As the federal shutdown continues, health centers in Northern Colorado and their patients are concerned about how Medicaid cuts would impact their families and communities.
Every weekday on the outskirts of Greeley, as many as 400 patients visit the Monfort Family Clinic at Sunrise Community Health in Evans.
“They are hard working families,” explained Sunrise CEO Mitzi Moran. “They are often your construction workers, your service folks at restaurants, truck drivers. It is the people that are making this economy work.”
The nation’s community health clinics are caught in the middle of a Congress divided over healthcare, leading to a government shutdown.
“It’s high school and grade school,” said patient Julie Shelanie, who was visiting with a physician’s assistant. “I don’t like you, so I’m going to fight with you. And can we grow up?” she wondered. “My granddaughter has Medicaid. Both my daughters have Medicaid. And if they cut Medicaid from my whole family, it’s really going to be hurting.”
At the moment, Sunrise still has federal money for reimbursements coming in until the health center’s grant cycle comes up again next year. But community health centers are required to provide services regardless of a person’s ability to pay. If the shutdown is still on, there would presumably be no money, and changes would have to be made in service.
Moran says she needs to plan ahead to budget. The shutdown has meant no new eligibility for the National Health Service Corps. The program provides money for clinicians to repay loans and is a big benefit that helps keep clinics like Sunrise staffed.
“There’s not enough clinicians to go around anyway. And now, one of our tools has been put on hold. And we don’t know how long because of the shutdown,” she explained.
Moran said their patients, about 40,000 plus people who get care at the clinic, are often people with little or no health care coverage.
“The vast majority of them live at an income level that indicates they would struggle with access to affordable healthcare; two hundred percent of the federal poverty line or less,” said Moran.
For years, there has been bipartisan support for funding. But there has been a shift, and changes in Medicaid could open a large gap.
“Community health centers get funding to take care of the uninsured, but that has stayed flat for ten plus years,” Moran said. “So as people come off of Medicaid and they are uninsured, they are still our patients, but we have no funding for them. Fifty percent of our patients have Medicaid as their insurance. And if we were to not receive payment for those services, that is devastating.”
Medicaid and support for the Affordable Care Act both finance a great deal of the healthcare provided at Sunrise.
“I’m not sure our leadership at the national level understands how precarious this really strong part of our healthcare system, how shaky things are right now,” she said.
The number of people who meet criteria for Medicaid coverage has declined since the COVID pandemic, when people were allowed to stay enrolled in Medicaid no matter their eligibility. Moran said as a result, two-thirds of the clinics in Colorado operated at a negative margin last year. When the unwind ended, Moran says many patients lost their coverage.
In one exam room, a couple from Guatemala visited to check on the pregnancy of the mother. During pregnancy and birth, Martina and the baby are eligible for Medicaid. The baby will remain eligible after birth, but the mother will not.
“They don’t have documentation, but they are paying taxes, and they are not stealing, and they are working,” explained Martina through an interpreter.
“They are very scared of losing it,” said the interpreter.
Hospital emergency rooms that participate in Medicare are required by a federal law passed during the Reagan Administration to provide some care. Congress enacted the Emergency Medical Treatment & Labor Act in 1986, which mandates that hospitals provide a screening examination, including active labor no matter of a person’s ability to pay. The hospitals are also required to provide stabilizing treatment to people with emergencies.
Emergency rooms could be where people end up if their health care coverage is cut. Moran worries about what Congress is considering. If there are massive cuts to the Affordable Care Act and Medicaid, she fears that a quarter of Sunrise’s patients could lose care.
“They won’t have insurance, they won’t have coverage for any of their health care, either at our clinics or if they need to go to the hospital for additional care. It is catastrophic for them, and it is really difficult for us to have a fourth of our patients no longer have a payer source,” she said.
It won’t just cost more in medical care, she explained. Moran said patients will end up in the hospital and be unable to care for their families, which will cause them to struggle further to cover housing and food.
“It is just so shortsighted to take affordable access to care away from people,” she said.
