The Need
Accessibility
Under the heading “once vulnerable, still vulnerable”, the Colorado Health Institute (CHI) in its 2017 Colorado Health Access Survey (CHAS) estimates that about 350,000 Coloradans still do not have health insurance (including about 13,100 in Boulder County). These “final uninsured” are among the most vulnerable and hardest to reach. As many as 25% of them do not have documentation, making them ineligible for most public insurance and unable to use the Affordable Care Act (ACA) marketplace.
About 61,000 of the uninsured are under the poverty line, nearly 50,000 don’t have a high school diploma, and about 115,000 are Hispanic. One in 7 uninsured Coloradans does not even know how to get health insurance; in Boulder County, 7.5% (or 2,224) of those persons eligible for Medicaid and premium tax credits are not enrolled, according to Internal Revenue Service tax data.
Only 8 of the 64 Colorado counties have more uninsured individuals than does Boulder County, according to CHI’s analysis of the 2015 American Community Survey. Its own study (the 2015 CHAS) analyzed zip code level demographic and economic data to gauge the probability of not getting a medical appointment as soon as one was needed. Boulder County zip codes ranged from 16.1% to 33.4%, with the latter being by far the highest percentage in the entire state.
For additional details on access to health care services, see
https://www.coloradohealthinstitute.org/research/colorado-health-access-survey
Affordability
Colorado Health Access Survey data also reveal that, despite historic health insurance gains, many Coloradans skip medical care because of its cost. Insurance often fails as a safety net. Health plans often require hundreds or thousands of dollars in out-of-pocket payments. Insurance plans ask their customers to pay an increasingly greater share of their bills out of pocket through rising deductibles and co-payments.
The Colorado Health Institute (CHI) recently concluded that the “affordable” part of the Affordable Care Act (ACA) is still elusive in Colorado: “The high cost of insurance continues to be the number one reason for not having health insurance, with 78.4% of the uninsured citing it... 10.1% of Coloradans say they didn’t get needed doctor care because it was too expensive, the same rate as 2015.”
According to Boulder County Trends, the Community Foundation’s report on key indicators, 13% of county residents were estimated to be living below the federal poverty level in 2015. This equates to nearly 41,500 individuals. The 13% rate is three percentage points higher than it was in 2000. The rate is higher in the City of Boulder (21%) than in the cities of Longmont (14%) or Lafayette (8%).
For additional details on socioeconomic trends in Boulder County, see
https://www.commfound.org/trends
Homelessness
Adding to the visible need for a medical safety net, the Community Foundation reports that homelessness in Boulder County continues to be a problem, with increasing numbers of families living in cars or couch-surfing, single homeless people coming from outside the community, and seniors unable to afford escalating rents and costs of home ownership.
A count (the annual Point in Time Survey) of persons experiencing homelessness on one January 2018 night in Boulder County found 592 homeless persons either unsheltered (158), in emergency shelters (283) or in transitional housing (151). This does not include those in temporary living situations or at risk of becoming homeless.
The trends over the past three years are not encouraging, with steady increases in the percentages of those in emergency shelters and those unsheltered, and decreases in the percentages of those in transitional housing. The PIT also concluded that over one-third (34.5%) of the homeless population in Boulder County were experiencing chronic homelessness. This includes those who were homeless for at least one year in the past three years and also have a disability.
For additional details on the Point in Time Survey results, see https://www.mdhi.org/pit_reports