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Behind the Numbers

A yoga instructor gets a raise — and loses her health coverage


2023 CHAS: Affordability of Care

More than a million Coloradans couldn’t afford the health care they needed.

May 8, 2024

One in five respondents (19.8%) said they did not fill a prescription, get general doctor care, or get specialty care when they needed it due to cost. This represents over 1.1 million people.

Health insurance makes a huge difference. More than half of people without insurance (56.2%) said they skipped care because of cost. That’s three times the rate of people with Medicaid or job-based insurance. However, one in four people with individual market coverage (25.5%) said they could not afford care they needed (see Figure A2). Many individual market customers choose lower-priced coverage that comes with higher out-of-pocket costs.

Racial inequities. As with many economic issues, people of color are more often and more severely affected by health care affordability problems. More than a third (35.0%) of American Indian or Alaska Native Coloradans said they skipped care because of the cost in 2023. Nearly a quarter of Black (22.5%) or Hispanic Coloradans (23.2%) said the same thing (see Figure A3). That’s more than 5 percentage points higher than white or Asian Coloradans. This means many people of color in Colorado are not getting the care they need and may be living with conditions that go unchecked, leading to worse health outcomes in the long run.

Cost details. The CHAS offers insights into the types of costs that kept people from getting health care. Of those who skipped care, two-thirds (66.8%) cited the cost of the visit. Around half blamed out-of-pocket costs, including the copay, deductible, or co-insurance. More than half said they didn’t get care because they weren’t sure how much they would have to pay. Finally, 56.1% said inflation has made it difficult to afford health care (see Figure A4). 

Surprise results. More than a quarter of Coloradans (26.4%) said they received a medical bill in the past year that they thought insurance would cover (see Figure A5). This happened despite new laws that ban surprise billing. Surprise bills often happen when a provider outside an insurer’s network gives care at a facility the patient thinks is in-network. The federal No Surprises Act took effect in 2022, along with a state law that mirrors the federal act. Despite the laws, the percentage of Coloradans surprised by a medical bill increased. It was 19.6% in 2021, nearly 7 percentage points lower than the 2023 rate. This result points to the complexity of medical billing and the difficulty of regulating it.

A stubborn problem. The CHAS has asked about forgone care because of cost in every survey since its inception. The numbers have hardly budged, always hovering around 20% of respondents who say they skipped care because they couldn’t afford it (see Figure A1). The numbers held steady even after a decade of policy work to lower the cost of care, including the launch of the Affordable Care Act in 2014.