Bucking the national trend, the rate of people without health insurance in Colorado has held steady this year, according to a major new study released Wednesday.
The every-other-year Colorado Health Access Survey found that a record-low 6.5% of Coloradans are without health coverage, identical to the survey’s 2017 finding and down from the 15.8% of people without insurance in 2011.
That will bring a big sigh of relief from health care advocates in Colorado, who had worried that the state might be following the national trend toward higher uninsured rates after the Trump administration and congressional Republicans weakened key pieces of the Affordable Care Act. Earlier this month, the U.S. Census Bureau reported that the number of people without health insurance in America had risen for the first time in a decade.
But all is not well in the data in Colorado, either.
“It’s important to look one level down,” said Michele Lueck, president and CEO of the Colorado Health Institute, which produces the study.
More people are covered by employer plans — about 53% of Coloradans — and fewer buy health insurance on their own. But more than 18% of people reported problems paying medical bills in the prior year, up from 14% in 2017.
“This is back up to pre-Affordable Care Act levels,” said Jeff Bontrager, the health institute director of research and evaluation who was the principal investigator for this year’s survey.
While fewer people reported earning especially low incomes, the uninsured rate increased for a big chunk of the middle class. For those who earn between two and three times the federal poverty level, the uninsured rate is 11.8%, up from 9.7% in 2017. That income level corresponds to about $50,000 to $75,000 a year for a family of four.
The uninsured rate also increased for those over age 50 but below age 65, the group just before the threshold for Medicare, for whom private insurance coverage is most expensive. It increased for kids 18 and under, too.
For the first time since Colorado Health Institute started the survey in 2009, the rate of people without insurance is higher in the 30-49 age group than in the 19-29 age group, though the uninsured rates in both age groups decreased in 2019 compared with 2017.
Among those without insurance, nearly 90% said their lack of coverage came down to not being able to afford it. That’s the highest percentage the health institute has ever seen in its surveys of people giving that reason for not having insurance.
So, despite the rosy top-line numbers, the health institute titled its report on this year’s survey, “Progress in Peril.”
“The story that’s emerging from the data contains some warning signs,” Bontrager said.
The Colorado Health Access Survey is considered the gold standard for data on the state’s health care market. Policymakers frequently cite it when deciding how to allocate resources or judging how many people a certain program might affect.
This year’s survey was funded by two foundations — The Colorado Health Foundation and The Colorado Trust — as well as by state agencies. Colorado Health Institute surveyed 10,000 households, this year using mailed letters to reach the respondents initially, before asking the respondents to take a phone or online survey.
In prior years, the health institute has conducted the survey exclusively through phone calls, which Bontrager said is getting harder to do as fewer people pick up when they see unknown numbers on caller ID. But, he said, the researchers did establish a comparison sample this year using the old methods to make sure this year’s results can be accurately compared to those from prior years.
“We do feel confident that we were able to trend the data,” he said.
Health advocates had worried that Colorado might begin to see an uptick in the uninsured rate as a result of efforts to weaken the Affordable Care Act. But Colorado officials have repeatedly sought to blunt those efforts.
For instance, when the Trump administration eliminated funding that helped people afford the out-of-pocket costs of insurance, Colorado regulators eventually used that as a way to reduce premiums.
Lueck said the steady uninsured rate may show the impact of the health care infrastructure that Colorado put in place following the passage of the Affordable Care Act. The state expanded Medicaid, created its own insurance exchange and reinforced many of the ACA’s policies in state law.
Kevin Patterson, the CEO of the state’s exchange, Connect for Health Colorado, echoed that, while vowing to continue working with others to make coverage more affordable and easier to buy.
“The steady rate of insured Coloradans reinforces the importance of operating our own marketplace,” he said in a statement. “However, it also means that nearly everyone in Colorado knows someone who is underinsured and struggling to afford coverage or care.”
Adam Fox, the director of strategic engagement for the Colorado Consumer Health Initiative, an advocacy group, said this year’s survey shows the need to expand the state’s efforts to help people struggling to pay medical bills. CCHI, for instance, is supportive of a state-run insurance program, known as a public option, that would cover immigrants. More than 27% of non-citizens living in Colorado are uninsured, a group that includes those here with documentation and those without.
“There’s a lot to be done to make insurance affordable for the many Coloradans who have been left behind,” Fox said in a statement.
So, despite the good news, this year’s survey will likely only spur lawmakers and the administration of Gov. Jared Polis forward with initiatives to further lower insurance premiums and also tackle the underlying costs of health care.
“These,” Lueck said, “are real and legitimate concerns of Coloradans.”