Thousands of people in Southwest Colorado are enrolled in Medicaid, but the state may not be able to maintain all that coverage if the Affordable Care Act is repealed.
President Donald Trump signed an executive order in January aimed at abolishing the law, also known as Obamacare. House Republicans announced Friday that a replacement could be introduced next month, but details are unknown, the Associated Press reported.
A report released last week by the Colorado Health Institute found if the law was repealed, the state would need $780 million to maintain Medicaid at its current level. It is unlikely Colorado could come up with the additional money, the report said.
Since the expansion of Medicaid, the percentage of people without insurance in Colorado has dropped from 14.3 percent in 2013 to 6.7 percent, the institute said.
As of December, about 12,000 people in La Plata County and 9,800 people in Montezuma County had enrolled in Medicaid, according to the Colorado Department of Health Care Policy and Financing.
It is too soon to say whether the expansion of Medicaid improved health for Coloradans, and it is difficult to track because the program sees quite a bit of turnover in enrollees, said Marc Williams, a spokesman for the state agency.
But experts believe that it is making a difference.
After the expansion at the San Juan Basin Public Health family planning clinic, more patients said they can go to a primary care doctor after a health screening, said Liane Jollon, executive director of the department.
Previously, patients often said they couldn’t go to a doctor because they didn’t have insurance, and that was why they came to the clinic instead, she said.
“For health care to work, you need a provider and a patient who is willing and able to participate,” she said.
Later this year, the Colorado Health Institute expects to have data that show residents’ health improving, said Joe Hanel, a spokesman for the institute.
“It takes a long time to fall into bad health, and it takes a long time to crawl back out of it,” he said.
Across the country, other states have seen positive outcomes from expansions.
An Oregon-based study found that two years after an expansion of Medicaid, the probability enrollees reported themselves in good to excellent health increased by 25 percent.
After Massachusetts expanded care in 2006, there was a decline in the overall death rate and in particular among those with conditions that should respond to treatment, said Douglas McCarthy, senior research director at The Commonwealth Fund, a foundation focused on health care research.
If the Medicaid expansion was preserved in Colorado, rural counties would likely see some of the largest health gains because they face the biggest challenges, McCarthy said.
Compared to urban areas, a higher percentage of rural Coloradans depend on Medicaid, said Allison Neswood, an attorney for the Colorado Center on Law and Policy.
The median household income in rural counties is 29 percent lower than in urban areas, and the nine counties between Fort Collins and Colorado Springs are home to 80 percent of the state’s jobs, a November report by the Center on Law and Policy found.
Those living in urban areas are likely to live longer, healthier lives compared to those in rural areas, the study found.
The counties with the highest rates of premature death in Colorado are clustered in the rural and southern areas of the state, it said.
Montezuma County was in the top 25 percent for premature death rates, while La Plata County was in the top 50 percent.
The Republican Party could introduce Medicaid block grants if the Affordable Care Act is repealed.
But it is unlikely that grants would keep up with inflation, leaving the state to pay for more and more care, Neswood said.
“A block granting situation would not be tolerable or sustainable,” she said.
But it could lead to more efficient use of funds, said Jeff Bontrager, director of research on coverage and access for the Colorado Health Institute.
An alternative to a set amount of funding could be a per-capita funding for each person enrolled in Medicaid, he said.
Rather than focusing on insurance costs as the Affordable Care Act does, a larger step toward reform would be to focus on reducing the ever-rising cost of health care, Hanel said.
“It kind of nibbled around the edges,” he said of the ACA.
One way to do this, he said, is to create a financial incentive for doctors to keep people healthy by paying them a set amount each month for each patient, instead of paying them for every service, such as a test or exam.