In southern Colorado’s San Luis Valley, clouds billow above the towering mountains of the Sangre de Cristo vary. A refrain of blackbirds whistle as they flit among the many reeds of a wildlife refuge. Massive, round fields of crops, interspersed with native shrubs, give it a really feel of bucolic quiet.
However amid the stark magnificence in one of many state’s most productive agricultural areas, there was a way of unease among the many neighborhood’s leaders as Congress debated a finances invoice that would radically reshape Medicaid, the federal government well being program for low-income individuals.
“I’m making an attempt to be anxious and optimistic,” stated Konnie Martin, CEO of San Luis Valley Well being in Alamosa, Colorado, the hub for well being care companies for 50,000 individuals in six rural counties.
Martin stated Medicaid is significant to rural well being care.
“I believe in Colorado proper now, almost 70% of rural hospitals are working in a damaging margin,” within the purple, Martin stated.
The well being system’s annual finances is $140 million, and Medicaid income makes up almost a 3rd of that, in line with Shane Mortensen, chief monetary officer for SLV Well being.
The working margin is razor-thin, so federal cuts to Medicaid might power tough cuts at SLV. “It will likely be devastating to us,” Mortensen stated.
The area is without doubt one of the state’s poorest. In Alamosa County, 2 in 5 residents are enrolled in Well being First Colorado, the state’s Medicaid program.
It’s a lifeline, particularly for individuals who wouldn’t in any other case have easy accessibility to well being care. That features low-income seniors who want supplemental protection along with Medicare, and folks of all ages with disabilities.
Envisioning a future with deep Medicaid cutbacks leaves many sufferers on edge.
“I regarded into our insurance coverage and, oh my goodness, it’s simply going to take half my verify to pay insurance coverage,” stated Julianna Mascarenas, a mom of six. She stated Medicaid has helped her cowl her household for years. Mascarenas works as a counselor treating individuals with substance use problems. Her ex-husband farms — potatoes and cattle — for employers that don’t provide medical insurance.
Throughout the state, Medicaid covers 1 in 5 Coloradans, greater than one million individuals.
That features kids in foster care.
“We’ve had 13 youngsters out and in of our dwelling, six of which have been born right here at this hospital with medicine of their system,” foster dad or mum Probability Padilla stated, referring to SLV’s flagship hospital in Alamosa.
“Medicaid has performed an enormous half in simply with the ability to give them the traditional life that they deserve,” he stated. “These youngsters require plenty of medical intervention.”
Chris Padilla, Probability’s husband, stated: “At one level, we had a preteen that wanted to be seen thrice per week by a psychological well being skilled. There’s no method that we might have accomplished that with out Medicaid.”
Workers and directors at SLV Well being ponder whether federal cuts will make it exhausting for the system to maintain its most cancers heart operating.
“It could possibly be fairly dramatically affected,” stated Carmelo Hernandez, SLV’s chief medical officer.
The hospital in Alamosa has its personal labor and supply unit, the kind of service that different rural hospitals throughout the U.S. have struggled to maintain open. About 85% of the hospital’s labor and supply sufferers are lined by Medicaid, Hernandez stated.

“If we don’t have obstetric companies right here, then the place are they going to go?” stated Hernandez, whose specialty is obstetrics and gynecology. “They’re going to journey an hour and 20 minutes north to Salida to get well being care. Or they’ll journey to Pueblo, one other two-hour drive over a mountain go.”
Tiffany Martinez, 34, was not too long ago compelled to consider that chance after giving beginning to her fourth baby.
Her being pregnant was high-risk, requiring twice-a-week ultrasounds and stress assessments on the hospital. She’s enrolled in Medicaid.
“Every little thing down right here is low-pay,” Martinez stated. “It’s not like we now have cash to simply be capable to pay for the physician. It’s not like we now have cash to journey typically to go to the physician. So it’s positively helpful.”
Offering Well being Care — And Jobs
With 750 employees, the well being system is the valley’s largest employer. Clint Sowards, a main care doctor, stated having much less Medicaid funds will make it tougher to draw the following era of medical doctors, nurses, and different well being care employees.
Sure medical specialties would possibly not be obtainable, Sowards stated. “Individuals must depart. They must depart the San Luis Valley.”
Kristina Steinberg is a household drugs doctor with Valley-Extensive Well being Techniques, a community of small clinics serving hundreds within the area. She stated Medicaid covers most nursing dwelling residents within the space. “If seniors misplaced entry to Medicaid for long-term care, we’d lose some nursing properties,” she stated. “They’d consolidate.”
Audrey Reich Loy, a licensed social employee and SLV Well being’s director of applications, stated the system makes use of Medicaid “as kind of the spine of our infrastructure.”
“It doesn’t simply assist these which are recipients of Medicaid,” she stated. “However because of what it brings to our neighborhood, it permits us to make sure that we now have kind of a security web of companies that we are able to then broaden upon and supply for your complete neighborhood.”

Looking for Extra Effectivity
Republicans in Congress who pushed for the large spending and tax regulation, which estimates recommend will lead to giant cuts to Medicaid, say they need to get monetary savings and make the federal government extra environment friendly.
Many within the Alamosa County area voted for Donald Trump. “He’s probably affecting his voter base fairly dramatically,” Hernandez stated.
He stated Medicaid cuts might give President Trump’s supporters second ideas, however he famous that politics is a delicate subject that he principally doesn’t focus on with sufferers.
Sowards stated he understands that some individuals consider the Medicaid system is ailing and expensive. However he stated he has grave doubts in regards to the proposed remedy.
“Shedding Medicaid would have drastic repercussions that we are able to’t foresee,” Sowards stated.
Cuts Would Create Ripple Impact
SLV Well being’s regional financial impression is greater than $100 million a 12 months, with Medicaid accounting for a serious a part of that, Martin stated.
Any Medicaid cuts would hit the well being system exhausting, however they might additionally have an effect on small companies and their workers. The area is feeling financial stress from different modifications, like current cuts the Trump administration made to the federal workforce.
The San Luis Valley is dwelling to the Monte Vista Nationwide Wildlife Refuge, Nice Sand Dunes Nationwide Park, and different federally managed lands.
Joe Martinez, president of San Luis Valley Federal Financial institution, stated that not too long ago laid-off federal employees are already coming to banks saying: “‘Can I discover a method to get my subsequent two months’ mortgage funds forgiven? Or can we do an extension?’ Or: ‘I misplaced my job. What can we do to ensure that I don’t lose my automobile?’”
Ty Coleman, Alamosa’s mayor, traveled to Washington, D.C., in April to speak to Colorado’s congressional delegation. He stated his message about Medicaid cuts was easy: “It will probably have a devastating financial impression.” Coleman put collectively a protracted checklist of potential troubles: Extra power illness and better mortality charges. Longer wait instances for care. Medical debt and monetary pressure on households.
“It’s not simply our rural neighborhood however the communities, rural communities, throughout Colorado as properly, and the US,” Coleman stated. “And I don’t suppose individuals are getting it.”
This text is from a partnership that features CPR Information, NPR and KFF Well being Information.