Jun 28, 2017

Bethany Pray currently serves as CCLP's Deputy Director. Her areas of expertise include regulatory analysis and advocacy for Medicaid and commercial coverage, access to behavioral health benefits, Medicaid eligibility and much more.Staff page ›

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Senate health plan is a prescription for disaster

by | Jun 28, 2017

Most of us would welcome real reform: reform of the way we pay for health care, and reform of the way we prevent and treat pressing problems like asthma or hepatitis or heart disease or opioid dependence.

But instead of real reform, the Senate’s Better Care Reconciliation Act (BCRA), like the earlier House plan, is built on ideological clichés about personal responsibility and weakened government, rather than knowledge about what makes health care systems work and people healthier.

Yesterday afternoon, after struggling to amass sufficient support, Senate leadership called off a vote on BCRA. The decision came on the heels of an analysis from the Congressional Budget office that projected that next year, 15 million more people would be uninsured nationally if the plan were approved. By 2026, the increase in the number of uninsured would jump to 22 million people.

Though it may seem that the Senate version is marginally less brutal to the Medicaid program than the House version, the 15 million children, adults and older Americans dropped from Medicaid by 2026 under BCRA would promptly be joined by millions more, because the funding drops more steeply after the CBO projection period. A comparison of the Affordable Care Act with House and Senate plans can be found here.

Under the plan, almost half of Colorado’s Medicaid enrollees would lose coverage.

Billions of dollars of the federal funding that buttresses the Medicaid program and access for lower-income Coloradans to immunizations, wheelchairs, blood pressure medication, opioid treatment, and nursing homes would be transferred instead to just 10 percent of wealthy households. The effects on Colorado’s budget from Medicaid cuts alone would be devastating, with a cumulative loss to the state of $15 billion by 2030. The above chart, by the Colorado Health Institute, demonstrates how deep those cuts would be in Colorado.

The cuts are projected to begin in 2021, with $280 million less in funds coming to Colorado by 2022. In 2030 alone, the Medicaid shortfall would be a full $3 billion. Without those federal funds, the Colorado Health Institute projects that by 2030, 630,000 Coloradans would lose Medicaid coverage, with the affected group including not just the expansion population but also children, people with disabilities, and older Coloradan –putting futures and lives at stake. Additional cuts to public health funding would hamstring state programs for suicide prevention, immunizations, and water-quality testing.  Those budgetary losses would be compounded by reduced tax revenue as health care employment dropped.

Meanwhile, the top 0.1 percent of Americans, according to Forbes, would add $250,000 per household to their existing incomes of $5 million or more. That household’s one tax break would mean the loss of Medicaid coverage for 166 Colorado children for a year, or an end to nursing home and home health care for 10 elderly disabled adults. Income inequality – worse now in Colorado than at any point in the last century, and a drag on long-term economic growth – would grow.  Drug makers would pull in an extra $20 billion, and tanning salons and medical device makers would be relieved of current taxes on their industries.

Private coverage would cost far more for rural Coloradans and older Coloradans.

Fewer Coloradans of all ages would purchase coverage on the individual exchange, both because subsidies would be reduced, and because plans would likely cover less of post-premium health care costs and drop essential benefits like maternity care and mental health treatment.

A healthy individual who is no longer required  to purchase insurance under BCRA and who faces an unmanageable deductible of $6000 along with high copays might understandably choose to go without coverage  – leaving the market to sicker and older enrollees and further driving up the cost of the insurance they depend on.

The Kaiser Family Foundation estimates that the impacts of the reduced subsidies and more extreme age ratings would be harshest on older Coloradans and in rural areas: a 60-year-old Grand Junction resident who makes $42,000 a year would see premium costs rise from $4,480 to a staggering $20,050 per year. As the CBO report estimates, even when “eligible for premium tax credits, few low-income people would purchase any plan.” Plans including comprehensive benefits “would become extremely expensive.”  And the current limits on out-of-pocket spending by individuals would be a thing of the past, such that medical debt and bankruptcy are likely to surge again to pre-ACA levels.

Health matters.

In the coming days, Senate leadership will push for a vote on BCRA.  Although some centrist Republicans Senators, like Susan Collins of Maine and Dean Heller of Nevada, have criticized the likely effects of BCRA on those who are covered by the Medicaid expansion and rural residents, Colorado’s senator Cory Gardner has yet to share his position with constituents.

Please speak up and let Sen. Gardner know that cutting federal funding to Medicaid and reducing federal subsidies for older and rural Coloradans would be a disaster for the physical, mental and economic health of Colorado.

-Bethany Pray

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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.