This article was published in the Ouray Plaindealer and Ridgway Sun, weekly newspapers in Ouray County. Though it sounds current, this piece dates to December 2002, when Ouray County was beginning to feel the squeeze. As producer of the monthly health section in the weekly paper, I spoke regularly with the County Nurse, County Medical Officer, and others making decisions and enacting them for the health of the townspeople.

If you are one of the many people who have been going through life with crossed fingers in lieu of health insurance, you are part of a growing problem in Colorado. Charity care and bad debt combined add up to about 7.5% of Montrose Memorial Hospital’s gross annual revenue, according to Leann Tobin, marketing director for the hospital. Larry Wall, president of the Colorado Health and Hospital Association, said, “The amount of charity care and bad debt hospitals provide statewide has increased substantially.”

Reasons for this, he explained, are that insurance continues to get more expensive while the economy remains in a slump; a lot of employers have decided they can’t afford to maintain their health plans; and employees don’t have the financial security to pick up the cost.

According to Wall, in 1998 the amount of charity care and bad debt for hospitals across the state was $468 million. In 2001, the most recent data collected, that figure had grown to $736 million. Because the state legislature has not found a panacea, it’s likely that the figures for 2002 will have climbed at least another $100 million, Wall said.

To plug the growing financial leak represented by patients who don’t pay their full bill, clinics and hospitals shift the cost back to the business side that does pay. Translation: higher premiums for those who are paying for insurance. This, in turn, puts coverage further out of reach for people trying to make ends meet in a struggling economy.

Ouray County Nurse Cheryl Roberts reported, “It’s a real problem. More residents are coming to public health, but health departments no longer do direct service. Our budgets have been decreased.” Ouray County Health remains involved in providing immunizations, women infant and children services, and homemakers services (to serve elderly and shut-ins). Roberts also tracks disabled kids and provides basic services at low cost for county children in general.

“We now work on initiatives to find gaps and get other agencies to take them on,” explained Roberts. When people come with needs to the clinic on Second Street in Ouray, “We put them in touch with any free services, modified services or services based on a sliding fee,” said Roberts.

She recommends that uninsured families with young children stop in the office to apply for CHIP (Colorado Health Insurance Protection) Plus, a plan for children brokered out by Rocky Mountain HMO. Families qualify based on income compared to number in family, assets and debts.

“A lot of folks in this area could qualify and don’t know it,” Roberts said. Roberts said she believes tourism is a big reason why our state is in such a healthcare crisis. Jobs based on tourism often are not long-term and stable, like those that provide good benefits, she said. “I sat in a meeting and heard Kay Alexander talk about how we have to fix the roads to ensure tourism. But if tourism is a foundation for the state, they have to realize that inviting people creates health and human service needs,” she said.

Montrose Hospital tries to wrap up all accounts within 18 months, Tobin explained. “The business office will sit with people (who can’t pay) and help fill out papers,” she said.

Many people are referred to Medicaid or the Colorado Indigent Care Program. Colorado Indigent Care Program (CICP) is funded by the state via taxpayer dollars, as described by a representative in the business office of St. Mary’s Hospital in Grand Junction. It is only available to documented Colorado residents. After reviewing a patient’s income, assets, number of people in the family and medical debts, CICP may reduce a patient’s hospital bills, but it won’t pay for ambulances or prescriptions. Few doctors take payment from CICP and the plan should not be considered as insurance, the source said.

Janet Jones, office manager for Mountain Medical Clinic in Ridgway, said the clinic doesn’t work with CICP so far, but offers a sliding fee schedule if a patient produces income documentation. Jones can also access some pharmaceutical companes that will donate prescriptions to people in need.

For those who don’t qualify for assistance, “We can accept monthly payments,” she said, “but we are a business… just like when you go to a grocery, you have to pay for the groceries.” Preventative care often falls by the wayside for struggling families, but low-cost options do exist. For women, Jones recommends the Colorado Cancer Control Initiative, known as the Butterfly Program. It is accessed through the Montrose County Nurse’s Office. That program provides free breast and Pap exams for women in need.

Anyone can attain an inexpensive physical by attending the annual Health Fair sponsored by Montrose Hospital. Usually in February, the fair comes to Ridgway School. A person can have blood drawn and all routine lab work done for about $75, said Jones. That’s about half of what it would cost to have done at a clinic. Then, that person can bring the lab reports to Mountain Medical Clinic during Women’s Month or Men’s Month, when physicals cost half or less of the normal price.

Anyone is eligible for this, regardless of income. Mountain Medical schedules those reduced-price events each spring. St. Mary’s Hospital in Grand Junction is known as a charity hospital and also has programs that may apply for those with trouble paying. “We never turn anyone away,” said Karen Gosser of the hospital’s administration.

In nearby Mesa County, the Marillac Clinic, on the same site as the hospital, offers a full medical office, pharmacy and hospital labs on a sliding scale fee, said Gosser. That service is a product of the Sisters of Charity of Leavenworth, Kan. So far, no similar charity has stepped forward to help the people of Ouray County.