Las Animas County is Obamacare’s poster child. Obamacare purported to be about selling subsidized insurance through health exchanges. For all that hoopla, here’s the Colorado reality. Most growth of government-supported health care hasn’t been through private exchange coverage. Radical increases of the Medicaid numbers – right at one million total in our state – did happen.

Las Animas County had 2,128 on Medicaid in January. [h/t Steve Block, Trinidad Chronicle-News]. County DHS director Catherine Salazar also reported “other counties in Colorado were seeing similar increases in Medicaid caseload.”

Of Las Animas County’s 14,446 population, 4,344 (30% of the population) are on Medicaid. Medicare covers another 20% (minus some overlap). The state’s Obamacare exchange signed up a paltry 201 people in Las Animas County – fewer than its kids on CHP+ (239).

Las Animas County saw, on average, every single Medicaid patient at the ER once. Is this a rational way to provide care?

There are 25 beds in Mount San Rafael, the county’s only hospital. Voters last year rejected a tax increase for the hospital’s ER facility and other services.

Here’s the spooky thing about this Medicaid increase.

On average, of five Coloradans with ordinary insurance, one hits the ER. Ditto if there’s no insurance.  ER use more than doubles (44%) for Medicaid-covered Coloradans. (Probably because an ER visit is free under Medicaid, rather than requiring a hefty copay.)

I roughly estimate Colorado ER facilities will see an extra 100,000 visits. That’s FY 2015 compared to 2010 due to Medicaid expansion. Add in our 8.5% population growth.

Can Colorado’s emergency rooms handle this massive traffic boost? Where do needed docs and nurses come from?

When you take your child to the ER for a critical health need, how stressed will facilities’ caregivers be? Even assuming your child gets evaluated immediately? Our ER wait times are below the national average, but it’s still 244 minutes (2014 Report Card). That wait time will not shrink.

I promise you that it’s not just Mount San Rafael facing inundation. Nor only Las Animas County voters looking at higher taxes. Or seeing revenues diverted from schools and roads to healthcare needs.

Similar new burdens will hit physicians’ practices. Medicaid patients are just two-thirds as likely to get an appointment as a person with private coverage. And that helps explain their high Medicaid ER usage.

How do caregivers survive financially when they aren’t adequately paid? For most medical service categories – whether in the ER or physicians’ offices – JBC staff found “average reimbursement rates that were less than 80 percent of the Medicare rates.” (HCPF staff believes “the volume of Medicaid clients in Colorado is not great enough to significantly affect” at least some care decisions. Is that true even with a million on Medicaid?)

The feds paying most direct Medicaid enrollee costs for a few years doesn’t begin to cover this tidal wave.


Of course, some of the Medicaid wave is about money (that we don’t have). But it is also about the overloaded admissions clerk after midnight. It’s about the nurse who scrambles to manage care and patients’ prescriptions. It’s about the hospital budget folks balancing different prices for exactly the same care, depending on who’s paying. Even a nonprofit hospital can go broke.

Ordinary Coloradans – who won’t have access to care – will be the truest losers in this destructive surge of “free” care.