Hazzell Chévez works with a patient at Community Health Services in Aspen on Wednesday. The clinic works with patients on a wide range of health needs, recognizing that it may be the only health care that those patients seek.
Jason Charme/Aspen Daily News
For a system as complex as American health care, the pipeline from recent federal policy change to local impact is actually pretty straightforward. Grant funding has been reduced. Medicaid rules are changing. Health insurance is going to cost more. With less federal money going to some local needs, someone else will have to pony up. And communities may be the ones paying the price.
“It’s just been a domino [effect], like one crisis after the next, after the next,” said Logan Hood, the executive director of the nonprofit Community Health Services in Aspen.
The clinic is like a “safety net” for the community, offering preventive care like family planning and immunizations to about 2,600 patients a year. Roughly 60% of its clients identify as uninsured, paying fees on a sliding scale; some pay nothing at all, while others get discounted services. About 10% are on Medicaid, the government health insurance program for people with limited income and resources, and about 10% are on Medicare for people 65 and older and younger people with disabilities.
And this year, the organization was hit with a $148,000 shortfall — about 12% of its total budget — from unexpected reductions to federal and state grants.
That money, coming from a few different sources, would have supported family planning services, reproductive health care, cancer screenings and even dental programs that often serve low-income and vulnerable patients.
The team runs a friendly, bilingual office inside the Pitkin County Health and Human Services building, stocked with stickers and lollipops and children’s books to give away, plus meal kits for patients struggling with food insecurity. When someone comes in for one kind of appointment — a pregnancy consult, for example — they’ll talk through other matters too, including the “social determinants of health” like housing security and child care issues that contribute to overall wellbeing.
For many patients, this is their only source of health care. And while the clinic doesn’t do everything, they can “refer and navigate,” Hood said. The organization’s partnerships with a number of other local health care providers can help patients get what they need to feel well.
These patients are “the people who create the backbone of our community,” said Dr. Kimberly Levin, who serves on the board of Community Health Services and practices emergency medicine at Aspen Valley Health. They’re the ones working jobs in the service industry, cleaning, and construction who might not qualify for insurance through their employer and who might not otherwise have a place to go for preventive care.
A patient receives a vaccine at Community Health Services’ office in Aspen on Wednesday. The clinic offers both routine vaccines and shots required for travelers, with low- and no-cost options for people who don’t have insurance.
Jason Charme/Aspen Daily News
Absent a clinic like this one, they may see the emergency room as their only option, and might wind up needing “more acute care” for something that wasn’t caught early on, with a much higher bill to boot.
“For our community to function, we really need to take care of these people,” Levin said.
All this might explain why Hood is adamant that “we’re not disrupting services” at the organization that’s been around since 1971. Community Health Services is working to make up about $90,000 from other funding sources, like local governments, philanthropic foundations and other donors, to cover the initial bases at least. Reserves will help with the rest for now.
Some federal money could get restored, but it’s not a guarantee, and it might not be as much as organizations used to receive and rely on. Long-term, Hood and Levin say this nonprofit may have to adjust its funding strategy, and spend more time and resources on fundraising than they had to in the past.
“We are such a trusted health care provider and have been here for such a long time that I don’t want people to think that they still can’t come here and that we’re going away,” Hood said. “We’re going to do whatever it takes. The community has been showing support.”
But, in the meantime, she feels like she’s “waiting for the shoe to drop again.”
‘Tip of the iceberg’
Back in March, Hood received notice that Community Health Services would only receive $100,000 of the usual $125,000 the organization receives from Title X funding.
The federal program supports family planning and reproductive health care for patients regardless of their ability to pay, with a focus on low-income and vulnerable populations. Services can range from birth control to pregnancy counseling to tests for sexually transmitted infections.
Title X funds can also support HPV vaccinations and breast and cervical cancer screenings, as well as check-ins on other factors that impact wellbeing like obesity, mental health challenges and intimate partner violence. And it enables recipients to sign up for the federal 340B discount drug pricing program, so they can stretch those grant dollars further.
Mountain Family Health Centers, which operates multiple hubs of primary care in the Roaring Fork and Eagle River valleys, also receives Title X funding and also got dinged — losing about 25% of what they expected from that grant, equaling a loss of about $24,000, according to CEO Dustin Moyer. (At Mountain Family, however, Title X accounts for a smaller proportion of its overall budget.)
And they weren’t the only ones taking a hit. Hundreds of providers across the country received notice of a freeze on all or some of their federal Title X funding under the Trump administration this spring. Seven states were initially iced out completely, while 16 others saw Title X funds withheld from some of their clinics, according to an analysis from the health policy and news organization KFF.
In every other state — including this one, where Title X funding is funneled through the Colorado Department of Public Health and Environment’s Family Planning Program — grantees received just part of the money they were expecting.
Medical equipment sits on a counter at Mountain Family Health Center’s Basalt Integrated Health Center on Thursday. Mountain Family serves patients regardless of their ability to pay, with a sliding-scale fee system for those who are uninsured.
Jason Charme/Aspen Daily News
About half the funding for Colorado’s Family Planning Program comes from the federal grant, and about half comes from the state, according to information shared by CDPHE’s communications team. Colorado got just 45% of the money it was expecting from the feds, but it held up its half of the budget as if it had received the full amount, so the hit to providers was about 28% instead of double that. Cuts were applied based on the proportion of Family Planning Program clients they serve. No one in the state lost funding completely.
Here’s where it gets hazy: More federal funding “may be released,” according to the CDPHE media team, but “there is no definitive information at this time, posing challenges for the clinics, particularly those in small, rural, and frontier public health agencies.”
Some states have had their funding reinstated, and some groups have sued the Trump administration over the withholding of Title X funds.
But the Trump administration has also proposed an end to Title X funding altogether in 2026. As of late July, it was unclear whether that would actually take effect, according to KFF. This variability — the on-again, off-again funding, the possibility of reinstatement and relief and the possibility that there will be bigger cuts ahead — seems to be the trend with these funding changes, Hood said.
“It feels like tectonic plates, that they’re just shifting all the time,” Hood said.
In the worst case scenario — one in which funding for reproductive health care doesn’t get made up elsewhere, and services get cut at some providers — Hood said there could be an increase in unplanned pregnancy, teen pregnancy, and the number of people who go untreated for STIs, facing “long-term, very detrimental effects” to their health. There might be fewer early diagnoses for breast and cervical cancer, leading to more severe outcomes down the line.
And all that “puts pressure on hospital systems,” which might have to offer more “charity care” for patients who can’t otherwise afford it, Hood said. But she believes that outcome doesn’t seem likely here.
“We have some really good systems in our valley, and we’re really fortunate to be where we are,” Hood said. “And for reproductive health … I know Colorado, as a state, prioritizes health and families, maternal health and wellbeing for children. So we’re lucky, but we also have these external political threats happening as well, and we want to keep maintaining that so there is no disruption and no fear around accessing high quality care.”
It’s not the only grant that Community Health Services is looking to make up, though. Hood said that a separate program, administered by the Centers for Disease Control through CDPHE, will distribute just $53,000 out of the $140,000 she was expecting to support hundreds of breast and cervical cancer screenings. There may be some relief in the next few months with the reinstatement of some funding, Hood has heard, but it’s not like there’s a check just waiting to be mailed.
Funding for dental outreach programs, coming from the state, also took a hit, according to Hood. Community Health Services offers several different initiatives, including “Smiles for Students” dental care for kids in kindergarten through eighth grade, a “Bright Start Smiles” program for prenatal oral health and a dental hygiene program for seniors.
Funding cuts earlier this year initially amounted to a $36,000 loss from the $114,000 budget. (This week, she learned there would be some “holdover” funding, at least in the near term.) But the impact could be far greater next year: Hood is anticipating she may need to find other sources for all $114,000.
And we haven’t even talked about Medicaid and health insurance policy yet.
“My biggest concern is that this is just the tip of the iceberg,” Hood said.
Logan Hood, executive director of Community Health Services, speaks about the clinic’s offerings at the CHS office in the Pitkin County Health and Human Services Building in Aspen on Wednesday. Hood is grappling with grant cuts for programs that range from dental care to reproductive health.
Jason Charme/Aspen Daily News
The ripple effect of insurance policy
Emily Hilliard, the press secretary from the U.S. Department of Health and Human Services was adamant in her emailed response to a request for comment for this story: “As [Health and Human Services] Secretary [Robert F.] Kennedy and President Trump have reiterated on multiple occasions, there are no cuts to Medicaid.”
There are, however, changes to the rules, baked into the budget reconciliation bill that became law on July 4, sometimes called H.R. 1 and sometimes called the “One Big Beautiful Bill Act.”
Those updates include new work requirements, the removal of some immigrants from eligibility, and a policy that requires people to certify that they’re qualified for Medicaid every six months instead of just once a year.
They’ll also impact how states raise money for their part of the Medicaid program. Federal and state governments split Medicaid costs — it’s a 50-50 match in Colorado — and many states, including this one, use a tax on hospitals called a “provider fee” to help cover their part. Updated policies limit those provider fees, so states may need to find other ways to keep up their side of the Medicaid split; Colorado, unlike others, can’t raise taxes or borrow money to cover those losses because of state policies.
These changes and others are expected to reduce federal spending on Medicaid by more than $900 billion over the next decade while millions of Americans lose coverage. A KFF analysis projected that between 116,000 and 193,000 Coloradans would become uninsured as a result of the new Medicaid policies, some of which will phase in over several years.
The Trump administration and officials spearheading these changes have said they’re trying to root out “waste, fraud and abuse.” (Though other analysts say those claims are exaggerated.) Hilliard wrote that the bill “safeguards Medicaid for the vulnerable populations it was created to serve — pregnant women, children, low-income seniors, people with disabilities, and struggling families.”
But even if you don’t call it a “cut,” it could feel that way to the people who have lost coverage and the providers working to fill the gaps.
Moyer anticipates that some people will become uninsured even if they are eligible for Medicaid, because policies like the work requirement and six-month recertification cycle add more “hoops” to what is “already a really administratively burdensome process.”
They likely won’t be able to afford insurance from other carriers either, especially as different policies lead to rising premiums for people who get insurance on the individual health care marketplace, here called “Connect for Health Colorado.”
An enhanced tax credit that helped reduce premiums upfront — expanded in the COVID-era American Rescue Plan Act, from an existing tax credit in the Affordable Care Act — is set to expire at the end of this year unless Congress renews it by Sept. 30. (It was previously extended through the Inflation Reduction Act.)
Some of the people who lose out on that tax credit are expected to forgo coverage altogether because of the rising cost, and because, they figure, they’re generally pretty healthy, said Kate Harris, chief deputy commissioner of Colorado’s Division of Insurance.
“There’s still a level of tax credits that will exist. Unfortunately, from what we’ve seen, it’s just not enough for many people,” Harris said.
But other people “who tend to have higher claims and higher costs,” including those who are chronically ill, might not be able to take that risk, Harris said. And in turn, insurance companies will raise premiums to cover their own costs. On the Western Slope, base premium rates are expected to rise 38% next year. For those who also lose out on the enhanced tax credit, the cost will be even higher.
Cartoon fish decorate the wall around some medical equipment at Mountain Family Health Center’s Basalt Integrated Health Center on Thursday.
Jason Charme/Aspen Daily News
“We’re expecting that over 100,000 people will drop their coverage in Colorado,” Harris said.
Nationwide, the Congressional Budget Office forecast 4.2 million people may wind up uninsured from the rising insurance premiums.
But “many of them are still going to get sick, they’re still going to have emergencies, they’re still going to show up in the emergency department, they’re still going to need care, right?” Harris said. “And so really, the ripple effect that comes is on providers and hospitals who are now seeing a higher portion of uninsured patients, and that’s really obviously difficult for them, as well as for the people who are going uninsured and having to struggle with the cost of that.”
Providers will ‘eat the cost’
Mountain Family Health Centers will continue to serve patients regardless of their ability to pay through a model of integrated primary care, which puts physicians, behavioral health counselors, and dentists under the same roof. They even have enrollment specialists to help people navigate the complicated insurance process. The organization has locations in Basalt, Glenwood Springs, Rifle, Gypsum and Avon, plus several school-based health centers.
The comprehensive (and preventive) approach saves the entire health care system money, because it enables them to be efficient with resources and catch health issues before things get serious, Moyer said.
It can have a positive impact on patient wellbeing and their health care costs, too: Just think about the difference between a prescription for blood pressure medication and a trip to the emergency room for a cardiac event.
As a “Federally Qualified Health Center,” Mountain Family receives some government support to provide this care regardless of a patient’s coverage or ability to pay. About 27% of its patients were covered by Medicaid in the 2023-24 fiscal year, but another 45% weren’t covered by insurance at all. Rates of uninsured people tend to be higher in mountain communities, where people may make too much money to qualify for Medicaid but not enough to afford other coverage while dealing with the overall high cost of living, Moyer said. (Moreover, some people working service jobs — or multiple part-time jobs — don’t get coverage from their employer.)
Like Community Health Services up in Aspen, Mountain Family offers a sliding-scale fee system for people without coverage to pay based on their income. But that fee system leaves Mountain Family with a bigger chunk of the bill than it would otherwise pay with Medicaid reimbursements.
“We eat that cost,” Moyer said — and it’s already seen the impacts from policy changes in the past.
During the COVID-19 pandemic, a provision for “continuous eligibility” helped people stay on Medicaid to ensure continuous access to care. When that ended a couple years ago, and states had to reaffirm eligibility for everyone, about 2,000 of Mountain Family’s patients were disenrolled, some just caught in the administrative shuffle. The percentage of uninsured patients went up, the amount of revenue Mountain Family received from those visits went down, and they had to make difficult choices to downsize some of their services, including school-based health centers, to bridge the gap, Moyer said.
If there are more patients coming to Mountain Family without Medicaid or other insurance, “that translates to a revenue challenge.” And as new policies roll out, the organization could face a $1.6 million hit to revenue that they’ll have to make up somewhere else, “either through other revenue opportunities or in cost savings approaches,” Moyer said.
That just accounts for impacts to current patients — but not the “increased demands” they might see from patients at other providers who lose coverage and turn to Mountain Family for help.
“As a community, we’re going to have to try to rally around the fundraising,” Moyer said.
He’s worried, too, that people might delay care because they’re concerned about the cost.
“Even though a lot of times it’s a nominal fee that we charge as a co-pay, it still factors into when and how people access the health care system,” Moyer said. “I think it dissuades people from seeking care at the highest value point in time, which is early. It pushes people to not go see their doctor [or dentist] … until things are really painful.”
That’s already the situation for many in our region. According to the Colorado Health Foundation’s 2025 Pulse Poll administered this spring, some 33% of Western Slope respondents said they had postponed dental care in the last 12 months, and 26% postponed medical care.
A dental chair at Mountain Family Health Center’s Basalt Integrated Health Center is shown on Thursday. The integrated model puts physical, dental and mental health services under the same roof, allowing patients to have multiple touchpoints in the same visit.
Jason Charme/Aspen Daily News
Those numbers are even higher for those in lower income brackets. Among Western Slope respondents who made less than $75,000 a year, 46% postponed dental care and 29% postponed medical care.
Across the state, people who are uninsured are among the most likely to put off going to the doctor or the dentist. But postponing care early can lead to even steeper costs in the emergency room down the line.
“From a health care perspective, the earlier you can intervene, the more effective and efficient from a resource standpoint,” Moyer said.
It should come as no surprise that 48% of Western Slope respondents think the cost of health care is an “extremely serious” concern. Another 30% said it was “very serious.” Only the cost of housing and the overall rising cost of living ranked higher on a list of 18 different issues.
“If you have difficult decisions to make, because the housing costs and other things are so high here, … [you] can’t pay for everything,” said Dave Ressler, the CEO of Aspen Valley Health. “So what has to give?”
Aspen Valley Health, with a base of support from philanthropy and property taxes, will continue to care for patients in need, too. They averaged about $1.5 million to $2.2 million a year in uncompensated “charity” care between 2019 and 2023, according to its annual reports. As of 2023, they reported $9.5 million in Medicaid subsidies. They also provide direct financial support to partner organizations like Community Health Services and Mountain Family Health Centers, according to annual reports.
“We’re actually not covering all of our costs at the very bottom line, but that’s where our generosity of the community comes in,” Ressler said.
But for communities across the state, who will also be feeling these impacts and may not have so many funding sources to draw from, Ressler is worried. He’s also the chair of the Colorado Health Association Board, and he wants to make the case for universal health coverage.
“Every man, woman and child should have access to health care coverage, and that’s just getting worse now — it’s a giant step backwards,” Ressler said. “And our community is very fortunate, relatively speaking, compared to a lot of rural communities, … but if you look at the individuals in our community that are trying to get by and make a living and raise their children and work hard for those families, this is going to be devastating for them if they lose their Medicaid coverage [and if] they can no longer afford coverage on the exchange.”
The changes covered here are just some of the impacts local health care providers are grappling with, and just some of the impacts the community is facing at large.
“Every day there’s some kind of breaking news, or it’s constant, and I’m like, ‘What am I going to hear today that I didn’t even think was possible yesterday?’” Hood said.
She acknowledged the generosity of the community, but also the reality that there are “a lot of organizations and entities that have a need, and will have a need,” and she’s not sure that philanthropy on its own can fill the gaps left behind.
“There’s so many important things going on that are under threat or will be or can be, so I don’t know,” Hood said. “There’s a lot of noise out there right now, and people, I think, are just bombarded.