Petri dishes are great. Throughout my science education, I spent many hours peering into them to observe nature at work. I watched carefully, as these tiny samples often yielded powerful insight into larger, more complicated systems. Similarly, Colorado has been watched for years as a leader in health reform.
The 2008 Blue Ribbon Commission in Colorado was a big part of how Colorado became a Petri dish for health reform. Since then, we have consistently expanded coverage and made critical investments to improve efficiency and value in the health care system. We are also now embarking on a further expansion of Medicaid and the opening of our own state-based marketplace. We have a lot to be proud of.
That being said, one of the key rules in science is to remain an objective observer, and so it’s important that we are able to step back and accurately evaluate our outcomes. We need to be able to recognize that identifying problems or unexpected results doesn’t doom our experiment to failure, but is an opportunity to investigate further and make course corrections.
We must also stay aware of what is not changing in the Petri dish, or in this case, who will not be impacted by current reforms. One of these important conversations we need to have is about the remaining uninsured—those Coloradans who will not have health insurance, even after full implementation of the Affordable Care Act. The reality is, that reforms at both the federal and state level were not predicted to insure everyone. At the federal level, a 2012 estimate places the remaining uninsured at about 26 to 27 million people. In Colorado, data from 2008 estimates that about 390,000 will still be uninsured in 2016.
The remaining uninsured population will remain uninsured for a variety of reasons (PDF). Despite insurance options becoming more affordable through Connect for Health Colorado, some may still find that no options are financially feasible for them. Other individuals may be ideologically-opposed to the individual mandate or feel that they don’t need insurance and decide to opt out and pay the annual fine instead. All undocumented residents will be excluded from any of the options in the Medicaid expansion and through the Marketplace as well.
We also know that uninsured populations will vary drastically between different communities, and that there will be no one-size-fits-all solution. It is important that community leaders understand the makeup of their uninsured population, then lead productive discussions and intentional action.
As we work to find new paths to coverage for the remaining uninsured in our communities, our hospitals, safety net clinics, and community health centers will continue to play an essential role in our health care system. Community-specific responses, which best utilize community resources and assets, will be the key to meeting the needs of our uninsured populations.
We have a lot of eyes on us in our Colorado-shaped petri dish, watching and trying to understand how our environment is growing and changing as new laws take effect and new models of care are adopted. With dedication and discipline, we can ensure our grand experiment continues to thrive!