Newly released findings from a wide-ranging survey of health needs among Coloradans show that the percentage of those without insurance has remained flat, but concerns over healthcare costs and disparities in treatment are growing.
The data suggests more people may go uninsured in the future because they can’t afford care, Jeff Bontrager, principal investigator for the survey, said.
The Colorado Health Institute (CHI), with financial support from The Colorado Trust and The Colorado Health Foundation, conducted the bi-annual Colorado Health Access Survey between February and June of this year. Bontrager presented a briefing on the findings to the media earlier this week.
Some quick highlights:
- While the rate of those without health insurance has remained stable over the last four years, the raw numbers of people without insurance in some groups, including children, are going up as the population grows.
- Despite the booming economy, people say they are having problems paying for their medical bills as well as their food and housing.
- There was an upswing in the number of people seeking general care, but a decrease in people seeking needed care for mental health or substance use disorders.
- About 15% of people reported some kind of unfair treatment when receiving care.
CHI chose 10,000 Colorado households at random, and the surveyors double-checked the responses to ensure accurate representation of every demographic. CHI sent letters in English and Spanish to each household inviting people to participate either online or over the phone, and then followed up with postcards and reminders. To ensure accuracy, surveyors checked the data against a sample of phone interviews, Bontrager said.
Let’s dive deeper into some of the findings.
The uninsured rate remains the same overall, but some populations see changes
In 2013, the percentage of those without health insurance in Colorado was about 14%. The Affordable Care Act largely took effect the following year, and included an expansion of Medicaid and the launch of the state healthcare marketplace Connect for Health Colorado.
By 2015, the uninsured rate had dropped to 6.7% and two years later was at 6.5%, where it remains. Still the total number of uninsured people rose from 350,000 to 361,000 between 2017 and 2019 due to population growth, Bontrager said.
The survey breaks down the data into 21 “Health Statistics Regions,” which were developed by the Colorado Department of Public Health and Environment. Of the 21, Jefferson County has the lowest rate of uninsured at about 2.6%.
“We suspect that may have to do with a higher proportion of adults 65 and older,” Bontrager said, “as well as the fact that they tend to be higher income areas, too.”
Adults 65 and older qualify for Medicare.
The highest uninsured rates were in region 12, which includes Summit, Eagle, Grand, Garfield, and Pitkin counties, where 14% of residents are uninsured. That region also has some of the highest premiums in the country, Bontrager said.
Those counties have a high use of care, Joe Hanel, director of communications for CHI, said. The region is also dominated by a handful of hospitals, which, according to Hanel, frustrated Summit County residents. The county recently negotiated a new health plan with the local hospital to bring down costs by 20%.
Historically, 19-29 year-olds have had the highest uninsured rates, but this year 30-49 year-olds surpassed them. Still, the total number of uninsured went down for both groups despite population growth. The uninsured rate among children has gradually increased since 2015, hitting slightly more than 4% this year.
Hanel said that one possibility for the jump in uninsured children could be the more restrictive public charge rule, which is a test of whether an immigrant applying for a Lawful Permanent Residency, otherwise known as a green card, will become dependent on government programs. A report updated in May from CHI predicts 45,000 citizen children, and 3,000 non-citizen children, may lose their insurance because their family members are concerned about losing their status. The controversial rule change was adopted by the U.S. Citizenship and Immigration Service on Aug. 14.
While uninsured rates are dropping among people who identify as Hispanic or Latinx, they are still higher than other racial/ethnic groups. About 1 in 10 Hispanics reported they had no health insurance compared to one in 20 who identified as white.
The survey asked participants if they were citizens. A “no” response could mean everything from being here illegally to having permanent lawful status or legal permission to live and work here. Almost one-third of non-citizens reported not having insurance, a rate near four times higher than that of citizens.
Finally, the only demographic group that saw an increase in its uninsured rate was among people making 200-300% of the federal poverty level, which currently sits at $12,060 for a single person household. That income level is too high to qualify for Medicaid.
Potential problems with affordability
Though uninsured rates are stable and the economy is doing well overall, a significant portion of people reported they were having trouble affording housing and food and medical bills.
When asked why they lacked insurance coverage, almost 9 out of 10 answered cost. Among the insured, almost 1 in 5 said they had problems paying a medical bill in the past year, and in a newly added question, more than 3 in 10 people said they received a surprise medical bill.
CHI hasn’t measured the overlap between people who had trouble paying their bills and those who received a surprise bill.
Also new in this year’s survey: questions intended to look at broader health indicators. In answers to these questions, nearly 10% of respondents said they ate less than they thought they should because they felt there wasn’t enough money to pay for food. About 7% reported they were worried they may not have stable housing in the next two months. Food insecurity disproportionately affects the southwest, southeast, and northeast corners of the state.
People indicating that they ate less than they thought they should, because there wasn’t enough money for food, 2019
Another survey by CHI, released in August of this year, found that 3 in 10 Colorado renters are burdened by the cost of housing, forcing them to sometimes choose among food, housing, health care, utilities and other essentials. The survey found the high cost of living disproportionately affects communities of color, people with disabilities, rural communities, undocumented immigrants, families with children, and low-income households.
Inconsistencies in care
Overall, more people reported using healthcare, whether from a general doctor, specialist, or dentist. But the number of people seeking preventive care went down, Bontrager said.
This year the survey added a question asking people if they felt they were treated unfairly when seeking medical care. About 15% reported being treated unfairly sometimes or often, saying they thought it was because of their age, gender or disability status. Bontrager said in the future CHI wants to delve more into how gender affects care.
The number of people seeking mental health care went up overall, whether from a general doctor or a healthcare professional, but so did the number of people who did not get the necessary mental health or substance abuse care they believe they needed.
The cost of treatment was the number one reason for people forgoing mental health and substance abuse care. The second most common reported reason was that they did not feel comfortable seeking treatment because of stigma or difficulty admitting they have a problem. A smaller group said they didn’t seek treatment because they thought insurance wouldn’t cover it.
More data and analysis will be presented at the Hot Issues in Health Conference on Dec. 5.