By Kara Johnson Hufford and Phyllis Albritton
A recent Denver Post article by Meg Wingerter (“Colorado clinics, mental health providers see rising uninsured patients and worry it could become the new normal”) nicely captures the real challenges facing the state’s “safety net” for the most vulnerable Coloradans.
We chose to speak out together on this important issue because we represent the majority of community mental health centers across the state, what people euphemistically call the safety net.
To meet these needs, we call on state leaders to use unspent federal pandemic funds to ensure health care providers can keep their clinics open and continue to provide all the care patients need.
To summarize the problem, in recent months, many community mental health centers – safety-net clinics that care for people with the most serious mental illnesses – have seen their number of uninsured patients reach their highest level in the past five years. More than 40 primary care safety-net clinics across Colorado that do not receive federal assistance have seen a 10% to 25% increase in the number of uninsured patients. This is primarily due to the end of the federal health emergency related to the pandemic, which resulted in more than 500,000 Coloradans being removed from the Medicaid program.
The Colorado Behavioral Health Council and the Colorado Safety Net Collaborative are organizations that provide mental health care to families and individuals who may not otherwise be able to access it.
The situation is only getting worse for Coloradans who live in poverty, suffer from serious mental illness or substance use disorders, and have chronic physical conditions that could lead to emergency or life-threatening conditions if left untreated.
In an effort to balance their budgets, two Colorado community mental health centers have announced staff cuts and others are on the brink of losing staff. To preserve clinical jobs and programs, one community mental health center laid off 13 percent of its management staff, and another very small center laid off three of its five leadership positions.
Safety-net clinics that serve the uninsured are only seeing increased demand for their services as funding sources to cover costs dwindle, even though care at a clinic is much cheaper than a trip to the emergency department.And if a clinic is seeing a decline in Medicaid enrollment, it’s likely to end up the same as community health centers and other safety-net providers that have been forced to lay off staff.
Why are health care providers in this situation? After all, they knew that Medicaid enrollment would eventually fall once the federal government ended the public health emergency that guaranteed continued coverage during and after the COVID pandemic. One reason is that state estimates of Medicaid enrollment declines were optimistic. Of course, prediction is an art, not a science. But in some states, actual dropout rates have far exceeded projections. States have been unable to come up with the funds to cover services for the newly uninsured.
But an equally important reason is that private health insurance is fundamentally unaffordable. People with private health insurance, whether they buy it through their employer or on the Connect for Health Colorado Exchange, have seen their out-of-pocket costs continue to rise: premiums, deductibles, coinsurance, and copayments. This won’t change, and more people who were privately insured will likely become uninsured. The Federal Reserve Board periodically reviews the average amount needed to get a family through a crisis. For Coloradans who need our safety net services, every unexpected expense is about $400.
Remember, people don’t stop needing or seeking health care if they don’t have Medicaid or insurance. We’ve heard tough stories from people who were hospitalized when they were informed they were no longer covered by Medicaid, and from health care providers desperately trying to keep vital but underfunded programs afloat.
There are already unused federal funds being used to combat the pandemic. State policymakers should immediately release these funds to help struggling health care providers in the short term, then begin a longer-term effort to rethink how the safety net is funded.
These challenges affect all of us, whether we personally have access to safety net supports or not. Each of us feels the direct or indirect impacts, including increased health care costs, overcrowded emergency rooms, economic challenges from a poorly healthy workforce, increased public safety issues, and the diversion of public safety resources to manage people in mental and physical health crisis.
After all, the safety net covers us all, directly or indirectly, but it can’t do that if it only hangs on one thread.
Kara Johnson Hufford is CEO of the Colorado Behavioral Health Council. Phyllis Albritton is managing consultant for the Colorado Safety Net Collaborative.
