The bulk of federal health care reform is starting to roll out and big changes could be in store for Colorado’s rural areas. Many of these regions, including the Roaring Fork Valley, are full of people who are uninsured. A quarter of residents living in the mountain counties of Eagle, Pitkin, Garfield, Grand and Summit don’t have health insurance. With the Affordable Care Act, this group will be required to have insurance, or pay a penalty. But, it’s likely not everyone will apply. Aspen Public Radio's Marci Krivonen reports.
Michael Hawes walks through the warmly lit hallways of the Grand River Hospital and Medical Center. This is the place, he says, where he was treated for one of the scariest moments in his life.
"My heart attack was just about two and a half years ago, pretty much came out of nowhere, I thought I was healthy and ate relatively good, it just goes to show you, you never really know," he says.
The medical center in Rifle served his needs after initial surgery in Grand Junction. At 60 years old, Hawes is a retired musician.
"I moved to Aspen in the mid to late 70’s as a musician, mostly."
Through many of his younger years, he didn’t have insurance. Luckily, he discovered a state program for low income seniors before his heart attack. Many are not so lucky he says, especially in Colorado’s resort towns.
"A lot of my close friends, my Aspen friends, my musician friends, have ended up with heart attacks, so it’s definitely a challenge.”
Nan Sundeen is with Pitkin County Health and Human Services. She says the tri-county area of Eagle, Pitkin and Garfield Counties has always had a high rate of uninsured.
"We’re a resort industry, we have seasonal workers and we have mostly small businesses and insurance is expensive and then, we are always challenged with getting people insured who may not be lawfully present," she says.
She says the region’s large immigrant population is often not well-informed about access to insurance.
The federal Affordable Care Act requires people to have insurance on January first of next year. Many small businesses and seasonal workers in the Aspen region will find coverage through a state-run marketplace of health plans, also called an exchange. But, Sundeen says, many will skip coverage altogether.
"Where we will always struggle is people who are not lawfully present will not be eligible for this, but their children who are born here, are eligible and are required to have insurance. And then, out here in the wild west, we will always have people who are not willing to conform to the law.”
Right now, about 830,000 Coloradans don’t have health insurance, or 16 percent of the state’s population. Young people are the largest group without insurance. But, the poor, unemployed and mountain and rural areas also have high rates of uninsured. Jeff Bontrager tracks these statistics for the Colorado Health Institute.
"Grand, Eagle, Summit, Pitkin and Garfield Counties, for that region, we know that about 25 percent of residents in that region report being uninsured," he says.
After the Affordable Care Act is in effect in 2016, Bontrager expects the number of uninsured in the region that covers Pitkin, Eagle and Garfield Counties to be cut in half. So that, just 9.9 percent of residents here are uninsured, rather than 21 percent.
But, just because more people will be enrolled, doesn’t mean everyone will get access to care, says Nan Sundeen with Pitkin County.
"We may insure a whole bunch of people, but if the medical community doesn’t find a way to take Medicaid and take these insurances, it’s not going to really matter, we’re still going to have the same issue, where patients have to go far away to get the medical care they need.”
She says many physicians in the Aspen area don’t take Medicaid patients because the reimbursement is so low. She’s unsure how much doctors will be reimbursed under the health exchange plans.
Nurse Kathleen Chiocca gives a tour of a patient room at the Mountain Family Health clinic in Rifle. This is where many of the newly insured patients may come. It’s a federally-qualified health center. So, it earns more from taking a Medicaid patient for example, than a private physician does. Ross Brooks is the Executive Director.
“At Mountain Family, we are a primary care provider that takes care of all patients regardless of ability to pay, so we see a very high percentage of folks in our clinics in Glenwood Springs, Basalt and Rifle.”
Already, half of the patient load these clinics serve is uninsured. So, with the changes to the law, Mountain Family Health Centers expects more patients and more revenue.
"Having a patient who has health insurance is better reimbursement for us, to provide the service, for the patient themselves, it’s excellent because they don’t have to worry about putting bread on their table or making other life decisions when they have health insurance," Brooks says.
Back in Rifle at Grand River Hospital, retired musician Michael Hawes points toward his doctor’s office. Newly insured under a special program for seniors, Hawes says dealing with his heart attack and the resulting hospital bills without insurance would have been catastrophic.
"I don’t think I’d be here right now, to be honest with you, just because of the stress level of owing that much money. It was a God’s send, or whatever you wanna call it.”
Hawes’ plan called Old Age Pension is state-funded and will stay in place under the Affordable Care Act. Others who are uninsured can start to enroll in the so-called insurance marketplace in October.