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Historic Days for Health in Colorado

Insurance coverage in Colorado has reached an all-time high. That is big news by any standard.

Findings from the 2015 Colorado Health Access Survey (CHAS) reveal that 4.9 million Coloradans – 93.3 percent – now have health insurance. Only 6.7 percent – about 353,000 people – still do not have health insurance.

Five years after the Affordable Care Act was signed into law and less than two years after most of its major provisions went into effect, the CHAS results show that Colorado’s health landscape is changing.

These new findings are particularly interesting because Colorado is truly a case study of a state that opted to fully implement health reform. Colorado lawmakers opted to expand eligibility for the state’s Medicaid program for low-income residents. Colorado decided to build a state-based insurance marketplace, Connect for Health Colorado. And an insurance co-op, Colorado HealthOP, has opened here and is enrolling customers at a good clip.

The 2015 CHAS gives us the ability to measure the impact of those decisions, and it’s among the first statewide surveys to do so. As a bellwether state when it comes to health reform, many will be looking to the CHAS data to gauge what’s working, and what needs more work.

The CHAS is funded by The Colorado Trust. The Colorado Health Institute managed the survey.

We’ve spent the past few weeks poring over the data and analyzing what it means. Here are our top 10 takeaways:

1.      Health Insurance: Setting Records in Colorado

The 6.7 percent of Coloradans without health insurance dropped by more than half from 14.3 percent in 2013, before the ACA. The percentage stood at 15.8 percent in 2011.

2.       Medicaid Expansion: Higher-Than-Expected Enrollment

Medicaid enrollment soared by 450,000 between 2013 and 2015. The data show that despite concerns that the influx would make it a lot harder for enrollees to get care, that didn’t happen.

3.      Types of Coverage: A Changing Landscape

More Coloradans are covered by employer-sponsored insurance (50.9 percent) than any other type, but it dropped slightly from 52.6 percent. Levels of individual insurance, which includes Connect for Health Colorado, stayed flat. One of three Coloradans (34.2 percent) is now covered by public insurance – Medicaid, Medicare or Child Health Plan Plus (CHP+) – up from 24.2 percent.

 4.      Who Got Covered: Kids, Lowest Earners

Colorado’s kids are big winners. Only 2.5 percent of children under 19 remain uninsured, down from 7.0 percent. The uninsured rate for those earning at or below three times the poverty rate fell to 8.3 percent from 20.5 percent.

5.      Who Still Isn’t Covered: Young Invincibles, Hispanics, West Slope Residents

The “young invincibles” between 19 and 29 were targeted for enrollment, but still have the second-highest uninsured rate at 12.9 percent. The uninsured rate for Hispanics fell to 11.8 percent from 21.8 percent, but they remain the least likely to have insurance. The four-county region around Steamboat Springs retains the No. 1 spot with an uninsured rate of 13.0 percent.

6.      Uninsurance is Down, But Underinsurance is Up

Colorado also saw an increase in “underinsurance” to 16.4 percent from 13.9 percent. This is when people have insurance that doesn’t adequately cover their medical expenses. Often, these are plans with low premiums but high deductibles or high co-pay requirements.

7.      Cost: Still the Number One Reason for Lack of Insurance

Among the 353,000 Coloradans who still don’t have health insurance, high cost is still the top reason. While that hasn’t changed since 2009, it is showing a downward trajectory. The percentage of uninsured Coloradans who say they don’t need coverage has leveled off after a surge in 2013, falling to 20.8 percent from 24.9 percent. About 45 percent of Colorado’s uninsured are only willing to pay up to $99 a month for insurance premiums.

8.      More Insurance Isn’t Making it Harder to Get Care

Coloradans aren’t finding it much harder to get health care, despite predictions that the big spike in coverage would strain the system. There’s been an increase in the percentage of people who can’t get an appointment when one is needed, to 18.7 percent from 15.0 percent, but that’s less than many anticipated. This may change as the newly insured develop new health care habits. One good sign: the percentage reporting a preventive care visit in the past year rose to 66.1 percent from 61.9 percent.

9.      Affordability: Health Care Still Costs Too Much for Many

The percentage who didn’t see a doctor because it cost too much declined only slightly, to 10.4 percent from 12.3 percent, a  statistic many had hoped would drop faster as part of ACA efforts to make health care more affordable. The percentage who didn’t fill a prescription because it cost too much dropped a bit to 9.8 percent from 11.2 percent.

10.  Coloradans: Happier About Health Care

Coloradans give the health care system higher marks than two years ago. Nearly three of four (74.6 percent) say that it meets the needs of their family, up from 69.1 percent in 2013. About half (51.2 percent) say that it meets the needs of most Coloradans, an increase from 44.1 percent.

CHI has prepared many resources to accompany the release of the 2015 CHAS. Go to our website, coloradohealthinstitute.org, to find data workbooks broken down by region and topic, graphics, power points, and a CHI analysis of what the data say about health reform in Colorado.