Mar 28, 2023

Julia previously served as the Connelly Policy Advocate at CCLP, supporting CCLP's legal and legislative efforts to advance economic justice and racial equity in Colorado.

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Facility Fees Place Coloradans at Risk

by | Mar 28, 2023

On Friday, March 23, 2023, Julia Char Gilbert, CCLP’s Connelly Policy Advocate, provided testimony to the House Health & Insurance Committee for House Bill 23-1215, Limits on Hospital Facility Fees. CCLP is in support of HB23-1215.


Dear Madame Chair, Mr. Vice Chair, and Committee Members:

Thank you for the opportunity for the Colorado Center on Law and Policy (CCLP) to submit written testimony in strong support of House Bill 23-1215, Limits on Hospital Facility Fees. CCLP is a nonprofit organization dedicated to the fight against poverty in Colorado. As part of this work, CCLP fights to promote access to affordable health care for low-income Coloradans. Facility fees are concerning to CCLP because high, unexpected out-of-pocket medical costs threaten households’ economic stability and prevent Colorado patients from accessing needed health care.

Coloradans need and deserve more transparency and guardrails when it comes to health care costs. The majority of Coloradans report uncertainty about their ability to pay for even routine health care expenses.[i] And nearly 4 in 10 Americans report they would not be able to cover an unexpected $400 expense without taking measures such as incurring credit card debt or borrowing money from friends or family.[ii] Facility fees routinely exceed $400, placing everyday Coloradans at risk of financial distress and its many cascading impacts.

Further, despite inflation and fluctuations in the market, Colorado hospitals’ finances remain remarkably healthy, according to data from the Colorado Department of Health Care Policy and Financing published earlier this year.[iii] In Q3 of 2022, Colorado hospital systems reported robust cash-on-hand reserves, including Centura Common Spirit ($15.2 billion), Centura Advent ($6.3 billion), SCL/Intermountain ($11.1 billion), Banner Health ($8.7 billion), and UCHealth ($5.1 billion). The size of these reserves — even following a decrease in profits in 2022 due to investment losses felt across industries  — can be attributed to the staggeringly high profits that Colorado hospitals, including nonprofit hospitals, have reported in recent years. For example, in 2021, in the midst of the COVID-19 pandemic, nonprofit hospital Centura Common Spirit reported $3.0 billion in profits; SCL reported $2.2 billion in profits; and UCHealth reported $1.1 billion in profits. These data indicate that it simply not necessary for hospitals to charge patients facility fees for preventative care visits and telehealth visits in order to “keep the lights on.”

HB23-1215, with its proposed amendments, would gather critical data about facility fees, promote transparency in a uniquely opaque industry, and establish common-sense protections from unexpected fees charged for telehealth and preventative services. The bill is an important step towards a health care system that works for working Coloradans.

CCLP emphatically urges the Committee to vote yes on HB23-1215. Thank you for your time and attention.



Julia Char Gilbert

Connelly Policy Advocate

Colorado Center on Law and Policy


[i] Perry Undem and Robert Wood Johnson Foundation. Results from a Statewide Survey: How Coloradans Feel about Affordability and Healthcare Reform. March 2022.

[ii] Board of Governors of the Federal Reserve System. Dealing with Unexpected Expenses: Report on the Economic Well-Being of U.S. Households in 2019. May 2020.

[iii] Colorado Department of Health Policy & Financing. Hospital Insights Bulletin 2023. January 2023.


HB23-1215 was signed into law on May 30, 2023.

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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.