Tepid recovery leaves one in seven uninsured

By Katie Kerwin McCrimmon

The number of uninsured people declined slightly in Colorado over the last two years as the economy began to rebound.

But more than 741,000 people or one in seven Coloradans has remained uninsured while another 720,000 are underinsured, meaning that their out-of-pocket health costs exceed 10 percent of their income.

Nearly half of the uninsured said theyve gone without health coverage for more than five years and one in 10 have never had it.

We still have three-quarters of a million people who do not have insurance. Thats problematic, said Michele Lueck, president and CEO of the Colorado Health Institute, the health research group that every other year conducts the Colorado Health Access Survey (CHAS), funded by The Colorado Trust.

The last survey in 2011 found that about 850,000 or 15.8 percent of Coloradans were uninsured.

Douglas County has the lowest rate of uninsured people in the state while the northwest corner of Colorado has the highest rates. Source: Colorado Health Access Survey. (Click on image to enlarge.)

Lueck said the data reflect the boom and bust cycles so typical in the West.

Were seeing a very slow recovery. Thats the fundamental trend. In some ways, its surprising that we havent recovered better than we have over the past couple of years.

Overall, Colorados health picture shows a divided state.

  • As few as 5 percent of people in Douglas County, one of the states wealthiest, are uninsured while as many as 25 percent of people living in rural northwestern Colorado are uninsured
  • People who work for large employers tend to have good insurance while people who work on their own or for small companies dont.
  • In general, whites have much higher insurance rates and say they are healthier than Latinos or African Americans. Hispanics make up 38.6 percent of the uninsured in Colorado while the percentage of uninsured blacks jumped from 12 percent in 2009 to 19.6 percent in this years survey.
  • Meanwhile, theres a sharp divide between young and old. The survey shows that the people most likely to be uninsured are the so-called young invincibles who are between ages 19 and 26. Of this group, 27.1 percent are uninsured. As people age they are more likely to have insurance. Medicare, the public health program for seniors, covers nearly everyone age 65 and older.

It is a case of the haves and the have-nots, Lueck said. We can look at that through a number of lenses: employment status, income, education, and by race and ethnicity.

One of the surprising results of the CHAS is an apparent backlash among young people against the individual mandate requiring people to buy health insurance or pay financial penalties.

The percentage of young people, ages 19 to 26, who said they didnt need insurance, jumped from 12.7 percent in 2009 to 29 percent this year.

Lueck said the spike indicates some rebellion among the young. The Affordable Care Act requires everyone to buy health insurance so the lower cost of care for relatively healthy people will balance out the more expensive care for sick people.

Hispanics are uninsured at the highest rates in Colorado. While the state does not have a large population of African Americans, the rate of uninsured jumped among blacks between 2009 and 2013. A struggle to get jobs with health insurance could be to blame. Source: Colorado Health Access Survey. (Click on image to enlarge.)

(The intent) of the individual mandate was not to convince young invincibles that they dont need health care, Lueck said.

Most Coloradans continue to get insurance through their employers, but that number has declined from nearly 64 percent in 2009 to about 59 percent this year. Some health reform opponents have warned that more and more employers will drop health coverage, but so far, there has not been a precipitous decrease.

Overall, Lueck said the CHAS data can point a laser for policymakers and health advocates about where Colorado is doing well and where it is failing.

Researchers conducted this years survey during the summer of 2013 and the data provide a baseline for health coverage before most provisions of the Affordable Care Act go into effect next year.

Dr. Ned Calonge, president and CEO of The Colorado Trust, said he hopes that by the time the new CHAS is conducted in 2015, far fewer people will be uninsured in Colorado.

He said the problematic launch of both the federal and Colorado health exchanges is discouraging. (Click here to read Odious, embarrassing system driving down health sign-ups.)

I would hope that by the next time the CHAS is administered (in 2015) weve got it fixed, he said.

One of the fundamental problems with health care, said Calonge, is that the systems are far too complex and regular people are much more comfortable selecting tailor-made coffee drinks at Starbucks than they are in trying to pick health coverage.

Weve made it (health care) too complex for a normal person to look at, Calonge said.

Whats clear, said both Calonge and Lueck, is that when people have coverage, whether its for medical, dental or mental health care, they stay healthier.

The so-called young invincibles are uninsured at the highest rates in Colorado. The percentage of young people who said they didnt need health insurance jumped between 2011 and 2013, indicating a possible backlash against a mandate that everyone must buy health insurance. Source: Colorado Health Access Survey. (Click on image to enlarge.)

Conversely, not having coverage is a barrier to care. For instance, one in four people surveyed said that they had at least one poor mental health day in the previous month. Many did not seek help. Of those who did not, 78 percent were uninsured, 76 percent were concerned about the cost and more than 53 percent doubted their health insurance would cover behavioral health care.

As the Affordable Care Act goes into effect, many Americans will have access to behavioral health coverage for the first time. The CHAS will continue to monitor whether more people seek and receive mental health care in higher numbers as coverage expands.

Affordability is also a central component of Obamacare. In general, the Affordable Care Act assumes that people can afford to spend just under 10 percent of their earnings on health care. Once their costs exceed that percentage, customers are eligible for subsidies to help decrease their costs.

Lueck and other policymakers say it will be interesting to see if that definition plays in Paonia, a small town on Colorados Western Slope. In other words, will Coloradans on the ground feel that coverage is affordable even if it gobbles up 10 percent of their income?

People who responded to the CHAS and were uninsured said they would be willing to pay for insurance. About 25 percent of respondents said they would pay between $100 and $150 per month while another 30 percent of respondents were willing to pay about $200 a month.

President Barack Obama is trying to compare health premiums to a monthly cell phone or cable bill, but in some cases, people are finding that coverage will cost them far more. Sign-ups are lagging in resort areas like Summit County, Vail and Aspen. (Click here to read Polis fights sky-high rates as ski town sign-ups stall. And here to read Left out health reform bypasses some immigrants, resort workers. )

Time will tell how many people buy health insurance and if it improves their health.

The CHAS can be instrumental inquantifying who gets insurance, and understanding the link between insurance access and outcomes, Lueck said.