By William Burman, MD, Denver Public Health

The expansion of health insurance through the Affordable Care Act (ACA) is a historic opportunity to increase coverage in our community. Although the problems of the ACA roll-out have been widely publicized, there are success stories – even early in the process – and here is one from Denver County.

Approximately 100,000 Denver residents (one in five) lacked health insurance in 2013. Lack of health insurance:

  • Makes it more difficult to obtain medical, behavioral health and oral health care
  • Is associated with an increased risk of adverse health outcomes, including premature death.
  • Contributes to high medical bills, which are the leading cause of bankruptcy for individuals and families.

In addition to its individual risks, lack of health insurance is a threat to the community and business sector. Persons without health insurance receive medical care in our community, but it is often late in the disease course and in the most expensive settings (emergency departments and hospitals). Costs of providing care to uninsured patients are shifted to those with health insurance ("the hidden tax") and to employers, who pay much of the cost of health insurance.

To identify populations that would greatly benefit from ACA enrollment, Denver Public Health worked with the Colorado Health Institute to characterize Denver's uninsured population. While lack of health insurance is common throughout our community, it is particularly high among young adults and Hispanics. Importantly, we estimated that 75,000 of Denver's 100,000 uninsured residents are eligible for federally-supported health insurance (41,000 through the Medicaid expansion and 34,000 through federal support to purchase insurance on Colorado's online marketplace, Connect for Health Colorado).

To encourage target populations to enroll, the Denver Access to Care Task Force, a coalition of safety-net medical and social service providers, worked throughout 2013 to characterize safety-net care providers in Denver and provide education, training and information about the ACA's health insurance expansion. We worked with city departments (like the libraries and recreation centers), Denver Public Schools, The Piton Foundation's income tax assistance program, community-based organizations, business groups and others to provide information about health insurance expansion.

I'm proud and encouraged by the enrollment data we recently received for Denver:

  • Between October 1 and December 31, 2013, 22,564 Denver residents enrolled in the new forms of coverage that started on January 1, 2014. 16,076 enrolled in the newly expanded Medicaid and 6,488 purchased health insurance through Connect for Health Colorado.
  • These 22,564 newly-insured persons represent 30% of those who are eligible for federally-supported coverage (39% of those eligible for expanded Medicaid have already enrolled and 19% of those eligible for federal support to buy health insurance have already purchased insurance as of January 1, 2014).

Denver County leads all Colorado counties in enrollments into both Medicaid and new insurance plans through Connect for Health Colorado. Our Task Force had set a goal of 40,000 new enrollments by July 1, 2014, so we are now more than half-way there.

The expansion of health insurance promises to improve the health of individuals, transform the health care system and decrease the costs of employer-sponsored health insurance. There is much work still to be done to achieve these outcomes, but we are off to a great start in Denver.

William Burman, MD
Denver Public Health