In this rural Colorado valley, cuts to Medicaid would have vast ripple effects

The Sangre de Cristo mountains loom complete Colorado's San Luis Valley. Many successful this cultivation region voted for President Trump and are profoundly concerned astir cuts to Medicaid. Hart Van Denburg/CPR News hide caption

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Hart Van Denburg/CPR News

In confederate Colorado's San Luis Valley, clouds billow supra nan towering mountains of nan Sangre de Cristo range. A chorus of blackbirds whistle, arsenic they flit among nan reeds of a wildlife refuge. Big information fields of crops, interspersed pinch autochthonal shrubs, springiness it a consciousness of bucolic quiet.

Despite nan stark beauty successful 1 of nan state's astir productive cultivation regions, there's a consciousness of unease among nan community's leaders arsenic Congress debates a fund measure that could radically reshape Medicaid, nan authorities wellness programme for low-income people.

"I'm trying to beryllium worried — and optimistic," said Konnie Martin, CEO of San Luis Valley Health successful Alamosa. It's nan flagship wellness attraction installation for 50,000 group successful six cultivation counties — Alamosa, Conejos, Costilla, Mineral, Rio Grande and Saguache.

The numbers retired of nan measure astir deep Medicaid cuts were "incredibly frightening," Martin said, "because Medicaid is specified a captious programme to agrarian wellness care."

Konnie Martin is CEO of San Luis Valley Health successful Alamosa. Hart Van Denburg/CPR News hide caption

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Hart Van Denburg/CPR News

Martin's infirmary is not alone. "I deliberation successful Colorado correct now, astir 70 percent of agrarian hospitals are operating successful a antagonistic margin," successful nan red, Martin said.

Across nan hallway from her agency is Shane Mortensen, nan main financial officer. "The legume counter," he said pinch a flimsy grin.

The hospital's yearly fund is $140 million, and Medicaid revenues dress up astir a 3rd of that, according to Mortensen.

The operating separator is razor thin, truthful national cuts to Medicaid could unit difficult cuts. "It will beryllium devastating to us," Mortensen said.

Lifeline for wellness care

The region is 1 of nan state's poorest. Two successful 5 of Alamosa County's residents are enrolled successful Health First Colorado, nan state's Medicaid program.

It's a lifeline, particularly for group who wouldn't different person easy entree to wellness care. That includes low-income seniors who request supplemental sum complete and supra Medicare, and group of each ages pinch disabilities. More than 2,500 moving property adults successful nan region pinch incomes little than $20,820 a twelvemonth besides qualify, and would beryllium among those astir apt to suffer sum nether existent proposals.

Envisioning a early pinch heavy cutbacks leaves galore patients connected edge.

"I looked into our security and, ohio my goodness, it's conscionable going to return half my cheque to salary insurance," said Julianna Mascarenas, a mother of six. She says Medicaid has helped her screen her family for years. "Then really do I live? Do I insure my kids aliases do I support a tile complete their head?"

Julianna Mascarenas, a mother of six, says Medicaid has helped screen wellness attraction for her family for years. Hart Van Denburg/CPR News hide caption

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Hart Van Denburg/CPR News

Mascarenas useful arsenic a counsellor treating group pinch constituent usage disorder. Her ex-husband farms, potatoes and cattle, for employers that don't connection wellness insurance.

"So those moments that I was a stay-at-home mom and he's moving agriculture, what would've we moreover done? I don't moreover know," she said, erstwhile asked what would person happened if Medicaid wasn't there. "Now that I deliberation back, what would person we done? We would've had to salary retired of pocket."

Or spell without. Across nan state, Medicaid covers one successful 5 Coloradans, much than a cardinal people.

That includes children successful foster care.

"We've had 13 kids successful and retired of our home, six of which person been calved present astatine this infirmary pinch narcotics successful their system," said Chance Padilla, a foster parent. "Medicaid has played a immense portion successful conscionable being capable to springiness them nan normal life that they deserve."

He and his husband, Chris, who are some session managers, get reimbursed by Medicaid for nan costs of providing for nan kids that person lived pinch them. "These kids require a batch of aesculapian intervention," said Chance Padilla.

The programme besides covers intelligence wellness services for foster children. "At 1 point, we had a preteen that needed to beryllium seen 3 times a week by a intelligence wellness professional," Chris Padilla said. "There's nary measurement that we could person done that without Medicaid."

What happens to crab and maternity care? 

San Luis Valley Health's lobby is modern, built of reddish ceramic and glass. Down a hallway is nan crab halfway wherever patients travel for chemotherapy transfusions. Nurse Amy Oaks demonstrates really they ringing a ceremonial bell, to observe each clip a diligent finishes a people of treatment.

"It's conscionable a happy time," said Oaks. "It's exciting. It gives you nan chills, makes you cry."

But infirmary unit and administrators wonderment whether national cuts would make it difficult for nan infirmary to support nan crab halfway running.

"It could beryllium beautiful dramatically affected," said Dr. Carmelo Hernandez, nan main aesculapian officer.

Hernandez's specialty is obstetrics and gynecology. The infirmary has its ain labour and transportation unit, nan type of work that different agrarian hospitals crossed nan U.S. have struggled to support open.

Dr. Carmelo Hernandez, nan main aesculapian serviceman astatine San Luis Valley Health successful Alamosa, specializes successful obstetrics and gynecology. He and different infirmary leaders wonderment if immoderate services, including obstetrics, tin enactment unfastened aft heavy Medicaid cuts. Hart Van Denburg/CPR News hide caption

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Hart Van Denburg/CPR News

"If we don't person obstetric services here, past wherever are they going to go?" Hernandez asked. "They're going to recreation an hr and 20 minutes northbound to Salida to get wellness care, aliases they tin recreation to Pueblo, different 2 hr thrust complete a upland walk to get wellness care."

Tiffany Martinez, 34, useful pinch kids who person disabilities. She was precocious forced to deliberation astir that anticipation aft giving commencement to her 4th child, Esme, 3 weeks ago.

Her gestation was precocious risk, requiring twice-a-week ultrasounds and accent tests astatine nan hospital. She's enrolled successful Medicaid and said it's captious for galore moms successful nan valley.

"Everything down present is debased pay," said Martinez. "It's not for illustration we person money to conscionable beryllium capable to salary for nan doctor. It's not for illustration we person money to recreation often to spell to nan doctor, truthful it's decidedly beneficial."

About 85 percent of nan hospital's labour and transportation patients are covered by Medicaid. As nan programme has expanded complete nan years, galore of nan patients who sewage added were joined women from moving families.

"It impacted nan full family because of people that's a small nucleus past that grows pinch nan attraction of nan family and nan well-being of nan family," said Christine Hettinger-Hunt, nan hospital's main operating officer.

Hospital heals, and besides employs

With 750 workers, nan infirmary is nan valley's largest employer. One of those labor is Dr. Clint Sowards, a superior attraction physician. He grew up successful nan region, went distant for schoolhouse and came backmost to a good-paying job.

Sowards is focused connected nan truth that less Medicaid costs will make it harder to pull nan adjacent procreation of doctors, nurses and different wellness providers.

Certain aesculapian specialties mightiness nary longer beryllium available, Sowards explained. "People will person to leave. They will person to time off nan San Luis Valley."

Dr. Kristina Steinberg is simply a family medicine expert pinch Valley Wide Health Systems, a web of mini clinics serving thousands. She said Medicaid covers astir nursing location residents successful nan area. "If seniors mislaid entree to Medicaid for semipermanent care, we would suffer immoderate nursing homes," she said. "They would consolidate."

The programme besides pays for vaccines for children. In 2 adjacent communities, Colorado precocious recorded its first cases of measles this year, which is highly contagious.

"If you are connected Medicaid, you don't person immoderate insurance, you beautiful overmuch suffice for free vaccines for children," Steinberg said. "And I tin spot our vaccines dropping disconnected dramatically if group person to salary for vaccines, because immoderate of them are very expensive."

Medicaid sustains a section level of wellness attraction that is past disposable to nan wider population, including patients connected Medicare and commercialized insurance, according to administrators and clinicians.

"We really utilize Medicaid arsenic benignant of nan backbone of our infrastructure," said Audrey Reich Loy, a licensed societal worker and nan hospital's head of programs.

"It doesn't conscionable support those that are recipients of Medicaid, but arsenic a consequence of what it brings to our community, it allows america to guarantee that we person benignant of a information nett of services that we tin past grow upon and supply for nan full community."

Seeking much efficiency

Republicans successful Congress opportunity they want to prevention money and make nan authorities much efficient. Their fund would cut taxes by trillions of dollars — and possibly trim societal information nett programs for illustration Medicaid.

Many successful this region voted for President Trump — successful Alamosa County, he topped 54 percent. Hernandez admits Medicaid cuts could springiness group present 2nd thoughts.

"He's perchance affecting his elector guidelines beautiful dramatically," said Hernandez, noting authorities is simply a delicate taxable that he mostly doesn't talk pinch patients. "I can't ideate that hasn't crossed immoderate people's minds."

Sowards, nan family medicine physician, says he's baffled by nan thought of perchance slashing Medicaid spending. He understands that immoderate group judge nan Medicaid strategy is ailing and costly. But he has sedate doubts astir nan projected cure.

"Just because we autumn and break our wrists and our wrist is broken, doesn't mean that we request to trim disconnected our arm, okay?," he said. "Losing Medicaid would person drastic repercussions that we can't foresee."

Local system depends connected wellness care

Deep Medicaid cuts could battalion a punch for nan wider location system arsenic well.

The mini metropolis of Alamosa is nan hub of nan San Luis Valley. It has a main thoroughfare successful nan midst of revitalization. It has hotels, restaurants, shops and a java shop called Roast Cafe.

On a caller Wednesday, barista Ethan Bowen prepped a specialty portion called a Drooling Moose. "It's a achromatic cocoa mocha pinch a small spot of caramel successful there," he said.

The java shop and its adjacent brew pub do beautiful bully business present — successful portion because of ft postulation from adjacent San Luis Valley Health, which is simply a "huge portion of nan section economy," Bowen said.

Joe Martinez is president of San Luis Valley Federal Bank, nan valley's oldest financial institution. It's connected nan adjacent block.

He said nan vale is location to 3 of nan poorest counties successful nan nation. A batch of its group are enrolled successful Medicaid "and nan individuals that partake successful nan programme don't needfully person nan financial intends to recreation extracurricular of nan San Luis Valley for wellness care."

Cuts would deed hard

The hospital's location economical effect is more than $100 cardinal a year, pinch Medicaid accounting for a awesome portion of that, Martinez said.

Any Medicaid cuts would deed nan hospitals hard, but besides impact mini businesses and their employees. The region is already emotion economical accent from different changes, for illustration caller cuts nan Trump management made to nan national workforce.

The San Luis Valley is location to nan Monte Vista National Wildlife Refuge, Great San Dunes National Park and different federally-managed lands.

Martinez said precocious laid disconnected national workers are already coming to banks, saying, "'Can I find a measurement to get my adjacent 2 months owe payments forgiven? Or tin we do an extension? Or I mislaid my job, what tin we do to make judge that I don't suffer my vehicle?'"

Ty Coleman, Alamosa's mayor, traveled to Washington, D.C., successful April to talk to nan state's Congressional delegation. He said his connection astir Medicaid cuts was straightforward: "It tin person a devastating economical impact." Coleman put together a agelong database of imaginable troubles: much chronic illness and mortality, longer hold times for care, aesculapian indebtedness and financial strain connected families.

Downtown Alamosa, a hub for nan San Luis Valley's cultivation economy, is besides location to breweries, java houses, retail, and nationalist art. Hart Van Denburg/CPR News hide caption

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Hart Van Denburg/CPR News

"It's not conscionable our agrarian community, but nan communities, agrarian communities, crossed Colorado arsenic good and nan United States," Coleman said. "And I don't deliberation group are getting it."

Cuts would create ripple effect

Medicaid cuts indirectly tin effect different economical sectors, for illustration education.

"One of nan biggest factors driving authorities higher acquisition backing down is authorities spending connected wellness care," said David Tandberg, president of Adams State University successful Alamosa. The assemblage has astir 3000 students and is adjacent doorway to nan hospital. It's nan region's second-largest employer.

If national cuts are made to Medicaid, Tandberg said, nan authorities of Colorado will past beryllium forced to salary much to support wellness attraction services. This year, Colorado is facing a billion-dollar fund deficit. Public universities for illustration his will find they're competing pinch aesculapian institutions for precious authorities funding. "So anytime I perceive astir Medicaid cuts, it makes maine nervous," he said.