The ever-increasing cost of health care — and increasingly skimpy insurance plans — are threatening to undo progress made under the Affordable Care Act in helping people access care and pay for it, a comprehensive biennial survey has found.
Colorado’s uninsured rate held steady this year at 6.5%, according to the 2019 Colorado Health Access Survey — an encouraging sign of stability for a market that’s seen steep price spikes, rising out-of-pocket costs and the repeal of the federal mandate to purchase health insurance.
But the survey’s organizers warned that the low rate might be veiling warning signs of a health care system under strain, often from consumers having to pay an increasing share of their medical bills.
The number of people who reported problems paying for care hit its highest mark this year since the Affordable Care Act took effect, reaching 18.1% after years of declines.
And the number of people who went without needed mental health care rose from 382,000 to 660,000 Coloradans. The number of people who needed substance abuse help but didn’t get it also increased, from 67,000 to 95,000. (See accompanying story.)
“We’re sort of holding our own, despite a lot of market trends and political developments that could bring it down,” said Michele Lueck, president and CEO of the Colorado Health Institute, which oversaw the survey. “We have a strong infrastructure in place, and that’s getting stronger.
“But the warning signs are really significant, and we have to heed those warning signs and do something about them.”
The survey, conducted every two years, offers one of the best windows into Colorado’s health care system and the ease with which people can access it.
It sought input in English and Spanish from 10,000 households randomly selected across the state.
It was largely paid for by The Colorado Trust and the Colorado Health Foundation. Several state agencies also paid to include certain questions on the survey, including those focused on opioid misuse and access to care.
Unlike past years, the report’s authors released an initial data batch this week, and plan to release the rest of their data in December.
Overall, more people got health insurance through their jobs — rising to nearly 53% after dipping below the halfway mark in 2017. And fewer people said they were enrolled in Medicaid, the coverage program aimed at low-income and impoverished people, disabled Coloradans and children.
The shift isn’t too surprising, given Colorado’s booming economy and rock-bottom unemployment rate, now at 2.9%.
But signs of trouble are in those figures. Colorado’s Hispanic population continues to experience uninsured rates above 10%.
And the uninsured rate for people earning two to three times the federal poverty level — between about $25,000 and $37,500 a year for an individual — climbed to 11.8%. The survey’s organizers suspect that might be because of people having a hard time moving off Medicaid, stuck between earning too much for the program and too little to pay for private coverage and co-pays.
“We speculate that that’s a really hard transition to make,” Lueck said. “Because you’re still not making a lot of money, but you are on the hook, even if it’s a modest amount, to pony up for your health insurance.”
What remains to be seen is the effect of lawmakers’ work this spring passing several bills aimed at lowering health care costs. One created a “reinsurance” program — described as insurance for health insurance companies — that’s been credited with likely lowering insurance rates in 2020 by an average of 18.2%.
Other bills created a pilot public option program and took aim at surprise medical bills — a problem experienced by nearly one-third of the survey’s respondents.
“I think we have certainly made progress at the state level to address some of the affordability challenges in health care,” said Adam Fox, of the Colorado Consumer Health Initiative.
“But I think some of what we’re seeing in the survey data is that with high deductibles and high out of pocket maximums, some of the affordability issues are sort of being baked into the system and the plans as they are structured right now.”
For the first time, the survey examined factors beyond the health care system that nevertheless affect a person’s well-being.
Nearly 1 in 10 Coloradans said they couldn’t afford food at some point in the past year. And one in 15 said they worried about where they would live in the next two months.
Each problem plays an important role in the social determinants of health — the factors beyond physician’s appointments, access to pharmaceuticals or therapy sessions that can have an outsized effect on a person’s physical and mental health.
Time and again, El Paso County fared the same or slightly better than the state average on issues such as physical, dental and mental wellness, as well as in insurance coverage and ease in paying for care.
The county’s uninsured rate dropped from 7.5% to 5.6% — besting the state’s average. Yet the county scored slightly worse in patients who felt treated unfairly while getting medical care, as well as the number of people who talked to a mental health provider.
“Some of it’s encouraging, but there’s still a lot of work to be done, that we can’t let up,” said Susan Wheelan, director of El Paso County Public Health.