<\/p>\n
Hazzell Ch\u00e9vez 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.\u00a0<\/p>\n
Jason Charme\/Aspen Daily News<\/p>\n
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.<\/p>\n
\u201cIt\u2019s just been a domino [effect], like one crisis after the next, after the next,\u201d said Logan Hood, the executive director of the nonprofit Community Health Services in Aspen.<\/p>\n
The clinic is like a \u201csafety net\u201d 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.\u00a0<\/p>\n
And this year, the organization was hit with a $148,000 shortfall \u2014 about 12% of its total budget \u2014 from unexpected reductions to federal and state grants.\u00a0<\/p>\n
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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.\u00a0<\/p>\n
The team runs a friendly, bilingual office inside the Pitkin County Health and Human Services building, stocked with stickers and lollipops and children\u2019s books to give away, plus meal kits for patients struggling with food insecurity. When someone comes in for one kind of appointment \u2014 a pregnancy consult, for example \u2014 they\u2019ll talk through other matters too, including the \u201csocial determinants of health\u201d like housing security and child care issues that contribute to overall wellbeing.\u00a0<\/p>\n
For many patients, this is their only source of health care. And while the clinic doesn\u2019t do everything, they can \u201crefer and navigate,\u201d Hood said. The organization\u2019s partnerships with a number of other local health care providers can help patients get what they need to feel well.\u00a0<\/p>\n
These patients are \u201cthe people who create the backbone of our community,\u201d said Dr. Kimberly Levin, who serves on the board of Community Health Services and practices emergency medicine at Aspen Valley Health. They\u2019re 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.<\/p>\n
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A patient receives a vaccine at Community Health Services\u2019 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\u2019t have insurance.\u00a0<\/p>\n
Jason Charme\/Aspen Daily News<\/p>\n
Absent a clinic like this one, they may see the emergency room as their only option, and might wind up needing \u201cmore acute care\u201d for something that wasn\u2019t caught early on, with a much higher bill to boot.<\/p>\n
\u201cFor our community to function, we really need to take care of these people,\u201d Levin said.\u00a0<\/p>\n
All this might explain why Hood is adamant that \u201cwe\u2019re not disrupting services\u201d at the organization that\u2019s 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.\u00a0<\/p>\n
Some federal money could get restored, but it\u2019s 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.\u00a0<\/p>\n
\u201cWe are such a trusted health care provider and have been here for such a long time that I don\u2019t want people to think that they still can\u2019t come here and that we\u2019re going away,\u201d Hood said. \u201cWe\u2019re going to do whatever it takes. The community has been showing support.\u201d\u00a0<\/p>\n
But, in the meantime, she feels like she\u2019s \u201cwaiting for the shoe to drop again.\u201d\u00a0<\/p>\n
\u2018Tip of the iceberg\u2019<\/p>\n
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.\u00a0<\/p>\n
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.\u00a0<\/p>\n
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.\u00a0<\/p>\n
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 \u2014 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.)<\/p>\n
And they weren\u2019t 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<\/a> from the health policy and news organization KFF.\u00a0<\/p>\n In every other state \u2014 including this one, where Title X funding is funneled through the Colorado Department of Public Health and Environment\u2019s Family Planning Program \u2014 grantees received just part of the money they were expecting.<\/p>\n Medical equipment sits on a counter at Mountain Family Health Center\u2019s 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.\u00a0<\/p>\n Jason Charme\/Aspen Daily News<\/p>\n About half the funding for Colorado\u2019s Family Planning Program comes from the federal grant, and about half comes from the state, according to information shared by CDPHE\u2019s 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.\u00a0<\/p>\n Here\u2019s where it gets hazy: More federal funding \u201cmay be released,\u201d according to the CDPHE media team, but \u201cthere is no definitive information at this time, posing challenges for the clinics, particularly those in small, rural, and frontier public health agencies.\u201d\u00a0<\/p>\n Some states have had their funding reinstated<\/a>, and some groups have sued the Trump administration<\/a> over the withholding of Title X funds.<\/p>\n 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<\/a>. This variability \u2014 the on-again, off-again funding, the possibility of reinstatement and relief and the possibility that there will be bigger cuts ahead \u2014 seems to be the trend with these funding changes, Hood said.\u00a0\u00a0\u00a0<\/p>\n \u201cIt feels like tectonic plates, that they\u2019re just shifting all the time,\u201d Hood said.\u00a0<\/p>\n In the worst case scenario \u2014 one in which funding for reproductive health care doesn\u2019t get made up elsewhere, and services get cut at some providers \u2014 Hood said there could be an increase in unplanned pregnancy, teen pregnancy, and the number of people who go untreated for STIs, facing \u201clong-term, very detrimental effects\u201d to their health. There might be fewer early diagnoses for breast and cervical cancer, leading to more severe outcomes down the line.\u00a0<\/p>\n And all that \u201cputs pressure on hospital systems,\u201d which might have to offer more \u201ccharity care\u201d for patients who can\u2019t otherwise afford it, Hood said. But she believes that outcome doesn\u2019t seem likely here.\u00a0<\/p>\n \u201cWe have some really good systems in our valley, and we\u2019re really fortunate to be where we are,\u201d Hood said. \u201cAnd for reproductive health \u2026 I know Colorado, as a state, prioritizes health and families, maternal health and wellbeing for children. So we\u2019re 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.\u201d<\/p>\n It\u2019s 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\u2019s not like there\u2019s a check just waiting to be mailed.\u00a0<\/p>\n Funding for dental outreach programs, coming from the state, also took a hit, according to Hood. Community Health Services offers several different initiatives, including \u201cSmiles for Students\u201d dental care for kids in kindergarten through eighth grade, a \u201cBright Start Smiles\u201d program for prenatal oral health and a dental hygiene program for seniors.\u00a0<\/p>\n 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 \u201choldover\u201d 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.\u00a0<\/p>\n And we haven\u2019t even talked about Medicaid and health insurance policy yet.\u00a0<\/p>\n \u201cMy biggest concern is that this is just the tip of the iceberg,\u201d Hood said.<\/p>\n Logan Hood, executive director of Community Health Services, speaks about the clinic\u2019s 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.\u00a0<\/p>\n Jason Charme\/Aspen Daily News<\/p>\n The ripple effect of insurance policy\u00a0<\/p>\n 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: \u201cAs [Health and Human Services] Secretary [Robert F.] Kennedy and President Trump have reiterated on multiple occasions, there are no cuts to Medicaid.\u201d<\/p>\n 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 \u201cOne Big Beautiful Bill Act.\u201d\u00a0<\/p>\n Those updates include new work requirements, the removal of some immigrants from eligibility, and a policy that requires people to certify that they\u2019re qualified for Medicaid every six months instead of just once a year.\u00a0<\/p>\n They\u2019ll also impact how states raise money for their part of the Medicaid program. Federal and state governments split Medicaid costs<\/a> \u2014 it\u2019s a 50-50 match in Colorado \u2014 and many states, including this one, use a tax on hospitals called a \u201cprovider fee<\/a>\u201d 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\u2019t raise taxes or borrow money<\/a> to cover those losses because of state policies.<\/p>\n 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<\/a> 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.<\/p>\n The Trump administration and officials spearheading these changes have said<\/a> they\u2019re trying to root out \u201cwaste, fraud and abuse.\u201d (Though other analysts say those claims<\/a> are exaggerated<\/a>.) Hilliard wrote that the bill \u201csafeguards Medicaid for the vulnerable populations it was created to serve \u2014 pregnant women, children, low-income seniors, people with disabilities, and struggling families.\u201d\u00a0<\/p>\n But even if you don\u2019t call it a \u201ccut,\u201d it could feel that way to the people who have lost coverage and the providers working to fill the gaps.\u00a0<\/p>\n 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 \u201choops\u201d to what is \u201calready a really administratively burdensome process.\u201d<\/p>\n They likely won\u2019t 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\u00a0 \u201cConnect for Health Colorado.\u201d\u00a0<\/p>\n An enhanced tax credit that helped reduce premiums upfront \u2014 expanded in the COVID-era American Rescue Plan Act, from an existing tax credit in the Affordable Care Act \u2014 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.)<\/p>\n 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\u2019re generally pretty healthy, said Kate Harris, chief deputy commissioner of Colorado\u2019s Division of Insurance.\u00a0<\/p>\n \u201cThere\u2019s still a level of tax credits that will exist. Unfortunately, from what we\u2019ve seen, it\u2019s just not enough for many people,\u201d Harris said.\u00a0<\/p>\n But other people \u201cwho tend to have higher claims and higher costs,\u201d 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.\u00a0<\/p>\n Cartoon fish decorate the wall around some medical equipment at Mountain Family Health Center\u2019s Basalt Integrated Health Center on Thursday.<\/p>\n Jason Charme\/Aspen Daily News<\/p>\n \u201cWe\u2019re expecting that over 100,000 people will drop their coverage in Colorado,\u201d Harris said.\u00a0<\/p>\n<\/p>\n
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