In southern Colorado’s San Luis Valley, clouds billow above the towering mountains of the Sangre de Cristo vary. A refrain of blackbirds whistle as they flit among the many reeds of a wildlife refuge. Large, round fields of crops, interspersed with native shrubs, give it a really feel of bucolic quiet.
However amid the stark magnificence in one of many state’s most productive agricultural areas, there was a way of unease among the many neighborhood’s leaders as Congress debated a finances invoice that might radically reshape Medicaid, the federal government well being program for low-income folks.
“I’m making an attempt to be nervous and optimistic,” mentioned Konnie Martin, CEO of San Luis Valley Well being in Alamosa, Colorado, the hub for well being care companies for 50,000 folks in six rural counties.
Martin mentioned Medicaid is significant to rural well being care.
“I believe in Colorado proper now, almost 70% of rural hospitals are working in a damaging margin,” within the pink, Martin mentioned.
The well being system’s annual finances is $140 million, and Medicaid income makes up almost a 3rd of that, in line with Shane Mortensen, chief monetary officer for SLV Well being.
The working margin is razor-thin, so federal cuts to Medicaid may power tough cuts at SLV. “It will likely be devastating to us,” Mortensen mentioned.
The area is among the state’s poorest. In Alamosa County, 2 in 5 residents are enrolled in Well being First Colorado, the state’s Medicaid program.
It’s a lifeline, particularly for individuals who wouldn’t in any other case have quick access to well being care. That features low-income seniors who want supplemental protection along with Medicare, and folks of all ages with disabilities.
Envisioning a future with deep Medicaid cutbacks leaves many sufferers on edge.
“I appeared into our insurance coverage and, oh my goodness, it’s simply going to take half my verify to pay insurance coverage,” mentioned Julianna Mascarenas, a mom of six. She mentioned Medicaid has helped her cowl her household for years. Mascarenas works as a counselor treating folks with substance use problems. Her ex-husband farms — potatoes and cattle — for employers that don’t supply medical health insurance.
Throughout the state, Medicaid covers 1 in 5 Coloradans, greater than 1,000,000 folks.
That features youngsters in foster care.
“We’ve had 13 children out and in of our residence, six of which have been born right here at this hospital with medicine of their system,” foster mother or father Likelihood Padilla mentioned, referring to SLV’s flagship hospital in Alamosa.
“Medicaid has performed an enormous half in simply with the ability to give them the conventional life that they deserve,” he mentioned. “These children require plenty of medical intervention.”
Chris Padilla, Likelihood’s husband, mentioned: “At one level, we had a preteen that wanted to be seen 3 times per week by a psychological well being skilled. There’s no approach that we may have executed that with out Medicaid.”
Employees and directors at SLV Well being wonder if federal cuts will make it exhausting for the system to maintain its most cancers heart working.
“It may very well be fairly dramatically affected,” mentioned Carmelo Hernandez, SLV’s chief medical officer.
The hospital in Alamosa has its personal labor and supply unit, the kind of service that different rural hospitals throughout the U.S. have struggled to maintain open. About 85% of the hospital’s labor and supply sufferers are coated by Medicaid, Hernandez mentioned.
“If we don’t have obstetric companies right here, then the place are they going to go?” mentioned Hernandez, whose specialty is obstetrics and gynecology. “They’re going to journey an hour and 20 minutes north to Salida to get well being care. Or they’ll journey to Pueblo, one other two-hour drive over a mountain move.”
Tiffany Martinez, 34, was not too long ago pressured to consider that chance after giving start to her fourth youngster.
Her being pregnant was high-risk, requiring twice-a-week ultrasounds and stress checks on the hospital. She’s enrolled in Medicaid.
“The whole lot down right here is low-pay,” Martinez mentioned. “It’s not like now we have cash to simply be capable to pay for the physician. It’s not like now we have cash to journey typically to go to the physician. So it’s positively useful.”
Offering Well being Care — And Jobs
With 750 employees, the well being system is the valley’s largest employer. Clint Sowards, a main care doctor, mentioned having much less Medicaid funds will make it more durable to draw the subsequent technology of docs, nurses, and different well being care employees.
Sure medical specialties may now not be obtainable, Sowards mentioned. “Folks must depart. They must depart the San Luis Valley.”
Kristina Steinberg is a household medication doctor with Valley-Huge Well being Techniques, a community of small clinics serving hundreds within the area. She mentioned Medicaid covers most nursing residence residents within the space. “If seniors misplaced entry to Medicaid for long-term care, we’d lose some nursing houses,” she mentioned. “They’d consolidate.”
Audrey Reich Loy, a licensed social employee and SLV Well being’s director of packages, mentioned the system makes use of Medicaid “as kind of the spine of our infrastructure.”
“It doesn’t simply help these which are recipients of Medicaid,” she mentioned. “However on account of what it brings to our neighborhood, it permits us to make sure that now we have kind of a security web of companies that we are able to then increase upon and supply for the complete neighborhood.”
Looking for Extra Effectivity
Republicans in Congress who pushed for the large spending and tax regulation, which estimates recommend will lead to massive cuts to Medicaid, say they wish to get monetary savings and make the federal government extra environment friendly.
Many within the Alamosa County area voted for Donald Trump. “He’s probably affecting his voter base fairly dramatically,” Hernandez mentioned.
He mentioned Medicaid cuts may give President Trump’s supporters second ideas, however he famous that politics is a delicate subject that he principally doesn’t talk about with sufferers.
Sowards mentioned he understands that some folks consider the Medicaid system is ailing and dear. However he mentioned he has grave doubts in regards to the proposed treatment.
“Shedding Medicaid would have drastic repercussions that we are able to’t foresee,” Sowards mentioned.
Cuts Would Create Ripple Impact
SLV Well being’s regional financial affect is greater than $100 million a yr, with Medicaid accounting for a significant a part of that, Martin mentioned.
Any Medicaid cuts would hit the well being system exhausting, however they might additionally have an effect on small companies and their staff. The area is feeling financial stress from different modifications, like current cuts the Trump administration made to the federal workforce.
The San Luis Valley is residence to the Monte Vista Nationwide Wildlife Refuge, Nice Sand Dunes Nationwide Park, and different federally managed lands.
Joe Martinez, president of San Luis Valley Federal Financial institution, mentioned that not too long ago laid-off federal employees are already coming to banks saying: “‘Can I discover a technique to get my subsequent two months’ mortgage funds forgiven? Or can we do an extension?’ Or: ‘I misplaced my job. What can we do to ensure that I don’t lose my automobile?’”
Ty Coleman, Alamosa’s mayor, traveled to Washington, D.C., in April to speak to Colorado’s congressional delegation. He mentioned his message about Medicaid cuts was easy: “It will probably have a devastating financial affect.” Coleman put collectively a protracted listing of doable troubles: Extra persistent illness and better mortality charges. Longer wait instances for care. Medical debt and monetary pressure on households.
“It’s not simply our rural neighborhood however the communities, rural communities, throughout Colorado as effectively, and the USA,” Coleman mentioned. “And I don’t suppose persons are getting it.”
This text is from a partnership that features CPR Information, NPR and KFF Well being Information.