In southern Colorado鈥檚 , clouds billow above the towering mountains of the Sangre de Cristo range. A chorus of blackbirds whistle as they flit among the reeds of a wildlife refuge. Big, circular fields of crops, interspersed with native shrubs, give it a feel of bucolic quiet.
But amid the stark beauty in one of the state鈥檚 most , there was a sense of unease among the community鈥檚 leaders as Congress debated a budget bill that could radically reshape for low-income people.
Get top headlines and 萝莉少女 reporting directly to your mailbox each week when you subscribe to In The NoCo.
鈥淚鈥檓 trying to be worried and optimistic,鈥� said Konnie Martin, CEO of in Alamosa, Colorado, the hub for health care services for 50,000 people in six rural counties.
Martin said Medicaid is vital to rural health care.
鈥淚 think in Colorado right now, nearly 70% of rural hospitals are operating in a negative margin,鈥� in the red, Martin said.
The health system鈥檚 annual budget is $140 million, and Medicaid revenue makes up nearly a third of that, according to Shane Mortensen, chief financial officer for SLV Health.
The operating margin is razor-thin, so federal cuts to Medicaid could force difficult cuts at SLV. 鈥淚t will be devastating to us,鈥� Mortensen said.
is one of the state鈥檚 poorest. In Alamosa County, residents are enrolled in , the state鈥檚 Medicaid program.
It鈥檚 a lifeline, especially for people who wouldn鈥檛 otherwise have easy access to health care. That includes low-income seniors who need supplemental coverage in addition to Medicare, and people of all ages with disabilities.
Envisioning a future with deep Medicaid cutbacks leaves many patients on edge.
鈥淚 looked into our insurance and, oh my goodness, it鈥檚 just going to take half my check to pay insurance,鈥� said Julianna Mascarenas, a mother of six. She said Medicaid has helped her cover her family for years. Mascarenas works as a counselor treating people with substance use disorders. Her ex-husband farms 鈥� potatoes and cattle 鈥� for employers that don鈥檛 offer health insurance.
Across the state, Medicaid covers , .
That includes children in foster care.
鈥淲e鈥檝e had 13 kids in and out of our home, six of which have been born here at this hospital with drugs in their system,鈥� foster parent Chance Padilla said, referring to SLV鈥檚 flagship hospital in Alamosa.
鈥淢edicaid has played a huge part in just being able to give them the normal life that they deserve,鈥� he said. 鈥淭hese kids require a lot of medical intervention.鈥�
Chris Padilla, Chance鈥檚 husband, said: 鈥淎t one point, we had a preteen that needed to be seen three times a week by a mental health professional. There鈥檚 no way that we could have done that without Medicaid.鈥�
Staff and administrators at SLV Health wonder whether federal cuts will make it hard for the system to keep its cancer center running.
鈥淚t could be pretty dramatically affected,鈥� said Carmelo Hernandez, SLV鈥檚 chief medical officer.
The hospital in Alamosa has its own labor and delivery unit, the type of service that other rural hospitals across the U.S. . About 85% of the hospital鈥檚 labor and delivery patients are covered by Medicaid, Hernandez said.
鈥淚f we don鈥檛 have obstetric services here, then where are they going to go?鈥� said Hernandez, whose specialty is obstetrics and gynecology. 鈥淭hey鈥檙e going to travel an hour and 20 minutes north to Salida to get health care. Or they can travel to Pueblo, another two-hour drive over a mountain pass.鈥�
Tiffany Martinez, 34, was recently forced to think about that possibility after giving birth to her fourth child.
Her pregnancy was high-risk, requiring twice-a-week ultrasounds and stress tests at the hospital. She鈥檚 enrolled in Medicaid.
鈥淓verything down here is low-pay,鈥� Martinez said. 鈥淚t鈥檚 not like we have money to just be able to pay for the doctor. It鈥檚 not like we have money to travel often to go to the doctor. So it鈥檚 definitely beneficial.鈥�
Providing Health Care 鈥� And Jobs
With 750 workers, the health system is the . Clint Sowards, a primary care physician, said having less Medicaid funds will make it harder to attract the next generation of doctors, nurses, and other health care workers.
Certain medical specialties might no longer be available, Sowards said. 鈥淧eople will have to leave. They will have to leave the San Luis Valley.鈥�
Kristina Steinberg is a family medicine physician with , a network of small clinics serving thousands in the region. She said Medicaid covers most nursing home residents in the area. 鈥淚f seniors lost access to Medicaid for long-term care, we would lose some nursing homes,鈥� she said. 鈥淭hey would consolidate.鈥�
Audrey Reich Loy, a licensed social worker and SLV Health鈥檚 director of programs, said the system utilizes Medicaid 鈥渁s sort of the backbone of our infrastructure.鈥�
鈥淚t doesn鈥檛 just support those that are recipients of Medicaid,鈥� she said. 鈥淏ut as a result of what it brings to our community, it allows us to ensure that we have sort of a safety net of services that we can then expand upon and provide for the entire community.鈥�
Seeking More Efficiency
Republicans in Congress who pushed for the big spending and tax law, which estimates suggest will result in large cuts to Medicaid, say they want to save money and make the government more efficient.
Many in the Alamosa County region 鈥淗e鈥檚 potentially affecting his voter base pretty dramatically,鈥� Hernandez said.
He said Medicaid cuts could give President Trump鈥檚 supporters second thoughts, but he noted that politics is a sensitive topic that he mostly doesn鈥檛 discuss with patients.
Sowards said he understands that some people believe the Medicaid system is ailing and costly. But he said he has grave doubts about the proposed cure.
鈥淟osing Medicaid would have drastic repercussions that we can鈥檛 foresee,鈥� Sowards said.
Cuts Would Create Ripple Effect
SLV Health鈥檚 regional economic impact is , with Medicaid accounting for a major part of that, Martin said.
Any Medicaid cuts would hit the health system hard, but they would also affect small businesses and their employees. The region is feeling economic stress from other changes, like recent cuts the Trump administration made to the federal workforce.
The San Luis Valley is home to the Monte Vista National Wildlife Refuge, Great Sand Dunes National Park, and other federally managed lands.
Joe Martinez, president of , said that recently laid-off federal workers are already coming to banks saying: 鈥溾�楥an I find a way to get my next two months鈥� mortgage payments forgiven? Or can we do an extension?鈥� Or: 鈥業 lost my job. What can we do to make sure that I don鈥檛 lose my vehicle?鈥欌��
Ty Coleman, , traveled to Washington, D.C., in April to talk to Colorado鈥檚 congressional delegation. He said his message about Medicaid cuts was straightforward: 鈥淚t can have a devastating economic impact.鈥� Coleman put together a long list of possible troubles: More chronic disease and higher mortality rates. Longer wait times for care. Medical debt and financial strain on families.
鈥淚t鈥檚 not just our rural community but the communities, rural communities, across Colorado as well, and the United States,鈥� Coleman said. 鈥淎nd I don鈥檛 think people are getting it.鈥�
This article is from a partnership that includes 萝莉少女, , and KFF Health News.
is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF鈥攁n independent source of health policy research, polling, and journalism. Learn more about .