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The website for Connect for Health Colorado, the state's health insurance exchange, shown in October 2018. (Eric Lubbers, The Colorado Sun)

The past 19 months, Colorado’s health care system has seen unprecedented convulsion — a pandemic, hospitals filling up with coronavirus patients, doctor’s offices emptying due to patients putting off treatment, untold numbers of people losing their jobs and the health coverage that goes with it.

But amazingly, according to a new survey, one thing held steady throughout this turmoil: The state’s rate of people with health insurance.

In 2019, before the pandemic hit, the rate of people in Colorado without health insurance stood at 6.5%. Now, it’s 6.6%, a change that is not statistically significant. The uninsured rate remains at historically low levels.

“We felt like on the whole, the social safety net held during the pandemic, in a year when we could have seen skyrocketing uninsured rates,” said Jeff Bontrager, the director of research and evaluation at the Colorado Health Institute, which released the new survey on Wednesday.

What did change, though, was how people were covered. The survey found a decline in the number of people who were covered under a plan provided by an employer — to 49.8% of Coloradans from 52.7%.

The number of people covered by Medicaid jumped. Nearly a quarter of the state is now covered by Medicaid, up from about 19% in 2019.

Bontrager said one likely reason for that is a federal rule that prevents states from kicking people off the Medicaid rolls during the federally declared public health emergency, even if their income grew enough that they would normally no longer be eligible for Medicaid.

“We saw lots of evidence throughout the survey that people who were enrolled in Medicaid stayed enrolled in Medicaid,” Bontrager said.

That will at some point come to an end. The federal public health emergency is currently set to end in January, though it could be extended again, as it has been many times throughout the pandemic. When it does finally end, hundreds of thousands of Coloradans will have to find new coverage.

“There’s a lot of policy discussion happening right now about how to make a smooth transition,” Bontrager said.

The survey also found disparities in who is covered. People living in Douglas and Jefferson counties had the lowest uninsured rate. People living on the Interstate 70 corridor on the Western Slope and in the Upper Arkansas Valley had the highest uninsured rates.

Hispanic Coloradans also had a higher uninsured rate — 14.4%. The finding exemplified the deep health inequities people of color experience in Colorado.

Black Coloradans were more than three times as likely as white Coloradans to experience housing instability. More than 14% said they were worried they wouldn’t have stable housing in the next two months.

Nearly a third of Black Coloradans between the ages of 19 and 44 said they had trouble affording food, and more than a fifth of Hispanic Coloradans in that age range said the same. About 10% of younger white Coloradans said they had trouble affording food.

The survey, called the Colorado Health Access Survey, is considered the gold standard in the state for tracking trends in health coverage. It is conducted every other year. This year’s survey polled about 10,500 households between February and June.

Among its other findings:

  • The percentage of people covered by Medicare dropped in Colorado, to 11.5% from 13.7%. About 6% of Coloradans buy health insurance on their own.
  • The mental health crisis has reached unprecedented levels. Nearly a quarter of Coloradans reported having eight or more days of poor mental health in the previous month. More than 38% of Coloradans said their mental health declined during the pandemic. “We saw the highest rate of people reporting poor mental health since we started measuring this back in 2013,” Bontrager said.
  • Fewer people reported going hungry in the prior year — 8.1% — but food insecurity was higher in rural areas.
  • Use of health care services declined across the board, except for mental health care. But use of telemedicine exploded, with more than a third of people surveyed saying that they had a telemedicine appointment in the prior year. Among those people, 80% said the tele-visit was as good as or better than being seen in-person.
  • Fewer people said they could not take time off work to seek medical care — 10.5% in 2021, compared with 14.9% in 2019.
  • Significantly fewer Coloradans said they struggled to pay medical bills — 11.3% in 2021, compared with 18.1% in 2019. But Black and Hispanic Coloradans were more than twice as likely to report struggling to pay medical bills.

Michele Lueck, the Colorado Health Institute’s president and CEO, said the survey shows the diverse impacts of the pandemic and what she called the “syndemic,” the collection of pre-existing health crises and new health crises and consequences brought about by the coronavirus, the lockdowns and rules designed to stop it and the social programs intended to counteract its effects.

“That,” she said, “is echoed in the results.”

John Ingold is a co-founder of The Colorado Sun and a reporter currently specializing in health care coverage. Born and raised in Colorado Springs, John spent 18 years working at The Denver Post. Prior to that, he held internships at the Rocky Ford Daily Gazette, the Colorado Springs...