Deep program cuts and layoffs. Clinic closures. A health care provider on the brink of bankruptcy.
Colorado health care providers painted a bleak picture of the state’s health safety net at a Thursday listening session hosted by the legislature’s Joint Budget Committee.
But as bad as things have already gotten, the overarching message to lawmakers was even worse.
Unless things change — and soon — Colorado’s plummeting Medicaid rolls threaten to set off a downward spiral in the state’s public health system.
“I have never experienced a period as challenging as we now face,” said Simon Smith, the president of Clinica Family Health, which treats about 60,000 underserved patients in Boulder, Adams and Gilpin counties.
Known as the Medicaid “unwind,” the rollback of a federal expansion of who qualified for Medicaid during the pandemic was always expected to be challenging for medical providers across the state. Even resetting Medicaid levels to where they were in 2019, before the pandemic, would have meant a drop in payments to health care providers and a rise in uncompensated care.
But across the country, people who should still qualify for Medicaid have lost coverage as administrators struggle to re-verify people’s eligibility. And Colorado has disenrolled one of the highest percentages of Medicaid patients in the country — many of them incorrectly.
The state disenrolled so many patients, providers said, that not only are some of them treating more uninsured patients than before the pandemic, some have reverted to 2012 levels of uncompensated care. That’s before the state expanded Medicaid under the Affordable Care Act.
Clinica has had to lay off 100 staff members already, Smith said, cutting back on services that tend to save the health system money over the long term, including a walk-in clinic that helped keep patients out of the emergency room.
“We’re hollowing out primary care and preventative services,” Smith told the JBC. “We are turning away patients who have nowhere else to go.”
The cuts to small and midsize providers are already rippling through the health care system, providers said, driving up emergency room visits and uncompensated care at larger hospitals like Denver Health. Making matters worse, some providers said those who have managed to keep their insurance through Medicaid tend to be the sickest patients who need the most care. As a result, state reimbursement rates aren’t keeping up with the cost.
Devra Fregin, executive director of Clinica Colorado, which primarily treats low-income Spanish-speaking families, said she’s already laid off half her staff in Westminster. It still might not be enough to stave off bankruptcy, she said.
Fregin’s clinic, which relies on state funding and donations, is worse off than most. But more than half of all community health centers in the state are losing money this year, said Ross Brooks, the CEO of the Colorado Community Health Network.
“If nothing changes we are going to see additional clinic closures, additional laying off of staff, additional hiring freezes across our state,” Brooks said.
“WE WILL CUT SERVICES”
State lawmakers promised to “partner” with health care providers to find a solution to the crisis.
But Rep. Shannon Bird, a Westminster Democrat, acknowledged the elephant in the room: The state budget, facing a $900 million deficit, probably isn’t coming to the rescue.
“There can be many things at our disposal — a lot of new revenue at this point doesn’t seem like one of them,” said Bird, the JBC’s outgoing chair.
One area they’re likely to pressure for help: the Polis administration after its handling of the unwind led to Colorado disenrolling Medicaid patients at the second highest rate in the country, according to KFF, a health policy research group. More than 500,000 Coloradans were kicked off Medicaid for procedural reasons.
The long waitlist and complex process to re-enroll has left many patients staying at hospitals for 90 days or more while hospital staff try to get their coverage reinstated so they can then refer them to other facilities for needed care.
But without financial help while providers wait for enrollment to rebound, things will likely get worse before they improve.
Denver Health, the state’s largest safety net hospital, has become ground zero for the fallout, as it grapples with the ripple effects of layoffs across the state on top of its own drop in Medicaid clients.
In 2020, Denver Health incurred $60 million in uncompensated care, said Donna Lynne, the system’s CEO. In 2024, that more than doubled to $155 million.
As mission-based health providers, “we all do the same things,” said Lynne, a longtime health care executive who was also lieutenant governor under Democrat John Hickenlooper. “We don’t pay our employees market wages. We put duct tape around water pipes in our facilities.
“I’m getting to the point where I’m not going to do those things,” Lynne said. “We will cut services. And that’s going to be a challenge for the entire state, but our employees deserve to be treated like employees in other health care systems. We just don’t have the resources to do it.”
Boulder County’s clerk is among the few Colorado election officials with ranked choice voting experience. Here’s what she says about Proposition 131.
Boulder is among the handful of Colorado cities and towns that use ranked choice voting for their municipal elections.
In 2023, Boulder voters used the system, overwhelmingly approved by the electorate in 2020, to reelect Mayor Aaron Brocket. The election was run by the Boulder County Clerk and Recorder’s Office, which is led by Clerk Molly Fitzpatrick, a Democrat who is also president of the Colorado County Clerks Association.
If voters approve Proposition 131, the November ballot measure that would move Colorado to an all-candidate primary system followed by ranked choice general elections, clerks across the state would be tasked with implementing the changes. They’d likely look to guidance from Fitzpatrick, since she is one of the few election officials in the state with experience running a ranked choice voting election.
“We are one of the best-resourced counties in the state,” she told The Colorado Sun, highlighting how her office consulted with mathematicians and statisticians across the world to carry out the Boulder mayoral race in 2023. “I think it’s one thing for my county to do it. I think it’s a whole ‘nother thing to ask a tiny county to do it. There are just unanswered questions about how this would look and who is paying for it.”
The Colorado County Clerks Association has warned that local election officials across the state aren’t ready to implement Proposition 131 by 2026, which is when the measure, if passed, is supposed to go into effect.
That’s part of the reason the association, which is neutral on the ballot measure, supported an amendment to a broader elections bill debated by the legislature this year that requires 12 Colorado municipalities in counties of a certain size and with a specific demographic makeup to conduct ranked choice elections before a ranked choice election could be used in a race for state or federal office. Additionally, the amendment said Colorado could not move to the new primary system either until that requirement has been met.
Gov. Jared Polis, a supporter of Proposition 131, nearly vetoed the measure, Senate Bill 210 because of the clause, which was added in the final days of the General Assembly’s lawmaking term and first reported publicly by The Sun. He called on lawmakers and clerks to find a way to implement Proposition 131 by 2028 if the measure passes.
“If you ask me right now, at this moment, if I know that 64 counties can implement this, the answer is resoundingly ‘no,’” said Fitzpatrick, who hasn’t taken a formal position on Proposition 131. “And we need to take that seriously.”
The Sun interviewed Fitzpatrick about her experience running Boulder’s ranked choice mayoral election, what county clerks would need to feel comfortable implementing Proposition 131 and whether they think they can be prepared to run all-candidates primaries and ranked choice general elections statewide by 2028.
The following has been edited for clarity and length.
The Colorado Sun: How did you prepare for the 2023 mayoral election in Boulder?
Boulder County Clerk Molly Fitzpatrick: We knew in 2020 that we would be implementing ranked choice voting for the mayoral election in 2023, so we had lots of heads-up. In 2021, we got started on legislation at the Colorado Capitol. That legislation specifically talked about creating some rulemaking for how ranked choice voting could work. It also talked about timelines for getting voting equipment compatible with ranked choice voting. In 2022 is when we hired our project manager, who was dedicated to ranked choice voting and ranked choice voting only. In 2023 is when we did a lot of voter education, outreach work and then we conducted our election.
The Sun: How did the election go?
Fitzpatrick: It was a significant amount of work. It was not the easiest thing that we’ve done by any stretch of the imagination. I am very proud of what we did for the city of Boulder voters. I think our goal the whole time was “let’s run this election under the same standards that we have for any election we run.” And we were able to execute, I think, on that vision very well.
The Sun: Did you get the sense that voters understood the system? Were there many ballots filled out incorrectly?
Fitzpatrick: We had a lot of questions around how tabulation would work, and so we put up a website with different terms that voters would need to understand in order to know how tabulation worked. In terms of voters filling out ballots, anecdotally speaking, we didn’t have a lot of people who improperly marked their ballot. We did tons of education on that front. We did some events. We also included an insert with the mail ballots. And then we obviously put instructions on the ballot itself. We did receive some phone calls from folks about filling their ballot out, but, for the most part, the questions were around tabulation.
The Sun: What would Colorado clerks need to happen to feel comfortable running an election under Proposition 131 should the measure pass?
Fitzpatrick: I think it’s a question for the Secretary of State’s Office, because most of the systems and the requirements are, I would say, within their control. There are technologies that are not developed that need to be developed, including the risk-limiting audit software and including election night results reporting. It’s important for them to be developed on a timeline that gives counties a runway to practice before they deploy them in a live environment. This is a massive change to our election system, and so we want to make sure that the secretary’s office is creating training for local election officials on everything from ballot layout to candidate training to recounts. There’s just a million things that you have to consider when you’re running ranked choice voting. There’s also rulemaking. And then of course there’s voter education. The campaign in 2018 to inform unaffiliated voters in Colorado on how to vote in partisan primaries I think is a template of what could be used. But I think it would need to be like that campaign on steroids, because it’s such a bigger deal. It comes down to not only marking your ballot, but understanding tabulation, because voters in Colorado are very engaged.
Editor’s note: A risk-limiting audit is the statistical way Colorado elections officials double check the accuracy of election results.
The Sun: How long do you think it would take to get all of that done?
Fitzpatrick: It’s really not for us to say. I think it’s for the Secretary of State’s Office to say when they could meet the requirements.
The Sun: The governor wants the legislature to work with clerks to find a way to implement Proposition 131, should it pass, by 2028. Is that realistic? Are you all on the same page?
Fitzpatrick: I think if all of the systems are in place, we could implement this in 2028.
The Sun: If you had one final message to the citizens of Colorado on Proposition 131 from the clerks’ perspective, what would it be?
Fitzpatrick: We’re always going to work incredibly hard to ensure that the will of the voters is fulfilled. Practically, what that means to me, is that we will lead the legislation to implement this ballot measure. And we will ensure that counties are set up to be successful. Right now, 2026 seems completely unreasonable to have these systems developed by. But we’re going to fulfill the will of the voters.
Unpacking Heidi Ganahl’s election conspiracies
Heidi Ganahl, the 2022 Republican gubernatorial nominee in Colorado, has recently been spreading conspiracies about the election she lost by roughly 20 percentage points.
Her chief claim is that the voting systems in some Colorado counties have Wi-Fi access cards that allow for internet connectivity. That’s accurate, said Boulder County Clerk Molly Fitzpatrick, a Democrat who is also president of the Colorado County Clerks Association, but not the whole story.
“Old equipment did have a wireless card that was always known about as a vulnerability,” she said. “And so what happened is that that capability was removed during the trusted build process that the Secretary of State’s Office does with Dominion Voting Systems and counties.”
The trusted build process is effectively a software update.
Fitzpatrick said the Secretary of State’s Office also sends out instructions to the roughly 12 counties that still have that old equipment to verify that the Wi-Fi connectivity is disabled. Additionally, there is a state elections rule requiring that the counties verify that the capability is turned off before an election.
“There (are) basically three times that a county would verify” that the Wi-Fi access isn’t functional, she said.
Most Colorado counties use newer voting equipment that doesn’t have Wi-Fi capability. And the counties that have the old equipment had disabled the internet access capability well before the 2020 election, Fitzpatrick said.
“It’s unfortunate that it’s being taken out of context and manipulated,” she said. “But that’s where we’re at.”
Ganahl is encouraging people to become ballot “drop box observers” for the 2024 election.
“We’re not going to intimidate voters,” she said. “We’re not going to do anything (not) according to the law. We’re going to keep an eye on our drop boxes to make sure they are secure.”
Want to reach Colorado political influencers and support quality local journalism? The Sun can help get your message attention through a sponsorship of The Unaffiliated, the must-read politics and policy newsletter in Colorado. Contact Sylvia Harmon at underwriting@coloradosun.com for more information.
PROPOSITION 131
Former U.S. Rep. Ken Buck, a Windsor Republican, announced in a Washington Examiner opinion piece Thursday that he will be voting for Proposition 131, the November ballot measure that would move Colorado to an all-candidate primary system followed by ranked choice general elections.
Buck said he hoped open primaries would stop Democrats from trying to elevate fringe candidates in Republican primaries and that they would help mainstream conservatives win in Colorado moving forward.
“Instead of nominating party standard-bearers, our failed primary system elevates fringe candidates who further erode trust in our politics and who have no business representing the public,” he wrote. “If the GOP is going to return to being worthy of the moniker ‘the party of Lincoln and Reagan,’ we need to reform our electoral process to ensure that the next Republican president is greeted with a conservative majority committed to enacting a conservative agenda, not looking for extra TV airspace.”
Buck, who resigned from Congress in March, is now working as an adviser for Unite America, the election reform nonprofit linked to former DaVita CEO Kent Thiry that is supporting Proposition 131 and ballot measures like it across the country.
A spokesperson for Unite America said Buck became an adviser “recently,” though he has been talking with the group since he left Congress. The spokesperson didn’t answer questions about whether Buck is being paid.
AMENDMENT 80
Public Schools Strong, the issue committee opposing Amendment 80, the ballot measure that would place a right to school choice in the state constitution, is buying TV ad time, according to Federal Communications Commission records. You may have also seen some of their ads running on streaming services.
The committee had raised $750,000 through Sept. 25 and spent just $71,000. The committee’s major donors include the Colorado Fund for Children and Public Education, Stand for Children, the Colorado Education Association and Educators for Equity. The Colorado Fund for Children and Public Education, Stand for Children and Educators for Equity are all nonprofits that don’t disclose their donors. CEA is the state’s largest teachers union.
COLORADO SENATE
Arriana Belkin has been named chief of staff for the Colorado Senate Democrats. She takes over for Nellie Moran, who worked in the legislature for six years and is now pursuing new opportunities.
Belkin’s appointment was made by outgoing Senate President Steve Fenberg, D-Boulder. She had been serving as deputy chief of staff.
It will be up to Fenberg’s replacement to decide whether to keep Belkin as chief of staff. The next Senate president will be elected by the Democratic caucus in the days after the Nov. 5 election.
8TH CONGRESSIONAL DISTRICT
Republican state Rep. Gabe Evans is running a new TV ad in his bid to unseat Democratic U.S. Rep. Yadira Caraveo.
The 30-second spot features a reenactment of a police officer responding to a drug overdose. Evans implores viewers to back him and “stop Caraveo’s fentanyl crisis.”
Meanwhile, the Mainstream Colorado Fund, a federal super PAC that hasn’t had to reveal its donors yet, made another infusion into the race to benefit Caraveo. So far, the group has spent about $625,000 on the race.
COLORADO GOP
The El Paso County lawsuit challenging Colorado GOP Chairman Dave Williams’ leadership has been dismissed.
Eli Bremer and his allies, who were seeking to remove Williams, dropped the case after a judge ruled that they didn’t have enough support at an Aug. 24 meeting to remove and replace the chairman. Bremer, a former El Paso County GOP chairman and unsuccessful 2022 U.S. Senate candidate, claimed to be the rightful leader of the state party after the Aug. 24 gathering.
“As we’ve said previously, the state party will seek accountability against all of those who worked openly, or in the shadows, to sow chaos and orchestrate an unlawful coup against the majority will,” Williams wrote in an email this week to members of the Colorado GOP central committee. “And as we close the chapter on their failed coup, the rest of us need to unite and move forward together to defeat Democrats with less than a month left in this election.”
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Publish date : 2024-10-11 04:49:00
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