Colorado's health insurance programs for immigrants

Happy exhausted Wednesday, Colorado, especially to those of you trying to keep up with rapidly changing federal funding policy.

Yesterday's explosion of chaos in Colorado around the Trump administration's order freezing a bunch of federal grants and other funding was a good reminder for these next four years: As much as people may want to say it's a marathon, not a sprint, there will still be times when we will all be running really hard.

But it's also a reminder that, after the pace slows down, we still have to keep running.

(Literally just minutes ago, The New York Times reported that the order has been rescinded.)

Take a look at this 52-page supplemental memo the White House sent out with instructions for complying with the order, as obtained by Politico. Scroll past the first page to the spreadsheet of programs affected by the order. (That is 2.25-point font; we checked. And Helvetica, at that.)

Every single one of those programs has a person or a nonprofit or an industry that is (or perhaps would have been) affected by it. And, whatever you think about the order — whether you are for it or against it or blah on it or confused about it or undecided yet what you think — we can all agree that it is consequential. And that means, if the order returns or takes another form, it's worth paying attention to what those consequences are, whatever they are.

We here at The Sun are long-attention-span people, so we are committed to doing just that. Thanks for your support to help us — and if you have insight into particular impacts, always feel free to email us at [email protected].

OK! It's news time.

John Ingold

Reporter

TEMP CHECK

IMMIGRATION

Colorado has expanded health insurance programs for immigrants. What happens now?

More than 24,000

The number of people who have signed up for health coverage through two Colorado programs for immigrants

During the administration of former President Joe Biden, Colorado took bold steps to expand health coverage to immigrants in the state, regardless of their legal status.

Tens of thousands of people took advantage of those programs to gain coverage for themselves or their children. The hope of supporters is that this will lower the uninsured rate in Colorado since immigration status can be a major barrier to obtaining health coverage. Providing access to coverage for primary and preventive care could also reduce the amount the state spends paying for emergency care for uninsured noncitizens who have a health crisis.

Now, as the administration of President Donald Trump vows an aggressive crackdown on people living in the country without documentation, the long-term fate of those programs is unclear — the programs rely at least to some extent on federal funding.

But, perhaps more urgently, Colorado has collected a lot of names and contact information for people the Trump administration may be looking for. So what's the potential that the state could be forced to hand those over?

It's a little unclear, though it's also not certain how useful the information would be to federal immigration agents.

First, the basics: Colorado law generally prohibits state agencies from asking about immigration status or from sharing identifying information for the purposes of immigration enforcement.

"Federal law doesn't require that state agencies or private companies share information with immigration officials," César Cuauhtémoc García Hernández, a law professor at Ohio State University (previously at the University of Denver), who specializes in immigration enforcement law, wrote in an email.

"A federal law bars Colorado from refusing to share information about a person's citizenship or immigration status with (Immigration and Customs Enforcement), but that law only applies to information that the state already possesses and Colorado law has barred state officials from asking for this information since 2022."

The coverage expansions largely come through two programs.

One is called OmniSalud, and it gives people who are not eligible for federal subsidies state help to purchase private health insurance plans. The program works in conjunction with the state's insurance exchange, Connect for Health Colorado, but it doesn't use the exchange's platform.

Instead, Colorado created an entirely new exchange called Colorado Connect to handle the sign-ups. This means that the data is stored separately and is not shared with the federal government. Colorado Connect does not ask about immigration status, said Kevin Patterson, the CEO of Connect for Health Colorado.

For 2025, more than 13,000 people signed up for coverage through Colorado Connect, including 12,000 who signed up to receive subsidized coverage through OmniSalud. (Because of funding limitations, OmniSalud enrollment is capped, but people can still buy unsubsidized coverage.)

The second program is called Cover All Coloradans, and it rolled out only at the start of the year. The program allows children and pregnant people to receive Medicaid coverage regardless of their immigration status.

That program has now enrolled more than 11,000 people.

The Colorado Department of Health Care Policy and Financing shares some information about these enrollees with the federal Center for Medicare and Medicaid Services, which is also known as CMS.

"Historically, CMS has used the information only for the purpose of determining eligibility," Marc Williams, a state Medicaid spokesman, wrote in an email.

Patterson and Williams said the state is committed to safeguarding enrollees' information. But where this gets murky is what would happen if the federal government obtained a court order directing Colorado to hand the information over.

Williams wrote that the state "will continue to comply with all subpoenas, warrants and court orders as required by the law."

Patterson said, if a court order or subpoena arrived, "There's a legal process we would have to go through."

García Hernández said, while it's possible that immigration authorities could obtain a court subpoena or search warrant for the information, it would be unusual.

"ICE rarely does that," he wrote.

Watch ColoradoSun.com in the coming days for a full story on this issue. If you would like to follow more of García Hernández's legal analysis on the Trump administration's immigration actions, you can sign up for his newsletter.

Section by John Ingold | Reporter

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ARTIFICIAL INTELLIGENCE

At Denver Health, your doctor will see you now (and not their screen)

"I think it is the most transformational technology I have seen in my medical practice, ever."

— Denver Health Dr. Daniel Kortsch

Dr. Daniel Kortsch is a pretty popular guy these days in the hallways of Denver Health, the hospital where he works in primary care.

Colleagues come up to him for spontaneous hugs. He's received at least one box of chocolates.

The reason for this affection has to do with Kortsch's other job at the hospital — as chief medical information officer, sort of a guru at the intersection of technology and patient care. Over the past few months, Denver Health has been testing and now widely rolling out an artificial intelligence program that helps doctors transcribe conversations with patients and then convert them into notes that can be entered into the hospital's electronic medical records system.

Sound simple enough? Well, for doctors overburdened with tedious documentation work long after their day at the clinic is over, it is life-changing.

"It's transformational," Kortsch said. "I think it is the most transformational technology I have seen in my medical practice, ever."

The program comes from a company called Nabla, which now counts 50,000 doctors and other medical practitioners across the globe — but mostly in the United States — as adopters. The Nabla program supports 35 languages, and it integrates directly with a hospital's medical record system.

Doctors simply talk with their patients naturally while the program works in the background. At the end, the program produces a summary of the visit for the doctor to review. If the doctor gives the OK, those notes get entered into the hospital's records system.

What used to take dozens of minutes per patient now takes a few seconds. The result, Kortsch said, is less time working in the clinic after-hours to catch up on documentation and less "pajama time," the term doctors use to describe the hours at home at night spent on digital paperwork.

The hospital is reporting lower burnout among doctors, higher satisfaction among patients. And more eye contact between doctors and patients, as physicians turn their eyes away from the computers where they had previously typed furiously during visits and turn them toward the people they are actually treating.

"The only difference you'll notice," Kortsch said, "is that your doctor looks at you more."

Watch ColoradoSun.com in the coming days for a full story on Denver Health's use of AI.

Section by John Ingold | Reporter

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DISEASES

No major uptick in Colorado tuberculosis cases, despite the Kansas outbreak next door

78

The preliminary number of tuberculosis cases reported in Colorado in 2024

To our east in Kansas, public health officials are dealing with a tuberculosis outbreak that is among the nation's largest since at least the 1950s. (You may have read that it is the largest in U.S. history, but that is erroneous.)

But here in Colorado, we have seen no such explosion of cases of the bacterial disease, even though the number of cases reported in Colorado last year exceeded the number of cases reported so far in the Kansas outbreak.

Confused? It's likely a terminology issue.

To a layperson like, say, a health care journalist, the term "outbreak" is often used to mean a new emergence of a lot of infections. But to an epidemiologist, the term outbreak is more specific — it implies linked chains of transmission that bind those infections together.

So, when Kansas reports 67 people being treated for active cases of tuberculosis as part of the outbreak, the implication is that those cases are all connected to some common origin of infection and being spread locally.

In preliminary numbers, Colorado last year reported 78 cases of tuberculosis, down from 89 cases in 2023 but above the average of 70 cases per year the state reported pre-COVID pandemic.

Tuberculosis circulates more widely in some countries outside the United States, and it is not all that uncommon for states to report cases in people who traveled to or immigrated from those areas. Sustained person-to-person transmission of the disease within the United States is much more rare.

"In general, our cases each year tend to be sporadic or associated with limited local person-to-person transmission," Kristina Iodice, a communications director with the Colorado Department of Public Health and Environment, wrote in an email. "We are not seeing increases similar to those in Kansas."

Section by John Ingold | Reporter

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AFFORDABLE CARE ACT

Mountain communities nervously eye the subsidy cliff

A couple weeks ago, we told you about the hardship that might follow if enhanced federal subsidies that help people buy health insurance expire at the end of the year as scheduled.

After reading the item, Ian Billick, the mayor of Crested Butte, wrote in to tell us just how hard that hardship could hit in Colorado's mountain communities, where unsubsidized insurance is ridiculously expensive.

Billick and his family receive a monthly credit of around $1,500, thanks to the enhanced subsidies. If those subsidies were to go away, Billick would have to pay full freight for his health insurance plan for his family of four.

The price? It's $2,500 a month — or $30,000 a year for a plan with a $9,000 deductible.

Play around long enough with this KFF calculator by plugging in mountain ZIP codes and you can come up with some truly astonishing figures — like a single 60-year-old from Glenwood Springs making $65,000 a year who could be looking at almost $1,000 more per month for insurance if the enhanced subsidies go away.

As Billick notes, that could wreak havoc not just on individuals and families, but also employers in the community, too.

For more on this, click over to today's story on ColoradoSun.com.

Section by John Ingold | Reporter

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MORE ENVIRONMENT AND HEALTH NEWS

— CBS News Colorado/Estes Valley Voice

— Denver Business Journal

— The Colorado Sun

— The Colorado Sun

— The Colorado Sun

— Glenwood Springs Post Independent

— The Colorado Sun

CHART OF THE WEEK

The administration of President Donald Trump over the past couple of weeks threw the scientific community into chaos when it imposed a freeze on grant reviews and communication at the National Institutes of Health and then again when it imposed a freeze this week on a wide variety of federal grants and assistance. (On the former, the administration has since said the NIH can continue working on ongoing and mission-critical research.)

The NIH is a powerhouse biotech funder in the United States, issuing more than $37 billion in grants to more than 2,800 entities in the 2024 federal fiscal year, which ended in September. Of the 47 grant recipients in Colorado, the University of Colorado Anschutz Medical Campus — officially part of CU-Denver — receives by far the most.

The campus took in nearly $350 million in NIH grants last fiscal year, about 60% of the total NIH funding that came to Colorado. CU-Anschutz ranked 27th nationally for NIH funding — though far behind the roughly $860 million that first place Johns Hopkins University received.

Other major recipients of NIH funding in Colorado included CU-Boulder, Colorado State University, National Jewish Health, the University of Denver and two private companies: Denver-based software company Palantir Technologies and Boulder-based biopharmaceutical company Crestone Inc.

After news broke of last week's freeze, we reached out to CU-Anschutz to see if its research teams' NIH funding had been affected. The Trump administration also imposed a freeze on ARPA-H, a separate research funding agency within the U.S. Department of Health and Human Services.

"We are closely monitoring all of these changes, but so far we have not received any information to indicate a change in the ARPA-H funding or other federal funding coming to us," David Kelly, the campus's senior director of media relations, wrote in an email.

Section by John Ingold | Reporter

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— John & Parker

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