Is Colorado's safety net needed after health reform? Learning from Massachusetts' experience

Where does an uninsured Coloradan go for needed medical care? According to CHI’s analysis of the 2008-09 Colorado Household Survey, 17 percent of uninsured Coloradans reported the hospital emergency department as the place that they would go if they needed a medical professional.  Another 36 percent reported that they would visit a community health center or other public clinic. Each of these access points are part of Colorado’s health care safety net, a patchwork of clinics and hospitals that provide physical, oral health and behavioral health care services to uninsured individuals and families.

While many safety net patients tend to have low family incomes and/or are uninsured, others are covered by publicly financed coverage programs (such as Medicaid, Child Health Plan Plus or Medicare) or have other characteristics that make them vulnerable to compromised access to health care. Safety net services vary by community and are available in a variety of settings, including:

  • Community health centers
  • School-based health centers
  • Rural health clinics
  • Community-funded safety net clinics and family practice residency clinics
  • Low-income community dental clinics
  • Community mental health centers
  • Local public health departments
  • Hospital emergency departments

Given federal health reform’s mandate that all Americans purchase or otherwise attain health insurance coverage, will there still be a need for the health care safety net once the legislation is fully implemented? One way to answer this question is to look at the experience of other states. When Massachusetts passed comprehensive health reform in 2006, the state’s community health centers experienced an increase in patient volume. Many individuals who had utilized safety net services when they were uninsured continued to use the safety net. Adults with complex health care needs composed a disproportionate share of the new patients, and the state’s community health centers are faced with the challenge of staff recruitment and retention amidst this increased demand. Massachusetts’ experience suggests that states’ safety net providers will continue to play a significant role in the provision of health care services in the post-reform era.

The Colorado Health Institute established the Center for the Study of the Safety Net in 2009 to monitor the changing dynamics of the state’s health care safety net in Colorado. The Center will be working with communities and stakeholders to carefully assess the impact of state and national health reform on Colorado’s safety net providers to ensure that informed, evidence-based policy decisionmaking is possible in the midst of the dynamic changes that will be occurring as health reform is implemented over the next five years.

Jeff Bontrager is the director of research on coverage and access at CHI.