Mar 7, 2019

Allison Neswood previously served as CCLP's Deputy Director of Strategic Priorities. She is an expert in public health insurance plans (Medicaid and CHP+), Aid to the Needy Disabled, immigrant access to services and health equity.

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CCLP Testimony in Support of HB-1184

by | Mar 7, 2019

The following is testimony from Allison Neswood, Health Care Attorney at Colorado Center on Law and Policy regarding House Bill 1184. It was given in front of the House Finance Committee on March 4.

Good afternoon. My name is Allison Neswood and I am a health care attorney with Colorado Center on Law and Policy. CCLP is a nonprofit, nonpartisan policy advocacy organization that works to ensure access to health care and economic security for Coloradans facing economic poverty. CCLP supports House Bill 1184 because it will help lawmakers understand the impact proposed legislation has on disparities.

Colorado has a problem with disparities. To illustrate my point, I’d like to start my testimony by talking about research captured in the Prosperity Now Scorecard. The Scorecard measures the relative prosperity of each states’ residents by looking at 52 different measures of economic and social well being.

Now, if you’ll look at the first handout I gave you (there’s a seven at the top, front and back). You’ll see that Colorado is doing pretty well when we look at the prosperity of our residents overall.  In fact, our state would score in the top 10 among the states and D.C. if we only looked at the overall numbers.

But the 2019 Scorecard also disaggregated 26 of the prosperity measures to understand how residents of color in each state were fairing in comparison to white residents.

If you will now look at the second handout (there’s a 42 at the top), you’ll see that Coloradans of color fair worse on all measures than Colorado’s white residents.

In fact, the gaps in economic well being, health and educational attainment are so large in Colorado, that the Scorecard data gave us a racial disparity rank of 42 among the 50 states and DC. For such a prosperous state, that is way too close to dead last.

In addition, I just want to note that this is a problem in all parts of Colorado. The last handout contains county level data I pulled from the Scorecard for seven of the Colorado counties represented by the members of this committee. You’ll see that it is a similar story in each county.

Now, I started by talking about how communities of color are struggling. So to do my friends and neighbors justice, I also have to talk about root causes. Our nation generated much of its great wealth through two of the most severe forms of human exploitation in modern history: chattel slavery and the dispossession of Native American land.

And the exploitation and neglect of our communities of color did not end with emancipation and the relegation of native people to reservations. We continued well into the 20th century to traumatize Native American communities by kidnapping native children from their families and placing them in federal boarding schools where they were beaten for speaking their language and where sexual abuse was rampant.

After World War II, government subsidized housing programs helped white families buy their first home in the suburbs, the GI bill helped white veterans get an education, purchase a home, and start a business, and the Social Security Act helped white Americans save for retirement and pass on wealth to their children. Many white Americans can trace their family wealth to these government policies. But people of color were largely excluded from these benefits.

Government endorsed redlining practices continued and exacerbated residential segregation and confined black Americans to neighborhoods that received minimal to no investment and that have been targeted by the negative externalities of highway development and industrial waste. Think about Flint, Mich.

We continue to harm people of color with inhumane immigration policies, the effects of which reach deep into our communities.

And we’ve dealt with the consequences of all this social exploitation and neglect with a biased criminal justice system and mass incarceration.

Disparities based on race are not the only type of disparities we see in society. But they are real and they teach us that discriminatory policies harm our people and that the harm is passed down through generations. In addition, disparities are costly for society as a whole. The Joint Center for Economic and Political Studies estimates that between 2003 and 2006, 30.6 percent of direct medical care expenditures for racial and ethnic minorities were excess costs stemming from health disparities. The center estimated that eliminating health disparities for minorities would’ve reduced direct medical care expenditures by nearly $230 billion.

Policymakers in Colorado should do all they can to understand the ways in which the bills they propose impact disparities. HB-1184 is a modest measure that moves us in that direction. I urge your support.

– By Allison Neswood



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To maintain health and well-being, people of all ages need access to quality health care that improves outcomes and reduces costs for the community. Health First Colorado, the state's Medicaid program, is public health insurance for low-income Coloradans who qualify. The program is funded jointly by a federal-state partnership and is administered by the Colorado Department of Health Care Policy & Financing.

Benefits of the program include behavioral health, dental services, emergency care, family planning services, hospitalization, laboratory services, maternity care, newborn care, outpatient care, prescription drugs, preventive and wellness services, primary care and rehabilitative services.

In tandem with the Affordable Care Act, Colorado expanded Medicaid eligibility in 2013 - providing hundreds of thousands of adults with incomes less than 133% FPL with health insurance for the first time increasing the health and economic well-being of these Coloradans. Most of the money for newly eligible Medicaid clients has been covered by the federal government, which will gradually decrease its contribution to 90% by 2020.

Other populations eligible for Medicaid include children, who qualify with income up to 142% FPL, pregnant women with household income under 195% FPL, and adults with dependent children with household income under 68% FPL.

Some analyses indicate that Colorado's investment in Medicaid will pay off in the long run by reducing spending on programs for the uninsured.


Hunger, though often invisible, affects everyone. It impacts people's physical, mental and emotional health and can be a culprit of obesity, depression, acute and chronic illnesses and other preventable medical conditions. Hunger also hinders education and productivity, not only stunting a child's overall well-being and academic achievement, but consuming an adult's ability to be a focused, industrious member of society. Even those who have never worried about having enough food experience the ripple effects of hunger, which seeps into our communities and erodes our state's economy.

Community resources like the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, exist to ensure that families and individuals can purchase groceries, with the average benefit being about $1.40 per meal, per person.

Funding for SNAP comes from the USDA, but the administrative costs are split between local, state, and federal governments. Yet, the lack of investment in a strong, effective SNAP program impedes Colorado's progress in becoming the healthiest state in the nation and providing a better, brighter future for all. Indeed, Colorado ranks 44th in the nation for access to SNAP and lost out on more than $261 million in grocery sales due to a large access gap in SNAP enrollment.

See the Food Assistance (SNAP) Benefit Calculator to get an estimate of your eligibility for food benefits.


Every child deserves the nutritional resources needed to get a healthy start on life both inside and outside the mother's womb. In particular, good nutrition and health care is critical for establishing a strong foundation that could affect a child's future physical and mental health, academic achievement and economic productivity. Likewise, the inability to access good nutrition and health care endangers the very integrity of that foundation.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides federal grants to states for supplemental foods, health care referrals, and nutrition information for low-income pregnant, breastfeeding and non-breastfeeding postpartum women and to infants and children up to age five who are found to be at nutritional risk.

Research has shown that WIC has played an important role in improving birth outcomes and containing health care costs, resulting in longer pregnancies, fewer infant deaths, a greater likelihood of receiving prenatal care, improved infant-feeding practices, and immunization rates

Financial Security:
Colorado Works

In building a foundation for self-sufficiency, some Colorado families need some extra tools to ensure they can weather challenging financial circumstances and obtain basic resources to help them and their communities reach their potential.

Colorado Works is Colorado's Temporary Assistance for Needy Families (TANF) program and provides public assistance to families in need. The Colorado Works program is designed to assist participants in becoming self-sufficient by strengthening the economic and social stability of families. The program provides monthly cash assistance and support services to eligible Colorado families.

The program is primarily funded by a federal block grant to the state. Counties also contribute about 20% of the cost.


Child care is a must for working families. Along with ensuring that parents can work or obtain job skills training to improve their families' economic security, studies show that quality child care improves children's academic performance, career development and health outcomes.

Yet despite these proven benefits, low-income families often struggle with the cost of child care. Colorado ranks among the top 10 most expensive states in the country for center-based child care. For families with an infant, full-time enrollment at a child care center cost an average of $15,140 a year-or about three-quarters of the total income of a family of three living at the Federal Poverty Level (FPL).

The Colorado Child Care Assistance Program (CCCAP) provides child care assistance to parents who are working, searching for employment or participating in training, and parents who are enrolled in the Colorado Works Program and need child care services to support their efforts toward self-sufficiency. Most of the money for CCCAP comes from the federal Child Care and Development Fund. Each county can set their own income eligibility limit as long as it is at or above 165% of the federal poverty level and does not exceed 85% of area median income.

Unfortunately, while the need is growing, only an estimated one-quarter of all eligible children in the state are served by CCCAP. Low reimbursement rates have also resulted in fewer providers willing to accept CCCAP subsidies.