The impact of the "big, beautiful bill"

Happy midday, Colorado, and welcome back to another edition of The Temperature.

A guy has sued the Colorado Rockies after being injured by a foul ball at the game, arguing that the team's abysmal level of play — 40 losses and only 8 wins on the season as of this morning — means fans are less engaged in actually watching the game. I think this about nails it: How dangerous of the Rockies to stage a baseball game in the middle of one of Denver's favorite nightlife venues!

You know what was an event where all the attendees were super-engaged? This year's Colorado SunFest. Thanks to everyone who made it out last week. I had a blast meeting all of you. And, for those of you who were unable to attend, we'll be turning out some podcasts based on recordings of the panels soon.

Like a curveball at altitude, let's fly straight into the news.

John Ingold

Reporter

TEMP CHECK

CONGRESS

What's in the big Medicaid bill — and how would it affect Colorado?

"A lot of it is still changing."

— One source speaking about the Medicaid bill

U.S. representatives may (or may not) cast the final votes this week on the House's version of President Donald Trump's "big, beautiful bill," which would, among other things, usher in major changes to Medicaid across the country.

Here at Temp HQ, we have been calling around trying to understand how the bill would impact Colorado — and getting a lot of hesitant responses from folks who note the bill is still being negotiated and could evolve as it finishes in the House and moves through the Senate.

"A lot of it is still changing and/or a bit nebulous," one source told us.

But we can at least sketch the outline of proposed changes and how they would hit Colorado. (The nonpartisan health care think tank KFF has this helpful tracker of all the health-related provisions currently in the bill.)

Here we go:

The bill would impose work requirements on childless, able-bodied adults.

People ages 19 to 64 who are applying for coverage under the Medicaid expansion — the part of Medicaid that covers people based on their income, up to 138% of the federal poverty level — would have to show proof of work or participation in other activities like going to school. Parents and other caretakers of dependent children would be exempt.

Medicaid expansion in Colorado covers about 370,000 adults. The Urban Institute has estimated that such work requirements would result in roughly 120,000 people in Colorado losing Medicaid coverage — because they either failed to meet the requirement or because of administration friction in trying to prove they do.

The bill would require states to redetermine eligibility more frequently.

Currently, the state checks every year to see if Medicaid enrollees are still eligible for coverage. The bill would step that up to every six months.

One risk here is that, with more frequent checks, more people who should be eligible for Medicaid could lose coverage due to paperwork glitches. For background: During the COVID pandemic, federal rules prevented states from disenrolling people from Medicaid. When that stopped, Colorado saw one of the biggest declines in Medicaid enrollment, with critics saying that a clunky process resulted in eligible people getting kicked off coverage.

Using Congressional Budget Office estimates, KFF has projected that the bill overall would cause 140,000 more people in Colorado to be uninsured. This could have a massive impact on Colorado's safety net hospitals and medical clinics, which already have been struggling with higher rates of uninsured patients.

The bill would freeze new provider fees.

Almost every state, including Colorado, takes advantage of a system whereby they charge taxes — we call them fees in Colorado, due to TABOR — on hospitals and then use that money to leverage higher amounts of federal Medicaid funding.

In Colorado, it works like this: Hospitals pay a fee based on inpatient days and outpatient charges. That pool of money attracts a chunk of matching federal dollars. The state then redistributes the combined amount back to hospitals, giving the hospital industry as a whole a net win and helping to compensate for the fact that Medicaid shorts hospitals on payment for the services its members receive. (In Colorado, Medicaid pays about 80 cents on the dollar for what it costs to provide a service.)

In 2023, hospitals paid about $1.3 billion in fees, and the state ended up distributing about $1.8 billion in what are called "supplemental payments" back to hospitals — so a roughly $500 million gain for hospitals. The payments especially benefit hospitals that treat a lot of Medicaid patients. (Other money from this system goes to pay for Medicaid expansion coverage.)

Early in the process of drafting the federal bill, there had been rumblings that Republicans could go after this system, and the Colorado Hospital Association warned that even scaling it back could cut $11 billion in federal Medicaid funding to the state over a five-year period.

What ended up in the bill — at least so far — is more modest: A freeze on new provider taxes or on increasing the rates of existing taxes. There are also more technical details, so it's somewhat unclear how this might impact Colorado. But Cara Welch, a spokesperson for the hospital association, wrote in an email that, "We believe the cuts in that specific area should not be as detrimental as we originally projected."

The bill would punish states with programs that provide health coverage for immigrants.

Colorado has two state-funded programs to provide health coverage for immigrants regardless of their legal status — one extends Medicaid coverage to children and people who are pregnant, the other offers subsidies to a limited number of people to help them buy private insurance.

Both of those programs would seem to run afoul of a provision in the bill that would punish states for providing coverage to immigrants who are undocumented.

The bill would reduce federal payments to cover the Medicaid expansion population. Currently, the feds pick up 90% of the bill, but states that violate this provision would see that rate drop to 80%. This could hit Colorado to the tune of hundreds of millions of dollars a year if the legislature did not repeal the coverage programs.

The bill would ban Medicaid payments for certain procedures and providers.

The bill would prohibit states from using federal dollars to cover gender-affirming care for people under 18. It would also ban payments to providers such as Planned Parenthood that perform abortions. Colorado has taken steps to improve coverage for gender-affirming care and to protect abortion access, but it is unclear to what extent these provisions would affect the state programs.

Section by John Ingold | Reporter

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BREAK-UPS

Kaiser and Intermountain are never, ever, ever getting back together (it seems)

"We are sorry to see our Kaiser doctors and their patients leave us."

— Saint Joseph Hospital president Scott Peek

Health insurer and medical provider Kaiser Permanente has moved its stuff out of two Intermountain Health hospitals, marking the latest step in a surprisingly public uncoupling.

In a letter sent to patients this week, Intermountain Health said Kaiser has started pulling its doctors from Saint Joseph Hospital in Denver and Good Samaritan Hospital in Lafayette and relocating them to other facilities. Those two hospitals had been mainstays of the Kaiser system. But this breakup has been a long time coming, after Kaiser last year announced that it had struck new partnerships with hospitals in the CommonSpirit and HealthONE systems.

"The bottom line is that we are sorry to see our Kaiser doctors and their patients leave us," Scott Peek, the president of Saint Joe's and Intermountain's Front Range Market, wrote in the letter.

The two hospitals are technically still in-network for Kaiser through the end of 2026, and Peek said the hospitals can still provide in-network emergency care to Kaiser members.

In a statement, Kaiser Permanente said it is about halfway through its transition to the newly added CommonSpirit and HealthONE hospitals, allowing Kaiser members to see Kaiser doctors when visiting some of those facilities. These hospitals include Rose and Presbyterian St. Luke's medical centers in Denver and Saint Anthony Hospital and Saint Anthony North Hospital, in Lakewood and Westminster, respectively.

Foothills Hospital in Boulder and Longmont United Hospital have also become in-network options, but, unlike the others, Kaiser doctors will not be stationed there.

"Through these hospital arrangements, Kaiser Permanente members have increased access to more of the Denver Metro's leading hospitals," the statement read. "These expansions are strategic business decisions that will help keep our high-quality care affordable."

Section by John Ingold | Reporter

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DYING

Across Colorado, not everyone receives the same level of end-of-life care

"Our research highlights racial and geographic disparities in end-of-life care across Colorado."

— Darcy Holladay Ford, director of research for the Center for Improving Value in Health Care

A mountain of evidence has shown that people of color, people who are poorer and people who live in rural areas don't have the same access to health care or receive the same level of care as those who are white, who live in cities or who are richer.

A new study shows that those health care disparities extend all the way to death.

Researchers at the Center for Improving Value in Health Care looked at Colorado health coverage claims data to examine end-of-life care across the state. The center, known as CIVHC, manages the state's all-payer claims database, a repository of anonymized information about who is receiving what treatment where and at what cost.

The study is the first in CIVHC's history to be peer-reviewed, published in the American Journal of Hospice and Palliative Medicine. The researchers looked at rates of hospice care and advance care planning — gentler forms of care that people generally say they prefer for the end of their lives — versus more intensive care like emergency and ICU visits.

They found that people who are Hispanic, Black or Asian are most likely to experience intensive care at the end of life, and that rural residents were more likely to have emergency visits and less likely to engage in advance care planning.

"Our research highlights racial and geographic disparities in end-of-life care across Colorado," Darcy Holladay Ford, CIVHC's director of research and the lead author of the study, said in a statement. "These racial and geography care variations point to a pressing need for policies and interventions that ensure everyone receives care aligned with their values and needs."

You can read more about the study on CIVHC's website or you can dive into the full study here.

Section by John Ingold | Reporter

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MORE HEALTH AND ENVIRONMENT NEWS

CHART OF THE WEEK

The proposed Medicaid changes we wrote about above will be a bigger deal in some representatives' districts than others. This map shows the estimated percentage of people covered by Medicaid per Congressional district.

The giant dark chunk in the western and southern parts of the state is the 3rd Congressional District, represented by Rep. Jeff Hurd, a Republican. An estimated 31% of people in the district are covered by Medicaid — which explains why Hurd has been outspoken among Republicans in urging protection for Medicaid.

The lowest percentages of coverage are in the 2nd Congressional District, represented by Democratic Rep. Joe Neguse, and the 4th Congressional District, represented by Republican Rep. Lauren Boebert. (While the 4th is sometimes thought of as a rural district covering the Eastern Plains, it also grabs a lot of affluent areas in Douglas County.) Both districts have about 16% of the population covered by Medicaid.

If you click the map image above, it will take you to an interactive version of this chart where you can also learn about the amounts medical providers in the district collect from Medicaid and how much hospitals collect in those provider fee-funded supplemental payments we talked about earlier.

Section by John Ingold | Reporter

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Just like a Rockies batter in the bottom of the ninth with the game on the line, we're outta here.

Thanks for hanging with us this week and for supporting local journalism. And thanks, just in general, for being you. Colorado's better with you.

Catch ya next week.

— John & Michael

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