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In Colorado, More People Are Insured But Cost Remains An Issue

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Marilyn Kruse couldn't get health insurance through her job as a substitute teacher in Jefferson County, Colo. Now she buys insurance through the state's health exchange.

On Wednesday, the Census Bureau gave Obamacare some good news: the number of people without health insurance dropped to 10.4 percent in 2014, down from 13.3 percent in 2013.

Colorado may be doing even better. When the Affordable Care Act launched two years ago, about 1 in 7 of the state's residents, or 14 percent, were uninsured, according to the nonprofit, nonpartisan Colorado Health Institute. That figure is now 6.7 percent, according to the organization's latest data.

Marilyn Kruse, a substitute teacher in the Jefferson County school district west of Denver, is one of those who got insurance after the Affordable Care Act launched.

For seven years before that, she went without insurance because she couldn't get it through her job. She had been denied coverage because she had pre-existing medical conditions; coverage that she could buy was extremely expensive. All the while, she continued to have health problems: a hip that needed surgery, carpal tunnel, bunions and a slipped disk.

"I had the disk go out and I was confused and scared," Kruse said.

She was scared that she couldn't pay to treat or repair her back problems. So she mostly avoided going to the doctor. When she did, she paid thousands of dollars out of pocket.

Then health reform launched. Kruse qualified for tax credits through Colorado's health insurance exchange, so she could buy a plan that came to $55 a month. "That was a very exciting moment in my life," Kruse said.

The size of the drop in the number of uninsured people was a surprise, according to Amy Downs, senior director for policy and analysis at the Colorado Health Institute. "I don't think that anyone was expecting it to really go down this much," Downs said.

In 2013, nearly 750,000 Coloradans were uninsured. Obamacare cut those numbers in half, to a level that was once considered unreachable, says Downs. (The Census Bureau's data for Colorado show a less dramatic decrease. However, the Colorado Health Institute report was based on a survey performed in 2015, while the Census survey is from 2014.)

"We see a big growth in our Medicaid population that is much higher than we expected as well," Downs said.

Under the Affordable Care Act, the decision to expand Medicaid, the health plan for low-income Americans, was left up to the states. Colorado decided to expand. That's led the state to enroll about 450,000 people in the last two years. One in five Colorado residents is on Medicaid.

But the expansion in health coverage is tempered by rising concerns over cost and the number of people who are underinsured, which means out-of-pocket health costs are still too expensive.

The number of underinsured Medicaid enrollees in Colorado grew by more than 100,000 people since 2013, Downs said. "The increase in the underinsured really stood out for us."

An unaffordable out-of-pocket cost is defined in the Institute's survey as more than 10 percent or more of annual income. For those at 200 percent of the federal poverty level, any cost above 5 percent of income is considered unaffordable.

"People on Medicaid have really low incomes, so it doesn't take very much spending to get them into that underinsured category," said Downs.

Gwendolyn Funk, a 37-year-old who lives in Dove Creek in the southwest corner of Colorado, considers herself underinsured. "Well, I'm glad that I have insurance, it's just that I can barely afford my policy and my premiums, along with my children's," said Funk.

Funk's husband, a mechanical engineer, gets insurance through his employer. But it's too expensive for her and their two kids to get insurance through him. So they pay $500 a month to privately insure Funk and the children.

"We're going to have to choose between basically either eating or paying for health insurance," Funk said. "It's going to be really, really difficult."

Still, nearly 75 percent of Coloradans give the state's health care system a thumbs up, saying the current system meets the needs of their family.

This story is part of a reporting partnership that include Colorado Public Radio, NPR and Kaiser Health News.

Copyright 2015 Colorado Public Radio. To see more, visit

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