Down the newly remodeled halls of Peak Vista's Homeless Health Center, Rhonda Warwick sits on a bed, waiting to be examined.
She is a larger woman, 51, with long gray hair tied back, an oxygen tube affixed to her nostrils, and warm blue eyes. She is laughing. And boy, can she laugh — like a thunderous clap of joy.
"If it wasn't for this setup, I'd be dead!" she says, cracking up.
Not all would see the humor in Warwick's situation. She suffers from asthma, four bleeding ulcers, atrial fibrillation and a host of other problems. After years of working office jobs, and a short career as a judo wrestler 20 years ago, she's now unemployed. And she's lived in the R.J. Montgomery New Hope Center, a homeless shelter, for the past 2½ months.
Warwick says she got to this spot because she decided to care for her elderly mother. Slowly, Warwick's assets began to trickle away. Her home. Her land in the country. And then, her mother.
Warwick lived in an apartment for two years, gradually selling off all her possessions to pay the rent. She got weaker from illness. The federal government denied her first application for Social Security Disability Insurance. Finally, she didn't have anything left.
Since March, Warwick has visited this free clinic regularly, and been seen seven times at Memorial Hospital, racking up 24 days as an inpatient. Recently, she learned she needs to see a gastrointestinal specialist. But unlike clinic and emergency room workers, specialists don't have to serve the homeless, who are usually uninsured.
So it's a good thing Warwick just got her Medicaid card. Doubly lucky, really.
Until recently, people like Warwick didn't qualify for Medicaid. But in April, the state opened 10,000 Medicaid spots for very low-income adults without dependent children, as part of a pilot program. Applicants were to be entered into a lottery after the May 15 deadline, and chosen at random. But Warwick, along with all other applicants who met the strict requirements, was immediately ushered in — because, puzzlingly, few applied.
"I'm the first person I know who's been accepted," Warwick says with a grin. "Good timing, right?"
A high-need program...
The Colorado Health Care Affordability Act, signed by then-Gov. Bill Ritter in 2009, just seemed to make sense. Gradually, the law extended Medicaid or other public health benefits to more needy kids and parents, a greater number of people with disabilities, and some very low-income adults without kids.
The funding didn't come from already-stressed state coffers; rather, hospitals agreed to pay a fee that was matched by the federal government. In turn, they'd see higher compensation rates from Medicaid, and fewer uninsured patients (whose bills often go unpaid).
Tom Nash, vice president of financial policy for the Colorado Hospital Association, says hospitals pay a total of around $600 million in annual fees, and the feds still match it.
But that money doesn't stretch far in health care, so the state decided to only open 10,000 slots for low-income adults without dependents, and to set tough requirements. Most daunting: Applicants can't make more than about $90 a month.
The offering was seen as a small pilot, since Medicaid will extend to all poor adults without dependents (who meet income requirements) in 2014, under the national Patient Protection and Affordable Care Act.
Even so, the response was expected to be staggering.
...that nobody wants?
And yet, May 15 came and went with fewer than 10,000 applications submitted. Despite two weeks' notice, a state spokesperson couldn't say how many people applied; Nash says he heard it was around 6,000.
Chris Garvin, program manager for El Paso County's Aging and Adult Services, which handled enrollment locally with the help of Peak Vista, says about 880 locals applied by the deadline. Workers continue to fill out applications for people, since more than 1,200 slots have been reserved for El Paso County. (Interested people can call county Human Services at 636-0000, or Peak Vista at 632-5700.)
In assessing the lukewarm response, some blame paranoia about the government. Others, lack of advertising. Kimberly Hess, who works directly with applicants through Peak Vista, says some people make too much money to qualify. Others are so hard up that they don't want Medicaid, because it requires $2 co-pays.
Experts say both hospitals and patients lose if more don't sign up for Medicaid. Emergency rooms have become the new doctor's offices for the uninsured poor. In its fiscal year ending July 30, 2011, Penrose-St. Francis Health Services spent a whopping $114.6 million on uncompensated and charity care.
"Emergency departments are the most expensive place to get primary care — they're not intended for primary care," Nash says. "There are costs associated with emergency departments: their equipment, the fact that they have to be open 24/7 and staffed with highly skilled people."
Emergency rooms aren't ideal for patients either, who often need regular prescriptions and visits to specialists, which can be prohibitively expensive without insurance. Even charity clinics like Peak Vista's can't meet all those needs.
And some patients, at least, understand that. Warwick, for one, says it feels good to have insurance now.
"It is reassuring," she says. "Because I don't want to run up debts. Nobody with sense wants to."