Rebecca Kornas, MD, FACEP, and Cody Belzley

While most of the world has seemed to move on from the COVID crisis, Colorado’s health care safety net is still reeling from its impacts. We’re counting on Colorado’s lawmakers to chart a path forward to stabilize and secure the coverage programs and help providers who serve Colorado’s most vulnerable residents, before irreparable damage is done. 

COVID impacted supply chains and labor markets, driving up costs in health care significantly. 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. 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. (More detail in the cover story of this issue.) I’m guessing many of you are seeing this in your practices. 

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. 

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, 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.

But that progress we’ve made and the infrastructure we’ve built are now at risk. Hospitals are announcing service line closures, clinics are closing sites, physician groups are taking furloughs and Coloradans are struggling to find coverage they can afford. 

We need Colorado’s lawmakers to take bold action this year to stabilize the health care safety net providers and ensure a Medicaid eligibility and enrollment system that will allow Coloradans to get and keep coverage. The budget is tight, and we cannot solve our challenges in one state budget cycle, but we must make a meaningful downpayment on the solution this year and commit to continually work together in the years to come to strengthen what was lost after COVID. There is no more important or more urgent priority than protecting the health of the people of Colorado.