Medicare and the Role of Colorado's Safety Net

I recently helped my parents enroll in Medicare and a supplemental plan and this has given me pause to  think about the program. Medicare covers around 47 million seniors and disabled individuals, is highly popular, and is the latest political jai alai to be tossed around on spending cuts and deficit reduction. The stakes are high for policymakers as well as Medicare’s beneficiaries.

If I had to choose a single message from my health policy work, it is that coverage does not guarantee access. Access to care among Colorado’s Medicare beneficiaries has been a recurring issue since CHI began monitoring the state’s safety net. Multiple communities have said that elders and individuals with disabilities are finding it increasingly difficult to locate a Medicare provider.

That’s where safety net clinics step in. The safety net – essentially comprised of clinics and facilities that provide care to vulnerable populations around Colorado – has been serving an increasing number of older adults. For example, according to data from the state’s community health centers (CHCs), between 2000 and 2009 the number of adults ages 65 and over served by a CHC steadily increased from 14,000 to about 26,000, an increase of 82 percent. There are other factors that influenced this trend, including growth in CHC capacity, the state’s population growth and the aging of the population.

Let me emphasize this last factor: the state Demographer projects that the number of adults age 65+ will grow by 72 percent over the next ten years, the largest growth of any age group. This shift has major implications for safety net clinics as they develop chronic care models and programs to respond to the complex health care needs of Medicare beneficiaries. In addition, a recent analysis of access to specialty care in Colorado’s safety net found that Medicare patients face unique barriers to obtaining specialty care, such as distance to providers and lack of transportation.

My parents have been blessed with relatively good health (knock on wood) and the ability to maintain their regular physician through the purchase of a Medicare supplemental policy. Many older adults are not as fortunate, facing the triad of diminished income, complex health needs and barriers to needed care. These issues will continue to surface as the population ages and the long-term sustainability of Medicare is examined by policymakers. Meanwhile, the state’s health care safety net continues to consider how an increasing older mix of patients will affect its own sustainability. CHI will inform this discussion through policy analysis that includes the effects of an aging population on the safety net’s capacity to meet the demand for services.

Are health care providers in your community anticipating an aging population? If so, how are they preparing for it?

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