While the COVID-19 pandemic has faded from public attention, Colorado’s health care safety net continues to experience significant challenges. Medical professionals and advocates are urging state lawmakers to take action to stabilize coverage programs and support providers who serve vulnerable populations.
According to emergency room physicians, including those at AdventHealth Avista, the combined effects of increased costs from disrupted supply chains and labor shortages have put financial pressure on hospitals and clinics. The transition out of pandemic-era Medicaid policies, known as the “Medicaid unwind,” has further strained the system. More than 500,000 Coloradans—primarily low-income individuals or those facing other barriers—lost their insurance coverage during this process. This led to a rise in uncompensated care across Colorado.
The impact is being felt by hospitals, Federally Qualified Health Centers, community safety net clinics, behavioral health providers, specialty behavioral health clinics, and school-based health centers. Many primary care patients who would have received preventive services at places like Clinica Family Health and Wellness are now seeking care in emergency departments instead.
Physicians note that under the federal Emergency Medical Treatment and Labor Act (EMTALA), emergency departments must treat all patients regardless of ability to pay or time of day. While these departments provide necessary care, it is often less consistent than ongoing primary care.
Data from the Colorado Hospital Association indicates that hospital emergency departments are now seeing 50 percent more uninsured patients compared to before or during the pandemic. This translates into over 18,000 additional uninsured patient visits each quarter.
Reflecting on past efforts by state leaders, supporters point out that Colorado has previously prioritized investment in its health care safety net. Initiatives such as the Medicaid disability buy-in program and participation in Medicaid expansion under the Affordable Care Act helped reduce the state’s uninsured rate by half and maintained access to primary care throughout Colorado.
“Colorado’s poor management of the ‘Medicaid unwind’ compounded the challenge. More than half a million Coloradans, most of whom are low income and/or face other health or economic barriers, found themselves uninsured and led to increased uncompensated care across the board in our state,” said one physician. “Taken together the financial strain has been crushing for hospitals, Federally Qualified Health Centers, community safety net clinics, comprehensive behavioral health providers and specialty behavioral health clinics, and school-based health centers.”
“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,” another physician explained. “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.”
“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,” stated an advocate for expanded access. “As a state we created a Medicaid disability buy-in program… We opted in to [Medicaid] expansion and cut our uninsured rate in half.”
Supporters emphasize that continued investment is needed for long-term stability within Colorado’s healthcare system.
