Uninsured rate jumps as Colorado employers cut health benefits

By Katie Kerwin McCrimmon

A sharp drop in employers who offer health insurance and Colorados ailing economy have led to a dramatic surge in the number of Coloradans who are either uninsured or underinsured.

The Colorado Health Access Survey, a new report from The Colorado Trust and the Colorado Health Institute, has found that more than 1.5 million Coloradans or nearly one in three residents either have no health insurance or are underinsured, meaning they spend more than 10 percent of their income on out-of-pocket medical expenses.

The number of Coloradans getting their insurance through employers dropped to 57.8 percent this year from 63.7 percent two years ago.During that same period, the number of Coloradans without health insurance has jumped from 678,000 to 829,000.

Thats a huge number of people. Just think of 150,000 people. Thats the population of Grand Junction, said Dr. Ned Calonge, president and CEO of The Colorado Trust. The impact on individuals is almost unimaginable.

The increase from 14 percent to 16 percent of Colorados total population means that one of every six Coloradans has no health insurance. (Click here to see analysis of the data by Solutions partner,I-News Network.) Instead, many sick people are seeking care in expensive hospital ERs or are flooding safety net clinics, many of which now have months-long waiting lists. (Read Solutions earlier coverage: Poor patients stuck on waiting lists.)

Driving the dramatic changes are job losses and rising costs for health insurance. More and more employers are dropping health insurance coverage while individuals say they cant afford it. Among survey respondents, the No. 1 reason by far for not having health insurance was cost, with 85 percent of those surveyed saying they couldnt afford health insurance. Forty percent of respondents said their employer didnt offer insurance and 39 percent said they didnt have coverage because they lost or changed jobs. The survey also found a spike in the number of Coloradans who are chronically uninsured, meaning theyve been without health insurance for at least a year. That percentage jumped to 60 percent from 56 percent two years ago. Among the uninsured, 52 percent were out of work, compared with 47 percent who were jobless in 2009.

Were reaching a tipping point where there will be more people who are uninsured than are insured, Calonge said. The results tell us that things were not good in 2008 and 2009 and theyre getting worse. We have to do something and we better start to do it now.

Just as states are beginning to implement the Affordable Care Act and the U.S. Supreme Court has declared plans to review the law next spring, Colorado has lost ground on many fronts, according to Calonge. (Read about Colorado reaction on the U.S. Supreme Court decision.)

Among other survey findings:

• A majority, or 58 percent, of uninsured Coloradans are white, but Hispanics are disproportionately represented among the uninsured. While Hispanics comprise 20 percent of the states overall population, they represent 33 percent of the uninsured.
• Among the uninsured, young adults between the ages of 19 and 34 are most affected with 28 percent reporting that they dont have insurance.
• The poor are also profoundly affected with 28 percent of uninsured Coloradans reporting incomes below the federal poverty level.
• Uninsured people are more likely to visit an emergency room for health care. ER use increased in 2011 with at least 28 percent of respondents visiting an ER at least once in the previous 12 months compared to 24 percent two years earlier.
• Older adults who qualify for Medicare comprise the largest group of the underinsured because their prescription medications and other health costs exceed 10 percent of their income.
• Insurance rates among children are holding steady. Programs that started under former Gov. Bill Ritter to ensure that more children can enroll in Medicaid and the Childrens Health Plan have stabilized the number of uninsured children over the past two years. Currently children ages 0 to 18 comprise about 8 percent of the uninsured.

Colorados ski resort areas continue to have the highest rate of uninsured people. Solutions did a story earlier this year about the stark differences between Aspens elite and its high rate of uninsured people. (Read Posh Aspen provides dismal health coverage.) The 2011 survey showed that rates of uninsured people have climbed even higher in Pitkin County, Summit County and other resort areas, increasing from 21 percent two years ago to 25 percent this year.

We think a lot of it has to do with the kinds of employers, said Michele Lueck, president and CEO of the Colorado Health Institute.

In ski resort towns, service jobs can be seasonal or part time and rarely come with health insurance. Elsewhere along the Western Slope, natural gas drilling jobs come and go with changing energy demands and dont always include health benefits.

Lueck said Colorados geographical and economic disparities create unique challenges in Colorado. In some rural areas, medical providers are not accepting Medicaid, which means people not only have to wait for care, but they have to drive long distances to get it.

People are going to safety net clinics. There are weeks- if not months-long waiting lists, she said. It goes back to the provider question. Will physicians see Medicaid or Medicare patients? In the mountains, the answer is often, no. You have this issue of driving really far to find someone who will see you.

Among the underinsured, rates are highest in rural areas far from the resort areas: in the northwest and southeast corners of the state.

The survey also analyzed areas where people had the best and worst access to primary care. Mesa County had the lowest percentage of people who didnt have a medical home or regular place to seek care: 5.8 percent. That rate jumped to between 14 and 17 percent in ski resort areas, northern Colorado and southwestern corner of the state.

Mesa is one of the best counties in the country for high quality, low cost care, Lueck said. If you have a regular source of care, you are less likely to go to the ER.

The bottom line for many people is that continuing spikes in health costs are unsustainable.

Median family income has decreased by 10 percent whereas health insurance costs rose by 9 percent, Calonge said. Im now taking less (money) home and I have to pay more of that even to get coverage through my employer.

And its unclear whether the Affordable Care Act will immediately reduce the rates of uninsured. The U.S. Supreme Court has declared that it will hear the case challenging its constitutionality next spring and rule on it by the summer of 2012.

But, given the tough economic outlook, Calonge and Lueck dont see any easy solutions for policymakers.

Will anything drive change before the Affordable Care Act is implemented? Calonge asked. I think were in a tough spot. You look at increased revenues (for the state budget), then you hear that 90 percent of that will be absorbed by increases in Medicaid, leaving 10 percent for everything else. I think that puts us in a difficult placeHow we get from 2012 to 2014 is going to be a challenge for policymakers.