Gov. Jared Polis said Medicaid cuts in the Republican budget bill will throw hundreds of thousands of Coloradans off their health care, drive up costs for everyone and put providers like hospitals and community health at risk.
“It's really important that people understand the impact to people and to our state of what these really draconian health care cuts would mean,” Polis told a small group of health care leaders at a roundtable discussion Monday about Medicaid at UCHealth Broomfield Hospital in Broomfield.
GOP lawmakers, including members of Colorado’s congressional delegation, have said they aim to cut waste, fraud and abuse and can streamline the program without cuts to “lawful beneficiaries.”
But Polis said the changes will jeopardize hospitals, making it harder for them to keep their doors open.
“Many rural health care providers, hospitals won't be able to make it. We're going to lose rural providers with this,” Polis, a Democrat, said. “We're going to shift the cost of care onto everybody who buys insurance, gets insurance through their employer. We'll pay more, employers will pay more. Bad for business and bad for workers.”
Cost of care would rise
Polis said Coloradans losing coverage would drive up health costs for everyone. People who are uninsured will still need medical care and they’ll end up going to hospitals for emergency procedures, which are far more expensive than preventative care. Ordinary consumers will end up paying for what’s called uncompensated care in hospitals.
“Those costs are passed on in the commercial insurance market. So this will likely lead to 10 to 20 percent increases in what everybody pays for insurance,” Polis said. "Not to mention the human dimension of having hundreds of thousands of people just worry about even being able to get care.”
The governor made his comments as Senate Republicans looked to potentially cut Medicaid even more aggressively than the House version of the bill. Now on the table, a deeper cut to a hospital fee states like Colorado have used to help expand Medicaid coverage.
Hospital administrators say the fee is critical to helping hospitals care for Medicaid patients, but some conservatives see it as waste, saying providers aren’t now held accountable for how the tax money is used, limiting incentives to rein in Medicaid spending.
Pettersen says it increases bureaucracy
Rep. Brittany Pettersen said provisions in a Republican bill would cut nearly $800 billion from Medicaid, the health program for low-income Americans known as Health First Colorado, in the next decade.
Pettersen said the changes promise to decimate health coverage for many Coloradans, hundreds of thousands by some estimates. And the cost to the state of verifying one part of it, work requirements for enrollees, is the opposite of government efficiency.
“You're increasing red tape, paperwork. You're having $57 million that the state of Colorado would have to oversee just to comply,” she said. “So you're firing nurses and doctors and hiring bureaucrats.”
The work requirements would apply to 377,000 Coloradans who gained health insurance through the Medicaid coverage expansion. Some would be exempt due to the requirements, like those with disabilities, pregnant women, caregivers with young kids or those who are incapacitated.
Verifying enrolls twice a year
“The devil will be in the details,” of the budget bill, said Rachel Reiter, director of policy, communication and administration with the Colorado Department of Healthcare Policy and Financing.
The bill would require states to verify twice a year whether a Medicaid enrollee is working 80 hours per month. But states wouldn’t be able to automate renewals for most of the expansion population, which would ramp up the administrative burden.
“When people have to meet these requirements, we already know we get drop-offs, it hits our hospitals,” said Reiter. “When people show up, they think that they're covered, they're showing up in the ER, they realize that they don't have Medicaid anymore or showing up in our community health centers. What does it look like when we increase the requirement to twice a year?”
Polis was even more direct.
“It really drains health care to fund bureaucrats,” he said. “We don't need more bureaucrats, we need more nurses, doctors and caregivers. And this bill is the exact opposite. It'll shift resources away from actually providing health care into the bureaucracy.”
“I am very frustrated hearing my Republican colleagues bring talking points that sound good instead of really understanding some of the detrimental impacts that this is going to have,” said Pettersen, a Democrat who represents the state’s 7th Congressional District, the western parts of metro Denver.
Rural hospitals, providers at-risk
Colorado is one of the only states in the nation that hasn't had a rural hospital closure in the last 40 years, said Joshua Ewing, vice president of rural health with the Colorado Hospital Association.
“That in itself is something to be very proud of, but the reforms contemplated currently would change that unquestionably,” Ewing said. “We would see rural hospital closures in Colorado and that would have devastating impacts for our rural Coloradans.”
He said Colorado has 43 rural hospitals, and 85 percent of them don't have a sustainable operating margin — they don't make enough money from patient care each year to keep up with rising costs. Fifty percent run in the red every year, meaning they're losing money every year and struggle to keep their doors open.
In the last few months, two behavioral health facilities and two labor and delivery departments in rural Colorado have closed, due to rising costs and lasting impacts from the pandemic, he said.
'These are real people'
An analysis from the American Hospital Association found the current draft of the bill could result in $50 billion in cuts over the next decade.
Another hospital leader said the pain will be felt broadly.
“This is going to hit all of our hospitals,” said Merle Taylor, UCHealth’s president of Diversified Services and its community hospitals in the Denver region, including Broomfield Hospital.
“These are real people that we're talking about here with these cuts. It impacts their health, it impacts the health of the communities we serve,” he said. “It drives up costs too. And that's unsustainable for hospitals right now with the way our finances are. It's just not sustainable to make these cuts.”
