The trauma for families with trans kids
Plus: Are the feds withholding $339 million from Colorado?
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Howdy, Colorado, and happy almost-Valentine’s Day.
I thought I’d mine for some holiday-themed intro inspiration today in the ole mailbag of PR pitches. As always, these are real pitches that landed in my inbox.
Interview: Hollywood Specialist Enhancing Lips in Time for Valentine’s Day. Eww. Pass.
TV’s Newest Heartthrob Set to Steal the Spotlight on “Days of Our Lives.” I was always more of a Patch fan myself. Pass.
Colorado Springs Airport Named Among America’s Dating Hotspots. Did the airport’s Pizza Hut Express write this?
Colorado ranks as the No. 4 best state for single seniors. … While it has a moderate STI rate among seniors, its thriving senior community fosters engagement and connection.
????
You know what? Let’s just get to the news.
Reporter
TEMP CHECK
GENDER-AFFIRMING CARE
Major Colorado hospitals shut down gender-affirming care for minors. Families are reeling.
The message arrived unannounced last Wednesday, devastating but entirely expected.
“Dear TRUE Patient-Family, The White House released an executive order on Jan. 28…”
The note came not in an email or a letter, but instead pinged as a message in MyChart, the online portal that Children’s Hospital Colorado uses to send routine communications about medical care to patients.
Test results in? You get a MyChart message. Reminder about scheduled vaccinations? You get a MyChart message.
This message, though, was not routine. It informed families whose children receive care at Children’s Hospital’s TRUE Center, which provides gender-affirming services, that their treatments were being stopped. The hospital cited an executive order signed by President Donald Trump that threatens to strip federal funding from institutions that provide hormone-based gender-affirming care.
“…After thorough and thoughtful consideration, Children’s Colorado will transition its model of gender affirming care…”
Brittany, a Denver mom whose daughter receives care at the TRUE Center, scanned the note anxiously, looking for the bottom line. Even now, a week after the note arrived, she can’t read through it without breaking into tears.
“…We recognize the grief and anxiety that these changes will bring for the patients and families who have shown unwavering dedication and commitment to supporting children in embracing their true selves…”
She had been anticipating this message for days, after Denver Health and then UCHealth announced they would be shutting down most gender-affirming care for minors. Children’s was the last holdout among Colorado’s large health systems. But for just a single day.
And now, she said, families across Colorado with children who are transgender wonder what they will do next and where they will have to go to do it.
“Everyone is feeling completely lost and left behind,” said Brittany, who asked that only her first name be used out of concern for her and her daughter’s safety. “All of these institutions that said, ‘We stand with you, we support you’ are now just folding and stepping back and saying sorry, ‘We actually don’t support you anymore.’”
In the message to families, as well as in a statement to the media, Children’s said it would continue to offer “behavioral health and supportive care services” through the TRUE Center. In other words, it will still see patients for consultations.
Families say the hospital has previously given patients 6-month-long prescriptions, meaning those taking puberty-blockers or other hormone therapies won’t have to stop immediately. (The Trump executive order also targets institutions that provide gender-affirming surgeries to those 18 and under, but Children’s has never provided such surgeries to minors.)
Brittany said her daughter, who is 8, is too young to receive anything other than supportive services through the TRUE Center, so the announcement does not immediately affect her care. But she is approaching the age when doctors would want to start monitoring for signs of puberty. And when she does reach puberty, therapies that would have been available to her will now be, at a minimum, much harder to access.
“We have decided as a family that not receiving that care is not an option for our family,” Brittany said. “We will find a way to get that care for her, no matter what that takes.”
The most obvious route to do that would be through a private doctor who is not beholden to federal funding. But even there lie challenges.
Another Denver-area mom of a transgender child, who also requested anonymity out of fear for safety, said her son’s primary care doctor has been supportive of her son’s transition. But that doctor’s practice was acquired last year by UCHealth — part of the ongoing consolidation of the health care system — meaning the doctor won’t be able to step in and prescribe what Children’s no longer will.
The mom said her family has cached about a year’s worth of medication to continue her son’s transition. Beyond that, moms are trading whispers about which private doctors will provide care, though they also worry about those doctors becoming overwhelmed. Her family has talked about moving overseas if they can’t receive gender-affirming care here.
Hardest of all, families are deciding how — and whether — to tell their kids what is happening. Brittany said she hasn’t told her daughter yet, not wanting her to carry that fear. But the other Denver-area mom said she told her son.
And then she hugged him tightly.
“They now have their government against them, and they know it,” the mom said. “They’re not safe, and they know it.”
Section by John Ingold | Reporter
MONEY MYSTERIES
The feds promised Colorado $339 million for health insurance. The money hasn’t arrived.
Jan. 15
The date Colorado was awarded $339 million for health insurance programs
In the closing days of former President Joe Biden’s administration, Colorado received a bit of a surprise: The federal government had awarded the state $339 million to help fund various health insurance programs.
The money itself wasn’t the surprise. These dollars are what are known as pass-through funds. The state receives them because it has implemented various health insurance programs — like reinsurance and the Colorado Option — that save the federal government money on insurance subsidies. In recognition, the feds send a portion of that savings back to Colorado every year.
What was surprising about this award was that it came so early in the year. In other years, the announcement has come much later. Last year’s, for instance, didn’t arrive until September. But this year’s announcement landed Jan. 15.
Five days later, the presidential administration changed. And Colorado is still waiting for its money.
In response to questions from The Colorado Sun, the state Division of Insurance confirmed that it has not yet been able to pull down its pass-through funds for 2025 from the federal payment system.
It is not uncommon for the funds to take a couple weeks to show up in the system after being awarded. But the delay has now stretched on longer than usual.
Colorado Insurance Commissioner Michael Conway declined to comment on the situation and what it might mean, including whether Colorado’s money may be subject to a funding freeze in President Donald Trump’s administration.
The federal pass-through dollars flow into an entity called the Colorado Health Insurance Affordability Enterprise, where they pool together with money collected from a fee on insurers. That combined pool is then used to fund the reinsurance program, as well as to provide extra subsidies to some lower-income consumers and to provide subsidies through the OmniSalud program to immigrants who are ineligible for federal insurance subsidies.
Colorado is among the states that have sued the Trump administration over its previously announced funding freeze. After a judge blocked the freeze and ordered money to flow, Colorado and other states filed a motion saying that funds were still being held up.
In a letter sent Friday to the White House, Colorado leaders said “more than $570 million in obligated funding remains inaccessible.” It is unclear whether the health insurance pass-through money is included in that tally.
Section by John Ingold | Reporter
HEALTH LEGISLATION
A new bill would cap hospital prices — but only for state employees and a few others
Democrats at the state Capitol this week brought back an idea many in the party have long sought to implement: Price caps on what hospitals can charge privately insured patients.
But the proposal is a medium-sized swing at the big idea.
House Bill 1174, from Reps. Kyle Brown and Emily Sirota, would set a limit on what hospitals can charge. But those limits would apply to only two groups of patients: those covered by the state employee health plan and those covered by a plan in the small-group market, which is where small employers purchase coverage for their workers. (Full disclosure: The Colorado Sun’s employee health plan is a small-group plan.)
For these folks, the bill would set max prices for in-network services at most hospitals at 165% of what Medicare pays. Max prices for out-of-network care would be capped at 150% of Medicare’s price.
Meanwhile, primary care and behavioral health care providers would benefit from a price floor under the bill. The prices they are paid by the two groups of patients could be no less than 135% of what Medicare pays.
There are roughly 200,000 people in Colorado covered in the small-group market, plus around 30,000 people covered under the state employee health plan.
“This bill is an innovative way to reduce health care costs for all Coloradans — from our cities to our rural communities,” state Sen. Iman Jodeh, an Aurora Democrat and another sponsor of the bill, said in a statement.
Price caps have long been floated as a way to control rising hospital prices for those who are privately insured. Government programs like Medicare and Medicaid are able to set the prices they pay. Those prices are typically below what it costs hospitals to provide services, which leads to higher prices being charged to privately insured patients. (More on this below in the Chart of the Week.)
Hospitals, though, say this plan endangers their finances at a time when many are struggling with rising costs and rising numbers of uninsured patients — leading to higher amounts of care they’re not getting paid for.
“We cannot deplete one part of our safety net to save another,” Jeff Tieman, the president and CEO of the Colorado Hospital Association, said in a statement. “It is deeply disappointing that the governor and legislators would seek to further destabilize hospitals when they face ongoing financial challenges and unprecedented federal uncertainty.”
Section by John Ingold | Reporter
MORE ENVIRONMENT AND HEALTH NEWS
CHART OF THE WEEK
The shift toward public insurance
Hoo-boy, look at all those colors! This eye-dazzler is one way of visualizing how insurance coverage in Colorado has shifted over the years.
It shows what is called “payer mix” of patients visiting Colorado hospitals — in other words, how many patients were covered by private insurance, how many by Medicare, etc.
As you can see, the percentage of patients covered by public insurance — visualized by Medicare at the bottom in purple and Medicaid up next in blue — has increased to the highest level since at least 2009. Meanwhile, the percentage covered by private insurance — in dark green — is the lowest it’s been in that time.
(Red shows people covered by the Colorado Indigent Care Program, while that puke-ish green shows people who paid entirely out-of-pocket without any kind of insurance.)
This chart runs only through 2023, which means it doesn’t capture the impacts of Medicaid disenrollments after the end of pandemic-era federal policies. But it’s still important for understanding the report this chart comes from.
The analysis is included in the annual report for the Colorado Healthcare Affordability and Sustainability Enterprise. One of the things this report does every year is it tracks what’s called the “cost shift” between public insurance programs to private insurance. In general, public insurers pay hospitals less than what it costs to provide a service — in 2023, Medicare and Medicaid paid 73 cents and 79 cents on the dollar, respectively.
That means hospitals often cost-shift to privately insured patients, making them pay more to make up the difference. In 2023, private insurance paid $1.63 for every $1 worth of care received.
This is just one report that the state Department of Health Care Policy and Financing released recently. Others focus more on hospital finances and on whether hospitals are living up to their obligations to provide benefit to the community.
You can read all of these reports on HCPF’s website.
Section by John Ingold | Reporter
Roses are red.
Facts are true.
And we couldn’t report them
Without you.
Thanks for all the love you show us, Valentine. We love you right back.
— John & Parker
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