By Katie Kerwin McCrimmon
ASPEN – The mountain man drives up the aptly named Castle Creek Canyon in a beat up 1981 rust-colored Chevy pickup. He winds past massive multimillion dollar estates owned by California wine billionaires and Texas oil barons.
Hollywood stars Antonio Banderas and Melanie Griffith own a home nearby, and tennis great Martina Navratilova lives up the road.
Wearing a gas-stained Aspen Ski Co. parka from decades ago when he worked on World Cup courses, A. Paul Disnard drives as far as he can. Then, the jeep road becomes impassable, buried in several feet of snow. The 64-year-old loads provisions from his pickup onto a sled attached to an ATV. Then he straps on his portable oxygen canister as his ailing lungs – punctured a year earlier in an ATV accident – hunger for air.
Disnard still has two miles and 2,000 more vertical feet to go on a backcountry journey before he reaches his home, a squatter’s camp clinging to the back of Aspen Mountain, the ritziest ski area in the world.
An unsold $4 million spec home sits unoccupied a half-mile away. Disnard’s address: a disputed mining claim fittingly dubbed “Rebel.” In the winter, it’s only accessible by ATV or snowmobile. There’s no running water or electricity. He huddles at night in a propane-powered, wind-whipped camper 11,000 feet above sea level as the mercury plunges to 28 below zero. Oxygen tanks feed each breath he takes.
Disnard’s doctors want him off Aspen Mountain, where he has lived the last 13 years. They think the cold, thin air high in the Rockies is too hard on his lungs. But Disnard has nowhere to go. A building contractor, he’s found little work since his accident put him in the hospital for more than a month.
“I’m afraid of Denver,” Disnard said. “Here I’m left alone. I’m not breathing carbon monoxide. I have birds who actually know me. There’s a calming tranquility. The serenity alone is priceless.”
Haves and have-nots experience profound health insurance gap
Welcome to Aspen, land of the haves and have-nots where Gucci meets Grizzly Adams. As the national debate over health coverage takes center stage in Washington, Aspen provides a portrait of one of our nation’s deepest health care divides.
In Aspen, New York hedge fund managers and nouveau riche visitors can pop into doctors’ offices in town when they break a leg on the slopes or suffer from altitude sickness. But the poor are not welcome.
“We don’t take Medicaid,” an impatient clerk at Aspen Medical Care says, eager to shift her attention to a cash-paying Russian client in a fur coat and boots who has just walked in after a fall.
In fact, almost no primary care doctors in the Aspen area take Medicaid and very few take Medicare.
Dr. Glenn Kotz, a solo practitioner in Basalt, is one of the very few who does. He loses money on most Medicaid and Medicare patients, but believes in seeing these patients.
“This is the only ethical and moral stance I can take,’’ said Kotz, a family practice doctor. “I am a provider in a reasonably rural area. My philosophy is that I have a responsibility to take care of patients in my community. Either they can pay me or they can’t, but I have a responsibility to take care of them. “
For locals who are uninsured, underinsured or even publicly insured, seeing a doctor in Aspen means paying cash, going to the hospital ER or heading “down valley.” One Aspen doctor requires retirees with Medicare to pay $500 in cash to be seen the first time.
Even commercial insurance can be useless in Aspen. Pediatricians at times have refused to accept Aetna because the reimbursement rates were too low. Mothers with babies who are covered under Colorado’s child health plan, CHP+, must drive nearly 50 miles through the Roaring Fork River Valley to a public health center in Glenwood Springs for well baby checks or pay for the exams out of pocket.
Pitkin County had the dubious distinction in a 2010 Colorado Health Institute issue brief on children’s health insurance status of having the highest percentage in the state of children who were eligible, but not enrolled for CHP+. The program is supposed to provide a medical safety net for children. The report estimated that 339 Pitkin County children, or nearly 73 percent of those who were eligible, were not enrolled.
Even real estate brokers, who once scored a year’s earnings in a single multimillion dollar transaction, are now sheepishly calling Aspen’s public health clinic seeking to qualify for Medicaid so they can get their annual mammograms.
“Getting on Medicaid can be totally humiliating,” said Liz Stark, director of Community Health Services in Aspen. “There are very strict guidelines and some of these people are now qualifying.”
While the overall numbers are low, Stark has seen a doubling in demand for a health program that helps low-income middle-aged women.
“It’s always been a big struggle here with the super rich and the worker bees,” Stark said. She and her husband are among the worker bees. To survive in Aspen, Stark, who is a registered nurse, used to work four jobs. Her husband works for the U.S. Forest Service.
“We obviously have this big gap here, but our community is not considered medically underserved.”
Resort workers struggle: rent, food or health care?
Data regarding income levels and insurance rates in Pitkin and other counties come from the Colorado Household Survey, which was sponsored by Colorado’s Department of Health Care Policy and Financing and funded by the The Colorado Trust. Health experts at the Colorado Health Institute (CHI) conducted the survey at the peak of the recession.
Researchers interviewed 10,000 Colorado households between November 2008 and March 2009.
Survey respondents had to live in Colorado full time, so the results excluded ultra-wealthy second homeowners. Researchers conducted an extensive questionnaire on a variety of health issues, probing Coloradans about their health insurance coverage, access to care and out of pocket expenses.
Researchers at CHI continue to mine the survey data and compare it with other information. Recently, they matched two data sets: those showing poverty levels generated from census data and percentages of people with health insurance from the Colorado Household Survey.
They have found that the highest percentages of uninsured people in Colorado live in the wealthiest ski resort areas from Aspen to Vail to Summit and Grand counties.
“It was surprising,” said Jeff Bontrager, senior research analyst at the Health Institute. “We were not anticipating that the highest uninsured rates in the region would be along that corridor.”
At the time that the survey was conducted, about 21 percent of residents in the resort counties did not have insurance. That was higher than Colorado’s poorest areas like the San Luis Valley in southern Colorado, which ranged from about 15 to 20 percent and struggling ranching counties like Moffat and Jackson in northwestern Colorado, which showed an uninsured rate of 11 percent.
Local health officials in Aspen think their rates of uninsured people have spiked even higher recently. The impacts of the recession seem to have hit many mountain communities later than other parts of Colorado or the U.S.
“Getting health coverage here has always been tough,” said Nan Sundeen, director of Pitkin County’s health and human services department. “In the past, we’ve generally talked about 15-to-20 percent uninsured. Now we’re talking about 25-to-30 percent. That is a huge change for us. In the past, people used to have two and three jobs to survive. Now, maybe they have one.
“The cost of living is so high that people have to make hard choices. In many cases, it’s eating and paying the rent,” Sundeen said.
For many of the working people in the mountain counties – whether they run small businesses, stock or clean hotel rooms or deliver pizzas – health insurance has become a luxury item.
Aspen mystique entices workers who scrimp on health care
Some struggling people are immigrants. Many are middle class. Exorbitant living expenses are putting health care out of reach for more and more workers.
“These are the people in the back rooms. They prepare the food and clean the rooms,” said David Adamson, executive director of Mountain Family Health Centers in Glenwood Springs where about 8,000 people a year seek care.
Studies have shown that as health insurance costs have risen dramatically over the last several years, fewer small businesses are offering health benefits. In other cases, people are selecting plans with high deductibles. This seems cost-effective at first, but some patients can’t afford the care they need.
Dr. Kotz, the Basalt family doctor, is finding that more patients are declining vital tests even if they do have insurance. One of his patients works for a major employer in the valley and desperately needs an MRI to diagnose why he has severe swelling in his foot. The patient’s pain is so bad that he needs daily painkillers. An X-ray and lab work didn’t provide enough information.
The patient will have to pay a $450 co-pay for the MRI. He had scraped together $400, but the provider wouldn’t do the MRI without the full $450. So the patient canceled the MRI.
“I told him that if we don’t treat this soon, it could result in permanent pain or disability. He needs to get this done or he may have a bad outcome,” Kotz said.
“It’s not just the menial laborers who don’t have health coverage,’’ said Michele Lueck, president and CEO of the Colorado Health Institute, who used to live near Aspen as a vice president for the Western Healthcare Alliance, an association of hospitals on Colorado’s Western Slope.
“It’s the pizza parlors and the little shops. There’s a professional class of business owners who have opted to be uninsured completely,” Lueck said.
Take Vince Savage. A psychologist, he owns a bed-and-breakfast retreat center in Marble and also directs a program funded by the Aspen Valley Medical Foundation called Valley Information and Assistance. Savage works to find creative solutions to help people with challenging, long-term health and addiction problems.
“We have the highest differential in the state between the wealthy and the working poor,” Savage says. “You’ve got the super rich and the barely hanging on. Working people here are almost by definition working poor.”
Through VIA, Savage might pay for medications for a client for a month or help find housing for a homeless person. He once paid auto registration fees so Paul Disnard, the mountain man, could keep driving to his remote mining claim. One of Savage’s most challenging former clients lived for years on the streets of Aspen in an old brown van. Holdover hippies from the 1960s, they loved the image of living in Aspen, even in a grungy van.
Savage found them housing in Glenwood, but for months they refused to go.
“We’re not down-valley trash,’’ they told Savage.
Savage, himself, doesn’t spring for health coverage. Instead, he swims regularly, has never smoked and avoids Aspen’s notorious party scene.
“I carry zip insurance. I refuse to do it. I’m 62 and hoping I can hold out until I qualify for Medicare. That’s my strategy,” Savage said.
“I see it as a ransom. I guess I’m an anomaly. I work in health care and I don’t have health coverage.”
Insurance companies pull out of Aspen area
Even Aspenites who want insurance can’t always get it. The area has a long history of insurance providers pulling out of the market. Private companies come in with tantalizing rates, then find they’re not sustainable and vanish.
“Aetna has been in and out. Wellpoint, the same. United Health Care just pulled out of the Roaring Fork Valley,’’ said Lueck, of the Colorado Health Institute. “They just stop offering it in these counties or zip codes. There’s extremely high turnover.”
The Aspen Chamber Resort Association recently suffered an insurance blow. They had teamed up with neighboring chambers of commerce to offer a group health plan, underwritten by Aetna. A sleek website still raves about the benefits of the Roaring Fork Community Health Plan. But a call to the information number reveals a voicemail message saying that the insurer is no longer involved with the plan.
“Aetna announced they were pulling out of any kind of group coverage,” said Erik Klanderud, the Aspen chamber’s director of member and visitor services.
His phones started ringing in October when employers learned that their rates would double or triple.
“(Aetna) changed the premiums for employers. This ranged from employers like the Aspen Skiing Co. with 3,500 employers to businesses with 25 employees,” Klanderud said.
The mad dash has begun to find a new insurance provider – hopefully one with doctors in the area.
“Being isolated in this valley, people had to spend time researching what plans were available. You don’t want to get into a plan where you have no docs up here,’’ Klanderud said.
After bad accident, mountain man qualified for Medicaid
Paul Disnard always carried workers comp insurance while working as a contractor and carpenter. In the best of times, he’d earn $30 or $40 an hour and years ago, lived in Aspen’s fancy “West-End” neighborhood, full of immaculately restored Victorians. But, like many in Aspen, he mostly went without health insurance.
Disnard’s surroundings kept him relatively healthy. He smoked all his life, but for fun would hike several miles over high peaks from Aspen to Crested Butte. Hauling water, cutting wood and fending off bears on his mountain camp kept him fit.
But in August of 2009, he hit a log while riding on his ATV and watched in slow motion as the vehicle landed on top of him, pinning him to the ground. He tried to call for help, but had no service.
“I was sitting there all night gasping for air,” Disnard recalled.
Finally, in the morning, he was able to text a neighbor for help. He knew he had a dislocated shoulder and a concussion. What he didn’t realize was that he had punctured his lungs and broken several ribs. He spent a month in the hospital. Health workers in Aspen helped him qualify for Medicaid. But, Disnard continued to smoke until he had a relapse, got pneumonia and doctors found blood clots on his lungs. He says he suffered a mini-stroke and had to be hospitalized again in Denver.
Disnard has no idea how much his medical bills totalled.
“I don’t even want to know,’’ he said. “I can barely afford car insurance. No one can really afford health insurance.”
Now that he’s on public health insurance, he travels down the mountain three times a week for pulmonary therapy sessions and see’s his heart and lung doctor regularly. He’s thrilled with the care he is receiving and is proud to have given up cigarettes for good. His oxygen supplier brings giant tanks as far as the roads will go. Then, Disnard straps them on his sled and heads up to his Aspen Mountain hideaway. Of his hand-to-mouth existence, Disnard grinned and said:
“I don’t let it bother me. I have what millions of people want. I’m living like St. Francis in the mountains.”