Our View - Sunday

The diagnosis

Doing a biopsy on Colorado’s uninsured ‘blob’

The push is on to provide health care coverage to more or all of Colorado’s uninsured, an issue that’s expected to move to the front burner next year, after the Blue Ribbon Commission for Health Reform makes its recommendations to legislators and the governor. The effort is predicated on the assertion that we’re experiencing a “crisis” that requires a dramatic response. But we’re not so sure.

It’s claimed that more than 785,000 people in the state are without medical insurance. The high cost of treating those people, when they show up at a hospital or doctor’s office with no way to pay, requires that we take action, according to those who created the commission.

But how accurate is that 785,000 figure? What do we really know about this amorphous blob called the uninsured? And where might a careful dissection of the blob take us, in terms of tailoring a cure to the malady at hand?

Could we be using a sledge hammer on a problem that requires a scalpel?

The first step in answering such questions involves some numbers crunching, so bear with us. A detailed study of the uninsured was conducted by the health care consulting firm, The Lewin Group, at the request of the commission. Its charts and graphs shine a sometimes surprising light on the subject.

The U.S. Census Bureau estimates there are 758,800 Coloradans without insurance, but that number is unreliable, according to the Lewin Group, because it underreports the number of Medicaid beneficiaries by 30 percent. After adjustments, it turns out there are an estimated 562,800 Coloradans who lack coverage throughout the year — whom we might call the chronically uninsured. The Lewin Group estimates the average number of Coloradans who are chronically or temporarily uninsured during any given year is 785,200, or about 17.2 percent of the population. That’s the number they use as a baseline.

There is a significant difference between the number of chronically uninsured and temporarily uninsured — which is important to keep in mind as we debate solutions. And when one takes a closer look at that 785,200 figure, some interesting subgroups emerge.

Just over 11 percent of the uninsured are eligible to participate in Medicaid or the Children’s Health Insurance Program, but elect not to. Roughly 20 percent are noncitizens, who are covered by Medicaid only in “emergencies” — which helps explain why indigent care costs are soaring. Another 11 percent of uninsured can get coverage through their employers, but choose not to. Another 10.4 percent can probably afford insurance, since they have an income exceeding 500 percent of the federal poverty level, but don’t have it. About 6.5 percent of the uninsured have family incomes above $100,000.

These subgroups constitute 49.3 percent of the total, which means just over 50 percent of Colorado’s uninsured (or 398,300 people) might be counted as the involuntarily uninsured — the people most of us visualize when we talk about the problem. And remember — this counts anyone who is even temporarily uninsured during a given year. Many of these people might just be between jobs.

That’s still a significant number of people, and the burden they impose on taxpayers and the medically insured is nothing to sneeze at. But it constitutes 8.7 percent of Coloradans (or about half the 17.2 percent figure we routinely see tossed around). Does this justify a massive overhaul of the system?

Here are some other interesting facts about the uninsured. Younger people make up the majority of the uninsured, not surprisingly. About 40 percent of Coloradans between the age of 19 and 24 go without — a group some call the “young invincibles.” Older age groups have progressively higher rates of coverage. Only 12 percent of children under 19 are uninsured, and about half of those are eligible for Medicaid but aren’t enrolled.

The roughly 20 percent of uninsured who are non-citizens aren’t really without medical care, because Medicaid covers them in case of “emergencies.”

This biopsy of the uninsured blob might help dispel the sense of “crisis” — and it should point us toward policy prescriptions that are less grandiose, less expensive, less government-centered than some of the ideas being bandied about.

Politicians should wade into this issue with the care of a physician, abiding by the credo, “First, do no harm.”

This housecleaning still not complete

We’re glad to see the city is close to approving a new operations manual for its real estate services office. We like the fact that all transactions above $50,000 in value will now have to come before City Council for approval. Bringing more discipline and uniformity to how city entities buy and sell land is a positive step.

But the problem was never really a lack of procedures: the problem was city and enterprise officials who ignored the procedures when it suited them, as Betty Clark-Wine discovered when she tried to enforce the rules. She was forced out as head of real estate services, readers may recall, when she began blowing the whistle on the irregularities she saw.

That led to a wrongful termination suit against the city, which is still pending, and left unanswered questions about the role former City Manager Lorne Kramer and his former deputy, Dave Nickerson, played in her ouster.

The city has never really offered a credible explanation for what went down: hiding first behind the fact that this was a “personnel matter,” and, more recently, behind the fact that litigation is pending. Instead of a thorough housecleaning, we got a vague and narrowly tailored review by the city auditor.

But we won’t consider the case closed — and the corrections complete — until the city comes clean on the events surrounding Clark-Wine’s dismissal.