Colorado’s health care safety net continues to experience significant challenges in the aftermath of the COVID-19 pandemic, according to local physicians and providers. Rising costs due to disrupted supply chains and labor shortages have strained resources across hospitals, community clinics, behavioral health providers, and school-based health centers.
The transition away from expanded Medicaid coverage has further complicated the situation. More than 500,000 Coloradans—many of whom are low-income or face other barriers—lost their insurance during what is being called the “Medicaid unwind.” This has led to a sharp increase in uncompensated care throughout the state.
“My emergency room physician colleagues and I are seeing it in our departments. As a physician at AdventHealth Avista, my team has worked closely with the clinicians at Clinica Family Health and Wellness over the years. For more than 40 years, Clinica has existed as a medical and dental care provider for low-income and underserved patients in the Boulder, Broomfield, Gilpin and West Adams counties. Over the past two years as the unwind has unfolded, community members who would typically go to Clinica for their care have been getting shuttled away from the high quality, preventive medical care previously provided by their primary care clinic teams to the only safety net that remains for them, the emergency department.”
Emergency departments are required under federal law to treat all patients regardless of ability to pay. However, these settings do not provide the same continuity or preventive focus as primary care clinics. Recent data from the Colorado Hospital Association indicates that hospital emergency departments are now treating 50 percent more uninsured patients compared to pre-pandemic levels—an increase of over 18,000 additional uninsured patient visits each quarter.
“In the emergency department, we are bound by the federal Emergency Medical Treatment and Labor Act (EMTALA) to see any patient, regardless of their ability to pay, with any complaint, day or night, 365 days a year, 24 hours a day. Emergency department teams also provide high-quality care, but in a more stochastic and disruptive manner than the wholistic approach that a well-functioning primary care clinic can. Data from the Colorado Hospital Association bears it out. Hospital emergency departments (EDs) are seeing 50 percent more uninsured patients than before or during the pandemic – over 18,000 more uninsured patients are visiting the ED every quarter. We cannot sustain this trend.”
Historically, state lawmakers have invested in programs such as Medicaid expansion under the Affordable Care Act and created disability buy-in options so individuals with disabilities could access benefits without leaving employment or impoverishing themselves. These efforts have contributed to cutting Colorado’s uninsured rate in half over recent decades.
“Historically, Colorado lawmakers have made investing in the health care safety net a priority because they know it is important to the health of individual Coloradans and the vitality of Colorado communities. As a state, we created a Medicaid disability buy-in program to allow Coloradans living with disabilities to be able to access the benefits of Medicaid without having to quit work and impoverish themselves to do it. We opted in to the Affordable Care Act (ACA) Medicaid expansion and cut our uninsured rate in half. We funded primary care clinics and hospitals to preserve and protect access to care in all corners of Colorado. Together, we have made incredible progress in Colorado over the last 20 years.”
Stakeholders say urgent action is needed from lawmakers now if further damage is to be avoided for vulnerable populations relying on these essential services.
