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Colorado clinics, mental health providers are seeing more uninsured people

Registered nurse Sue Covington, right, examines a patient at the Doctors Care clinic in Littleton on Thursday, May 30, 2024. (Photo by Hyoung Chang/The Denver Post)

Colorado health clinics 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 needs to prepare for a future where more people they have no cover.

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 requiring recipients to demonstrate that they still have low enough income to qualify.

Most of the half a million people who lost their Medicaid coverage in Colorado didn’t return their paperwork or otherwise failed to complete the process. For now, the state doesn’t have data on whether those people found other insurance.

After the ACA was passed in 2010, states and the federal government assumed the uninsured rate would continue to fall, and generally that has happened, said Phyllis Albritton, a management consultant for the Colorado Safety Net Collaborative, which represents clinics serving in primarily uninsured and do not receive federal funds.

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

“The big policy was that everybody was going to have coverage, so we didn’t have to worry about the uninsured,” Albritton said. “We have to accept that there will be uninsured people in Colorado.”

Despite the public perception that everyone can get affordable coverage through the individual market, people often find they can’t pay 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.

Nurse Ashely Arce works at the Doctors Care clinic in Littleton on Thursday, May 30, 2024. (Photo by Hyoung Chang/The Denver Post)
Nurse Ashely Arce works at the Doctors Care clinic in Littleton on Thursday, May 30, 2024. (Photo by Hyoung Chang/The Denver Post)

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

“It’s been a strange journey from where I thought I was going to close this place” because the number of uninsured people was supposed to drop so dramatically under the ACA, Kleinman said.

An analysis of the employer-based insurance market nationwide 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 Americans couldn’t pay a $500 medical bill right away, and about one in five reported they couldn’t pay even with a payment plan or the ability to borrow money from family, according to to the non-profit group KFF. .

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

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

Other low-income clinics that don’t receive federal funding also see a higher percentage of uninsured patients than they did before the ACA, when about 15 percent of the population lacked coverage, Albritton said. Clinics that receive this funding, known as federally qualified health centers, have also reported budget struggles as some of their patients fall off Medicaid and become uninsured.

The uninsured rate in Colorado 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 waivers.

Colorado’s Medicaid is winding down after the public health emergency, for the most part, ended in April, though some people with disabilities have extra time to prove 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 exceeded the 90-day deadline can re-register, but the process is more cumbersome.

In March, Medicaid enrollment fell by about 514,000 people from May 2023, or about 29 percent. At the same time, Marketplace enrollment increased by just under 16,000 people, and Child Health Plan Plus enrollment increased by more than 38,000. Data on how many people joined employer-sponsored health plans or became uninsured is not yet available.

Student nurse Helda McCauley, center, translates for registered nurse Sue Covington, right, to communicate with a patient at the Doctors Care clinic in Littleton, Thursday, May 30, 2024. (Photo by Hyoung Chang/The Denver Post)
Student nurse Helda McCauley, center, translates for registered nurse Sue Covington, right, to communicate with a patient at the Doctors Care clinic in Littleton, Thursday, May 30, 2024. (Photo by Hyoung Chang/The Denver Post)

Steps the state could take to help

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

Health care 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 health care hospital.

Lawmakers also appropriated funds for county and state agencies to hire staff so they can help people renew Medicaid coverage or find an alternative source of insurance, said Rep. Shannon Bird, D- Westminster and Chairman of the Joint Budget Committee.

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

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

“My hope is that all the good work that the (Health Policy and Financing) Department 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 decline as people learn they’ve lost coverage. Denver Health, which sees a disproportionate percentage of uninsured patients, reported that the increase in the number of patients without coverage began to level off this spring.

“We have seen a plateau in the increase in the number of uninsured patients, suggesting that the majority of patients who faced withdrawal due to the (public health emergency) have been canceled,” an unidentified Denver Health spokesperson said in – an email.

The latest data from other hospitals is from December. The Colorado Hospital Association reported that about 10 percent of people who showed up at emergency rooms that month had no insurance, compared to an average of about 7 percent from 2019 through mid-2023.

Denver Health paramedic trainer Keri Reiner, left, and paramedic Aiden Beatty, right, help a dog bite victim in north Denver on April 3, 2024. (Photo by Andy Cross/The Denver Post)
Denver Health paramedic trainer Keri Reiner, left, and paramedic Aiden Beatty, right, help a dog bite victim in north Denver on April 3, 2024. (Photo by Andy Cross/The Denver Post)

“The current situation is not viable”

Mental health providers have also suffered a financial impact.

Kiara Kuenzler, president and CEO of the Jefferson Center for Mental Health, estimated that their uninsured patient population has grown by about 60 percent, blowing a more than $7 million hole in their budget for the fiscal year that ends June 30. The center will not start to become uninsured. people away, but with supplies short, managers will have no choice but to cut some services for everyone if nothing changes, she said.

“We can’t say if, how or when cuts will happen, but the current situation is not viable,” Kuenzler said.

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