Medicaid, individual market health insurance would be harder to get in Colorado under GOP bill

Miami Herald

5 hours ago

Veronica Montoya relies on Medicaid for the $15,000 infusions that restrain her immune system from attacking her body, and worries she may lose that access if Congress adopts drastic changes to the health care program.
Provisions of congressional Republicans' "One Big Beautiful Bill Act" would add work requirements for some people covered by Medicaid and require them to go through the full process of proving eligibility twice a year instead of once.
The bill, backed by President Donald Trump, also would restrict immigrants' access to health insurance and raise costs for people who buy their health coverage on the exchange, while extending tax cuts for higher earners and spending more on national defense.
Taken together, the provisions would create hurdles for people who don't have job-based coverage to find and keep health insurance through Medicaid or the marketplace, even if they are employed or have a disability. While the bill wouldn't entirely return the U.S. health insurance market to its pre-Affordable Care Act state, it would take away options that helped bring down the uninsured rate, experts said.
The House passed the legislation in late May by a single vote. The bill's chances in the Senate aren't clear; both fiscal hawks and centrist Republicans have expressed concerns.
At face value, the work requirements shouldn't affect Montoya, because she has a disability and has caregiving responsibilities for her mother. But she also knows proving that could be a problem. Even without changes, Montoya said she sometimes struggles to prove her continuing eligibility because her condition causes "brain fog."
"It's very stressful to navigate a system that is set up to catch you," she said.
The health policy nonprofit KFF estimated between 120,000 and 190,000 people in Colorado could lose their insurance, mostly through falling off the Medicaid rolls, over the next 10 years because of the bill. If pandemic-era increased subsidies for individual coverage expire this year, the number of uninsured people in the state could rise by 140,000 to 240,000.
Colorado produced different estimates, finding as many as 110,000 people could leave the individual marketplace because the bill would make insurance harder to get and more expensive. The state hasn't estimated how many people could lose Medicaid coverage.
About 1.2 million people in Colorado had Medicaid coverage as of April, and about 296,000 bought insurance on the individual marketplace for the current year.
The Congressional Budget Office estimated that about 10.9 million people nationwide would become uninsured, with about 72% losing Medicaid coverage, and the rest losing insurance they bought through the individual marketplace because of eligibility changes in the budget bill. Another 5.1 million could lose individual coverage if enhanced subsidies expire this year.
The bill would require some people between 19 and 64 to work or complete other activities for at least 80 hours each month. States would also have the option to require applicants to show they met it in the months before applying for Medicaid.
If the economy takes a downturn, people may not be able to consistently work 80 hours a month to keep their coverage, said Adam Fox, deputy director of the Colorado Consumer Health Initiative. Theoretically, they could fill in the gaps by volunteering when their hours fall short, but no one knows how the state will track and verify that, he said.
Rachel Sanchez, of Greeley, said she can't hold down a job while going through her third bout with cancer. Medicaid paid for her care for ovarian and colon cancers, and for follow-up care that helped her recover from the physical damage that treatment inflicted. Now, it covers her medication for leukemia, which costs about $1,500 for a weekly dose.
Sanchez's two sisters also relied on the program during their cancer care. (The three inherited a genetic mutation that increases their odds of multiple cancers.) Not having to worry about paying for treatment, and eventually for supportive care as they neared the end of their lives, reduced the family's stress during a terrible time, she said.
Cancer patients "can't just get up every day and go to work, and then go to treatment, and then go back to work," she said.
The bill would mandate that states go through the full process of verifying eligibility every six months for people who qualified for Medicaid under the expansion, which raised the threshold for adults to qualify for Medicaid to 138% of the poverty line, or $21,587 for one person.
The process is complicated, said Diana Corona, a Denver resident. Once, she forgot to file some paperwork, and only discovered she and her husband had lost coverage when he got sick.
"It's back and forth, back and forth" trying to provide the right information, she said.
The intention behind the bill is to add friction to the system of getting and maintaining insurance through Medicaid and the individual marketplace, said Sara Collins, senior scholar at the Commonwealth Fund, which researches health policies.
If it passes, people will lose coverage, either because they don't understand how to keep it, or in the case of the individual market, because insurance has become too expensive, she said.
"The savings (projected with the bill) really come from people not being able to navigate the system," she said.
Fox said he thinks the estimates of how many people will lose coverage are low, particularly for states like Colorado, where county human services offices have to handle Medicaid eligibility. Automated systems already check recipients' income eligibility monthly, so making them fill out paperwork and the counties process it twice a year instead of once just creates more opportunities for people to get lost in the shuffle, he said.
Colorado can renew Medicaid coverage automatically for about three-quarters of people who qualify based on income by using existing databases, said Marivel Klueckman, eligibility division director at the Department of Health Care Policy and Financing. The rest have to fill out the full renewal packet. If they don't return the paperwork, they lose coverage even if they'd still qualify.
The renewal packet typically runs about 16 pages, though not all parts apply to every household. It focuses on changes in income and who lives in the home. People who qualify for Medicaid because of a disability have to fill out a longer packet, verifying their health status and assets.
If the bill passes, Colorado will have to assess how much the workload will increase for county offices that process the packets, Klueckman said. The state will also need to look for ways to verify how many hours people are working without requiring individuals to report it, she said.
People who lose Medicaid in the future would face more hurdles in buying coverage on the individual marketplace.
The bill would forbid states from allowing low-income people to enroll in the marketplace at any point during the year and would require potential customers to verify more information before they can receive tax credit subsidies, effectively ending automatic reenrollment. It also would shorten marketplace enrollment window to 45 days, from 76.
Marketplace plans also will be more expensive in the coming years, assuming the bill becomes law, Fox said. It directly raises the maximum deductible and out-of-pocket limit that plans can set, and paradoxically, would raise the price of bronze and gold plans by lowering the cost of silver plans. (Subsidies rise or fall with the cost of silver plans.)
Combined, the marketplace and Medicaid changes will return the insurance system to something close to its state when the Affordable Care Act passed in 2010, particularly if Congress also allows larger subsidies for the individual market to expire this year, Collins said.
Then, Medicaid covered only adults with the lowest incomes, and the individual marketplace was prohibitively expensive, she said.
"It's a way of repealing parts of the Affordable Care Act without really saying it," she said.
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