Colorado has spent years talking about healthcare as if good intentions were a funding mechanism. The Colorado Springs Gazette’s Healthcare Freefall series is now putting numbers against the promises, and the arithmetic is considerably less compassionate than the press releases.
This installment looks at what happens as Medicaid eligibility tightens, insurance costs rise, state resources shrink and hospitals absorb more patients who cannot pay. The answer is not some theoretical policy dispute conducted under the Capitol dome. It is more people delaying care, more patients eventually landing in emergency rooms, more uncompensated treatment and hospitals deciding which services they can still afford to provide. Eventually, somebody has to pay the bill. Apparently Colorado’s healthcare strategy has been hoping that somebody never shows up.
The Bullet Point Brief
- The emergency room is becoming the primary-care plan of last resort. The Gazette reports that hospital officials expect more uninsured and underinsured Coloradans to postpone routine care and eventually show up in emergency departments when their problems become worse. ERs are designed for emergencies, not blood-pressure checks and routine follow-up. But when the front door to ordinary care closes, people use the door that legally cannot.
- Medicaid covers a lot of people while paying hospitals considerably less than their costs. About 1.4 million Coloradans, roughly one in four residents, are on Medicaid. Hospitals say they receive about 67 cents for every dollar they spend treating Medicaid patients. You do not need a healthcare economics doctorate to understand that losing 33 cents on the dollar becomes troublesome when you make it up in volume.
- Charity care is exploding. According to the Gazette, charity care has increased 112 percent since 2021, a jump of $208 million. The Colorado Health Institute estimates about 345,000 residents have no insurance or government assistance. Those people do not magically stop getting appendicitis, cancer or broken bones because the spreadsheet says they lack coverage.
- Colorado has also made expensive promises of its own. The state’s Cover All Coloradans program, which provides coverage to women and children in the country illegally, has blown far past early cost expectations. The Gazette reports spending reached roughly $100 million in 2026, with projections above $151 million in 2027. Facing a $1.2 billion budget deficit, lawmakers are now tightening enrollment. Compassion is easy when somebody else is apparently picking up the tab. Budget season has a nasty habit of locating the somebody.
- Hospitals are already looking at what they can cut. Nearly seven in ten Colorado hospitals are operating on slim or negative margins, according to the article, while the Colorado Hospital Association estimates the state could lose $10.4 billion in federal funding by 2032 under H.R. 1. Hospitals are responding the way organizations with finite money eventually respond: labor and delivery units disappear, cancer programs shrink and other specialty services get scrutinized. The political slogan may be “access to healthcare.” The practical version can become “drive another hundred miles.”
My Bottom Line
Here is the part Colorado’s political class would rather bury beneath twelve layers of compassionate language: healthcare is not created by declaring it a right, passing another program or printing “access” on a government website. Somebody has to staff the hospital at 2 a.m. Somebody has to keep the obstetrics unit open. Somebody has to buy the MRI machine, pay the nurses, keep the lights on and absorb the difference when government reimbursement does not cover the cost.
That does not mean every hospital executive gets canonized, every federal cut is wise or every state failure explains the entire mess. The Gazette’s reporting does not justify pretending there is one villain wearing a convenient partisan jersey. Washington made choices. Colorado lawmakers made choices. State agencies made choices. Hospital systems made choices. Insurers made choices. All of them have spent years explaining why the problem belongs to the other guy. Meanwhile, the patient in Craig, Delta, Cortez or rural eastern Colorado just wants to know whether the nearest hospital will still deliver a baby, treat cancer or keep an emergency department functioning.
Colorado deserves a particularly uncomfortable examination of its own promises. You cannot endlessly expand programs, tolerate reimbursement below the cost of care, watch state healthcare spending consume an enormous share of the budget, discover programs costing multiples of their projections, and then act stunned when the machinery begins coughing smoke. Government can promise everybody a seat at the healthcare table. Government cannot repeal arithmetic.
So forget the dueling press conferences for a minute. Show us the receipts. Which services disappeared? Which communities lost them? What did Medicaid actually reimburse? What did programs actually cost versus what politicians promised they would cost? Which hospitals are cutting services, and why? Which officials were warned, when were they warned, and what did they do about it? That is where accountability lives. Colorado can keep congratulating itself for caring deeply about healthcare, or it can make sure there is still healthcare left to care deeply about. Those are becoming two very different things.
Source: Colorado Springs Gazette
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