There are millions of people across America with a health condition they would like to get checked out. Yet because they lack health insurance they don’t go to the doctor. More often than not, these health issues only worsen and by the time they do seek medical attention, a health problem that might have been treated with a simple doctor’s visit becomes an expensive emergency room visit or even extended hospital stay.
The lack of health insurance is a challenge that crosses all ethnic lines, but according to a report by the Center for Migration Studies nearly one in five of those uninsured is Hispanic American. The number represents almost three times that of White Americans.
Uninsured Latinos make up nearly half of the uninsured population with as many as one third of the country’s estimated 65 million Latinos having no health coverage.
The result is that hospitals, especially city operated ones like Denver Health & Hospitals, must absorb the costs of treating the uninsured.
Just because a person is employed, though, does not automatically confer health care coverage. Latino immigrants, said the study, often work disproportionally in jobs that regularly do not include insurance benefits. These jobs are in construction, landscaping, food service, personal care and truck driving, jobs oftentimes in more dangerous environments.
Additionally, employers with fewer than 50 employees are not required to provide health insurance. It is estimated that close to half of all jobs fall into these categories.
To suggest that the nation’s healthcare system is complicated, vastly understates the reality. As an example, Denver Health and Hospitals CEO Donna Lynn said not everyone without health insurance pays nothing for their health care. But what they pay usually does not come close to the actual costs of their treatments. “A little over eight percent actually pays some small percentage of the bill,” said Lynn. There are, she said, five sources for payment of treatments including Medicaid, Medicare and commercial insurance. Still, despite the reimbursement, there remains a shortfall of the total costs and hospitals like DH&H show a deepening shade of red on its books.
While its name may seem to imply a clear-cut relationship with the city, Denver Health serves a clientele that reaches well beyond the city’s borders. Patients from all across the metro area are seen on a daily basis and patients from all across the state are also not unusual. No one is turned away.
“A little less than a third of our population,” said Lynn, is coming from Denver. “If you’re coming to the emergency room, by law we have to take them…we can’t say you can’t come here” from any metro suburb or anywhere else. DH&H also operates ten satellite clinics across the city and has “19 school-based clinics.” All told, DH&H doctors see more than 280,000 patients annually.
Though costs for a medical issue are lower if seen sooner rather than later, Lynn said it may be a matter of human nature that keeps patients from simply coming in when they should. “Patients who are uninsured are more likely to wait.” When that happens, “They end up in the emergency room.” The uninsured also often delay visits for their children.
One cost that has not bruised the books of Denver Health is the cost for delivering babies. “Last year,” Lynn said, “we delivered 3,800 babies” with very few of the deliveries not covered by insurance. “The state has emergency Medicaid.”
Another thing many might think is driving up Denver Health costs is the influx of immigrants that have landed in Denver over the past 18 months or so. “It has some impact,” Lynn said. But costs would be even higher if the new arrivals did not get treatments, including immunizations. “We want to make sure everyone is immunized.” Just one outbreak of measles could impact an entire community. “Migrants,” she said, are only a small percentage of Denver Health costs.
Still, said the Center for Migration Studies, the nearly 20 percent of Latinos with inadequate health insurance or none at all, is an improvement. The study says that in 2010 the rate was a staggering 33 percent without coverage. The improvement, said CMS, “rates began to improve in 2014 when implementation of the Affordable Care Act— Obamacare—provided new options” for lower or moderate-income earners. Medicaid expansion also aided in the lowest income brackets to get coverage.
The ACA Medicaid expansion opened things up to those with incomes up to 138 percent of the poverty level or slightly above $20,000. There still remain ten states, including Florida, Georgia and Texas that have not opted in. Each has a growing number Latino population, including new immigrants.
Not unlike the costs of everything from gasoline to groceries, hospital costs rise as well. And the red ink gets redder, too. In 2023, Lynn said, the DH&H deficit was $140 million, an increase of $80 million since 2020. “It has really been increasing at a pretty steady rate.”
While the federal, state and city governments make significant contributions to the costs of Denver Health, it is never enough, said Lynn. “This year we’re going to get a two percent increase in Medicaid,” she said. “That’s not enough for our costs, payroll and the cost of drugs.”
The costs of the underinsured or totally uninsured, realistically, are not going away. But Lynn said there are affordable insurance plans that are available. Connect for Care Colorado,” she said, is one option. You can get it “if you work for a small employer…you can go as a small group.” Denver Health also has its own health plan that can be purchased by small employers. “We try and get as many people involved.”
