Oct 13, 2017

Bethany Pray serves as CCLP's Chief Legal and Policy Officer. 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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Trump’s latest action attacks health care and working Coloradans

by | Oct 13, 2017

Chaos causes sleepless nights, panic and financial ruin, and sometimes – when the issue involves international relations or health care – chaos kills.

The decision announced yesterday by President Trump to end funding for cost-sharing reductions will engender chaos, with disastrous outcomes on a personal and market level unless Congress acts quickly. With the decision to expand association health plans, this is the second impulsive and harmful act in as many days.

Premium tax credits (PTC) help lower premium costs for the majority of customers who purchase coverage through a federal or state exchange, but cost-sharing reductions (CSR) help a slightly smaller group get more use of their benefits, by lowering deductibles and co-pays or coinsurance. For those at the lower end of the income scale, a Commonwealth study shows that a silver plan deductible of over $6,000 can dip to as low as $1,100, and co-payments for drugs may be halved. Cost-sharing reductions (CSR) will remain available to people who make too much to qualify for Medicaid but not more than 250 percent of the federal poverty level (FPL), i.e. less than $61,500 for a family of three, or $30,150 for an individual.

While insurance companies will still be required to offer CSR to these customers, the White House action eliminates the funding that insurance carriers get to cover those costs. Without that funding, carriers will need to increase premium prices by up to 15 percent for all customers in order for plans to remain solvent. That increase would be in addition to already major hikes planned for premium prices in 2018, because Colorado insurers were instructed to offer rates that assumed that the federal government would continue to support the CSR program. In total, we estimate premiums could increase by an average of 40 percent if Trump’s action stands for customers who don’t qualify for assistance. Those who do qualify will see minimal or no change to their monthly payments.

So, who loses?  First, this throws a massive wrench into preparations for open enrollment, slated to begin Nov. 1. Though our state exchange, Connect for Health Colorado, has done extensive contingency planning, the defunding will affect everyone’s ability to access coverage. The situation could be far worse on the federal exchanges.

Second, the roughly 75,000 Coloradans who in 2017 purchased their coverage and were not qualified for assistance (or failed to seek assistance) will see unaffordable premium increases in 2018. Individuals who simply can’t pay will lose access to necessary care: blood pressure medication, insulin, drug treatment, and other life-sustaining services that can’t be accessed through emergency medicine. Those most likely to find care unaffordable will be older Coloradans and Coloradans who live in high-premium areas in the Eastern Plains and the Western Slope and mountain corridor.

But in the end, everyone loses. Premiums will be expected to rise even more steeply in coming years to adjust for the fact that healthy people will drop out of the market and only the sick, with higher costs on average, will remain in the market. Carriers are expected to promptly exit the market – though their ability to do so for 2018 could be limited –  and it’s anticipated that large swathes of Colorado will have no access at all to individual coverage with credit assistance.

When tens of thousands of Coloradans lose coverage, all Coloradans suffer. When a million Americans lose coverage, as the Congressional Budget Office projected in August, public health crises have room to roam, and more uncompensated care means higher prices for everyone, even if your employer offers coverage. But on a more personal level, we want to live well and work well. We want our neighborhoods, our schools, and our businesses, to thrive. Getting access to health coverage and health care is key to making that happen.

We condemn this mean-spirited and destructive action that would throw the health insurance market, and millions of Americans, into chaos.

Senators Alexander and Murray continue to develop a plan that could reverse this destructive White House move. We ask that our Colorado delegation recognize that this health care chaos will lead to disaster and vote accordingly to stabilize markets, without compromising in ways that undermine the ACA’s consumer protections.

Please contact your U.S. senators and representatives and make your concerns about this cold-hearted decision known.

– By 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.