Denver Health, which sees a disproportionate share of uninsured patients, reported that the increase in patients without coverage has begun to decline this spring.

“We have seen a plateau in the growth of uninsured patients, which suggests that the majority of patients who faced disenrollment due to the (public health emergency) have disenrolled,” an unnamed Denver Health spokesperson said in an email.

The latest data from other hospitals are from December. The Colorado Hospital Association reported that about 10% of people presenting to emergency rooms that month had no insurance, compared with an average of about 7% from 2019 through mid-2023.

“The current situation is not sustainable”

Mental health providers have also taken a financial hit.

Kiara Kuenzler, president and CEO of the Jefferson Center for Mental Health, estimated that their uninsured patient population grew by about 60%, causing a hole of more than $7 million in their budget for the fiscal year ending in June 30. The center won’t start coming back uninsured people leave, but with supplies thin, managers will have no choice but to cut some services for everyone if nothing changes, she said.

“We simply cannot say if, how and when the cuts will occur, but the current situation is not viable,” Kuenzler said.

In the region that includes Jefferson County, the entity that administers Medicaid projected enrollment would drop by about 16%, or 33,000 people. Instead, it’s down by about 74,000 people, or 37%, Kuenzler said. Some federal and state money helps pay for care for uninsured people, but funding has not grown as fast as that group’s needs for behavioral health services, she said.