Health Relay

Luncheon serves food for thought on healthy schools

By Jennifer Kelly

An apple a day isn’t all it’s cracked up to be.

During the Colorado Legacy Foundation’s fifth annual Legacy Luncheon, nearly 1,000 guests watched the debut of the Foundation’s latest awareness-raising video. The video reinforces the idea that healthier school lunches and more jumping jacks in gym class are not going to solve school health challenges on their own.

To help our kids live healthier, we need to combine that apple and more jumping jacks with safe schools and neighborhoods. That means parents and communities need to work together to address the needs of the whole child.

Kids who are scared of violence on their walk home won’t be able to concentrate in math class. Children who hear their stomachs grumbling all day have a harder time learning to read. Teens who worry about their parents’ state of mind are more likely to struggle on tests.

The consortium of Colorado-based foundations and educators who gathered at the April 17 event are working to promote healthier schools. They also understand that schools and communities need to address the needs of the whole child to improve Colorado’s graduation rates and the state’s ability to produce healthy, successful adults.

Lt. Governor Joe Garcia

During the luncheon, speaker Dr. Ezekiel Emanuel reported that until the cost of health care stops spiraling out of control, state budgets for education will continue to suffer, and our efforts to help children in low-income schools and communities will continue to fall short.

According to Emanuel, in 2012, Americans spend $2.8 trillion on health care annually, making our health care spending equal to the total gross domestic of the fifth largest country.

Emanuel laid out recommendations for curbing health costs so that we can reinvest in education:

• Promote awareness, incentivize healthy behavior, and gradually change social norms especially regarding obesity, like we did successfully in the 1970s and ‘80s to reduce smoking
• Invest in early childhood education, because studies show that those who participate in such programs grow to be healthier adults, and raise healthier kids who earn better test scores and better jobs
• Focus on how delivering care to the 10 percent of the population who consume two-thirds of health care spending by providing "concierge care,” ensuring price and quality transparency, and focusing on the patient and their home-life versus what happens in the doctor's office

The good news: People are listening and working hard to do something about the many serious issues addressed at the luncheon.

Jennifer Kelly is a marketing and communications professional focused on early childhood education. In 2010, that focus culminated in her founding Penny Jar Kids, which creates Global Giving Kits to engage children in philanthropy while learning about the cultures they choose to support. She also writes jennswondering, a blog focused on the challenges of parenting.

Policy Speakout: Sequestration and health in Colorado

Bob Mook is the editorial manager of the Colorado Health Foundation.

For most people, life as they know it seems to be carrying on despite the massive sequestration on federal spending that went into effect on March 1, 2013.

Triggered after Congress and President Obama failed to reach an agreement on a long-term plan to shrink the federal deficit by $4 trillion, sequestration sets into motion automatic budget cuts to reduce the national debt by $1.2 trillion in the course of 10 years.

Many economists, however, warn that sequestration will hurt the economy. In fact, the Congressional Budget Office estimates it will slow down economic growth by 0.6 percent in 2013. Observers also have raised concerns about the impact of sequestration on the health care sector as well as the general health and well-being of Coloradans.

For example, sequestration reduces all Medicare payments by 2 percent – impacting health professionals who provide services to the elderly nationwide. It also enacts cuts to discretionary-spending programs, including those supporting clinical research, workforce training and community health centers.

Sequestration will be felt throughout Colorado by health care professionals, medical product manufacturers and other health stakeholders. For more details, see this March 2 article in The Denver Post.

Most means-tested programs for low-income individuals are exempt from the sequestration – including Medicaid, the state and federal partnership that provides coverage for people with lower incomes, older people, those with disabilities, pregnant women and some families and children. The Supplemental Nutrition Assistance Program (or SNAP) program, which provides food subsidies to millions of eligible individuals and families, also is immune to such cuts.

Having said that, there are still areas pertaining to health and health care that will impact Coloradans, including the following, according to a fact sheet from The White House:

• Vaccines for children: In Colorado, around 2,240 fewer children will receive vaccines for diseases such as measles, mumps, rubella, tetanus, whooping cough, influenza and Hepatitis B, due to reduced funding for vaccinations of about $153,000.

• Public health: Colorado will lose approximately $480,000 in funds to help upgrade its ability to respond to public health threats including infectious diseases, natural disasters, and biological, chemical, nuclear and radiological events. Additionally, Colorado will lose about $1.3 million in grants to prevent and treat substance abuse, resulting in about 3,500 fewer admissions to substance abuse programs.

• Nutrition assistance for seniors: Colorado would lose approximately $720,000 in funds that provide meals for seniors.

• Community health centers: A report from House Appropriations Democrats estimates sequestration will reduce federal funding for community health centers by about $120 million. While the total Colorado impact is unknown, it's estimated that community health centers in the state could collectively lose as much as $5.4 million in federal funding.

Putting these cuts in perspective, remember that just as the federal government taketh away, it also giveth. Case in point: Though cuts from the U.S. Department of Health and Human Services will take about $120 million from community health centers nationwide, President Obama's budget proposal allocates $3.8 billion for community health centers (including $2.2 billion in mandatory funding provided though the Affordable Care Act's Community Health Center Fund). Of course, there's no telling what those numbers will look like after they run through the legislative mill.

All told, the short-term impact of sequestration on your health depends largely on where you live, how much money you make and your age. But if economists and observers are correct, it appears that all of us will pay for it in some way.

Healthy Places: Steps toward a healthier Arvada

Edward T. McMahon is the senior fellow for Sustainable Development at the Urban Land Institute (ULI). He was the chair of the Colorado Healthy Communities panel in Arvada.

Is your neighborhood conducive to good health? Wherever you live or work, are you able to get to parks, trails, town centers or playgrounds? Can you get there without a car?

Increasingly, more communities across the country are asking these and more questions as they seek ways to encourage residents to be more active and improve their overall health.

Earlier this year, the Colorado Health Foundation launched Healthy Places, a five-year, $4.5 million initiative grounded in the idea that the design of the built environment can have a crucial and positive influence on improving public health by increasing physical activity.

During the first phase of Healthy Places, the Foundation selected three communities to participate in an advisory panel process with the Urban Land Institute, a nonprofit research and education organization which focuses on the use of land in order to enhance the total environment.

From March until May 2013, experts from ULI will spend a week in selected communities, assessing ways to enhance physical connections and encouraging more walking, biking and playing. The ULI panels will tour the areas, interview residents, business and property owners, city staff, elected officials and others and make recommendations on how to make the communities healthier and more focused on active living. Communities that complete the panel process will have the opportunity to apply for funding to implement their plans.

The Denver suburb of Arvada was the first of the three selected communities to participate. For the purpose of the Healthy Living initiative, the city of Arvada and its partners identified a small pocket of Arvada which had the most significant barriers to healthy living.

The other two communities, Lamar, a small town in Colorado's eastern plains and Westwood, a dense urban neighborhood in Denver will host ULI Panels in April and May of 2013 respectively.

Arvada's ULI Panel included several developers, an architect, a transportation planner, a specialist in downtown revitalization, and two experts in public health and active design. The panel found that Arvada is already a leader in developing parks, bike trails and other pedestrian facilities. Regardless, building a health-conscious community requires a long-term, strategic vision.

In Arvada and elsewhere, physical activity has been designed out of residents' daily routines. In the past century, desk jobs replaced manual labor, driving to destinations usurped walking and biking, elevators and escalators supplanted stair climbing, and TV and computer games displaced outdoor recreation (especially among children). Meanwhile, the design of our buildings and neighborhoods often makes physical activity unnatural or difficult.

Rather than telling people to go to the gym or to eat healthier food, the panel encouraged Arvada to seek opportunities to build exercise into citizens' daily routines by enhancing its unique set of assets. For example, Arvada has charming and walkable old town, three new transit stations and a network of linear parks and bike trails. The suburb's proximity to Denver and other major employment centers and its healthy fiscal condition are also factors in its favor.

Learn more about the panel's recommendations for Arvada in this report. After taking the panel's recommendations into consideration, Arvadans will have the opportunity to apply for additional Healthy Places funding to implement plans to better their community. In the meantime, stay tuned for Healthy Places developments in Arvada and elsewhere in the weeks and months to come.

Getting back to my original question, is your neighborhood conducive to good health? Whether you're from Arvada or another part of Colorado, what are your community's assets and liabilities in encouraging a healthy population? Share your thoughts in the comment box below.

Looking out for No. 1 in health

Editor's note: This posting originally appeared in Health Policy Solutions.

Michele Lueck is president and CEO of Colorado Health Institute.

In college basketball, being No. 1 means winning the Final Four. In cinema, it means taking home an Oscar. But when it comes to Colorado's health, being No. 1 could improve hundreds of thousands of lives and greatly benefit the local economy and business environment.

Though Colorado already is No. 1 in certain measures (we have the leanest and most-active adult population of any state), the 2012 Colorado Health Report Card shows there's plenty of room for improvements.

For example, we're No. 31 among other states in prenatal care and No. 38 in children's preventative dental care. And though our adult population is the leanest relative to other states, our obesity rate for adults and children has risen dramatically in recent years.

For the most part, Colorado is pretty average when it comes to health, but these statistics reveal a level of mediocrity that belies our national reputation as a healthy, vibrant and innovative state.

In fact, Colorado's grades haven't changed much since the Colorado Health Foundation partnered with the Colorado Health Institute to produce the first Colorado Health Report Card seven years ago. While that's frustrating in many respects, it also begs the question: "What if we were No. 1?"

For the first time ever, the 2012 Colorado Report Card looks at exactly what it would mean if Colorado were No. 1 in key health indicators.

For example: If Colorado were ranked No. 1 instead of No. 36 on the percentage of children without health insurance, an additional 78,593 children would have coverage.

Among the other possibilities if Colorado were No. 1:

• 2,100 more babies would be born at a healthy weight

• 123,400 more children would have access to a medical home

• 24,900 fewer children would be obese

• 32,600 fewer high school students would smoke cigarettes

• 92,600 fewer adults would report mental health difficulties

• 376,800 fewer adults would binge drink

• 16,200 more older adults would have all of their recommended immunizations

It's worth noting that most of these numbers reflect "modifiable health risk factors" – in other words, actions we can take to improve our health. A recent article in Health Affairs magazine noted that 22 percent of what we spend on health care can be mitigated or modified – such as lifestyle, behavior, the things we eat and how much we exercise.

Frankly, given our state's resources and collective brain power, being No. 1 in these indicators isn't much of a stretch.

Being No. 1 would not only make a difference to hundreds of thousands of Colorado lives, it's a goal that would boost business and the economy.

Tom Clark, CEO of the Metro Denver Economic Development Corp., once told me that health is a major factor that companies consider when they look to relocate or expand to Colorado. He said ranking in the "top three" of key health measures greatly improves the "win rate" of landing prospective employers.

For businesses that are already operating in the state, the supplement to the 2012 Colorado Health Report Card "Keeping Colorado Competitive: Roadmap to a Healthier, More Productive Workforce," shows how certain health indicators impact Colorado's economic health and competitiveness in terms of dollars saved.

For instance, Colorado employers and employees could save an estimated $121 million annually in health care costs if the state had the lowest rate of depression. Likewise, employers and employees could save an estimated $229 annually in health costs if obesity rates returned to 1996 levels.

The supplement also highlights nonprofits that are working to make a difference in improving Colorado's health. They include The Youth Foundation in Eagle County, which uses an evidence-based program to increase the level of physical activity among at-risk K-8 children. We also highlight Mental Health First Aid Colorado, which focuses on increasing literacy and awareness about mental illness, reducing social stigma and supporting the community with tools for coping with mental illness.

A vast majority of us aren't destined to win the Final Four or an Academy Award, but striving for the goal of being No. 1 in these key measures of health is worth doing and within reach. And it can be achieved through the individual and team efforts of Coloradans if work together.

A healthy workplace is everybody's business

Liliana Tenney is the co-director of Health Links Colorado at the Center for Worker Health and Environment at the Colorado School of Public Health.

With National Public Health Week upon us, promoting safety and health in the workplace is an essential ingredient toward improving the overall well-being of Coloradans.

The focus of this year's National Public Health Week is "Public Health is ROI: Saves Lives, Saves Money." On April 3, the theme of the day is "Creating A Healthy Workplace," with an emphasis on how wellness and safety are good for health and business.

Numerous studies have made the case for keeping our workforce safe, healthy and productive. Throughout the country, companies face a rapidly aging workforce. Public health initiatives target epidemic levels of obesity, diabetes, heart disease, depression, arthritis and other musculoskeletal conditions.

Today, more than ever, there is evidence that creating a healthy workplace can produce positive effects on employees' health, medical costs and productivity. Simply put, prevention makes good business sense. Case in point: obesity among full-time employees costs businesses $73 billion a year. Research also shows that medical costs fall by about $3.27 for every dollar invested in a worksite wellness program. Yet despite such positive evidence, only 27 percent of small businesses participate in employer-sponsored wellness programs.

Barriers regarding costs, time, participation and resources can prevent new health promotion programs from getting off the ground.

More high-quality research is needed to identify recommendations and strategies specific to small businesses. One size does not fit all. For an employer focused on the bottom line, taking on the challenge of wellness can be overwhelming. However, taking simple steps toward that direction can make the idea of a healthy workplace more approachable. By adopting some of the fundamentals, small businesses can set themselves up for success.

Six essential elements proven to support healthy workplaces include:

• Secure senior level management support

• Understand what the needs are within your company to design a program that addresses what is most important

• Form a wellness team of people from your company who are interested and passionate

• Establish goals and objectives

• Allocate some resources to get things started

• Collect information on participation and listen to employee feedback to make changes

Health outcomes for Colorado employers and employees span across work, home and community — establishing a need for a coordinated effort to develop integrated, comprehensive ways for small businesses to adopt and implement sustainable health and wellness programs.

Policy Speakout: 'Breakfast After the Bell' serves better education

Summer Gathercole is the Colorado state director of Share Our Strength.

No child should go hungry. Yet, more than one in four Colorado kids struggle with hunger. In fact, more than 270,000 of them start their school day with an empty belly. And learning suffers.

Teachers see the effects of hunger in their classrooms every day and they tell us that hungry kids struggle to focus and often fall behind in school. A recent survey by Share Our Strength's No Kid Hungry campaign showed that three in five teachers regularly see kids come to the classroom hungry.

Colorado State legislators Rep. Tony Exum, D-Colorado Springs, and Rep. Dominick Moreno, D-Commerce City, recently introduced legislation to rectify this situation. House Bill 1006, the Breakfast After the Bell School Nutrition Program, would require Colorado schools to serve a nutritious breakfast to all students for free, after-the-bell, if 70 percent of the school's students qualify for free or reduced-priced lunch the first year.

Many schools across the state already serve breakfast — although not all students who are eligible eat breakfast. In some schools, cost can be a barrier for low-income families. In some cases, the meal is served before school starts, so students who rely on the school bus for transportation arrive too late to eat.

With Breakfast After the Bell, Exum and Moreno designed a program that knocked down those barriers to good nutrition and still preserved flexibility. Each school can serve breakfast in a way that makes sense for students, teachers and staff.

Schools can serve breakfast in the classroom, with staff delivering food after school begins, or they can set up carts with grab-and-go meals for students to take with them into their first class. Others may establish an extended passing period so students can eat in-between classes.

Breakfast After the Bell would enable 81,000 more Colorado kids to eat a nutritious breakfast. And research shows that this means 81,000 more Colorado kids will have the chance to excel in school and in life.

Share Our Strength recently collaborated with Deloitte on a study exploring the correlation between school breakfast and achievement. The results are remarkable.

For example: If 70 percent of Colorado elementary and middle school students eating a free or reduced-price lunch were also eating school breakfast, the potential outcome could be 60,438 fewer school absences per year 40,292 students scoring higher on standardize math tests per year; and 10,073 more high school graduates.

Healthier kids who do better in school are more likely to graduate. That means a stronger workforce and a more competitive Colorado economy. Breakfast After the Bell will help thousands of Colorado kids get started on that path.

The ABCs of school-based health centers

Erica Snow is the senior program officer of Health Coverage for the Colorado Health Foundation.

Many Colorado children are going "back to school" for their health care needs.

That's because Colorado's 55 school-based health centers (SBHCs) provide accessible, affordable and high-quality physical, behavioral and oral health care to a steadily growing number of students in the state.

While each SBHC program is different, their facilities are located within school grounds. Most are staffed by a multi-disciplinary team of medical and behavioral health specialists. Sometimes, dental professionals are also included on the team. Currently, 23 of Colorado's 178 school districts host SBHCs. Generally, SBHCs are located in communities where access to care is limited for a large number of children because of low income, lack of health insurance or geographic isolation.

Studies show school-based health care positively impacts students in many areas including:

• Reduced absenteeism

• Increased access to preventive and mental health care

• Increased care coordination and referral completion

• Reduced emergency and urgent care visits

• Increased health knowledge among students

It's worth noting that SBHCs aren't just conveniently located for students – they're important for the educational experience. After all, sick kids can't learn, but thanks to SBHCs, students who would otherwise fall between the cracks of the health system have a place to go.

According to a fact sheet from the Colorado Association for School-Based Health Care, of the 28,930 children seen at SBHCs in 2011-12, 27 percent were uninsured, 53 percent were enrolled in Medicaid or Child Health Plan Plus (CHP+), 13 percent were covered by other types of insurance and 6 percent did not report. For the 27 percent of kids who are uninsured, most school-based health centers assist eligible families in applying for Medicaid/CHP+. As yet another side benefit, SBHCs have been shown to reduce costs for Medicaid programs because they reduce emergency room and inpatient utilization.

Services provided at SBHCs might include comprehensive well-child and well-adolescent exams; immunizations; treatment for illness or injury; management of chronic conditions such as obesity, diabetes or asthma; mental health assessments and treatment; prevention programs including smoking cessation, violence, pregnancy, and substance-abuse counseling; and nutrition counseling. As seen in this 9NEWS profile, SBHCs also provide dental services, including dental hygiene education, screening, sealants and fluoride varnish.

Recognizing the important role school-based health programs play in the health and wellness of Colorado's children, the Colorado Health Foundation launched a $10.8 million, four-year initiative in June 2009 to support SBHCs in communities throughout the state. Under the Foundation's School-Based Health Care Initiative, we set out to support the planning and implementation of more than 20 new school-based health centers.

Based on the number of students already served by SBHCs in Colorado, it is estimated these new centers will provide services for an additional 15,000 students each year.

Of course, merely making money available doesn't ensure that these SBHCs are effective or sustainable in the long-term. To help SBHCs move toward sustainability, the Foundation requested that they complete a four-year business plan and financial pro forma. A team of evaluators was then asked to determine if these tools have been effective in helping SBHCs make progress and to track development on eight sustainability factors. The team's mid-term findings are now available online via an executive summary, "The Colorado Health Foundation's School-Based Health Care Initiative."

While the Foundation's school-based health care initiative is still ongoing, the takeaways from the evaluation provide a good starting point for improving a concept that provides a crucial safety net for Colorado's vulnerable children and youth, many of whom might otherwise fall between the cracks and not get they need in order to stay healthy and in the classroom.

Wanted: Innovative thinking for aging Coloradans

Sally Schaefer is chair of the Colorado Health Foundation's Board of Directors.

Meeting the needs of an aging population is a hefty challenge that demands innovative, homegrown solutions. Communities can tackle that challenge by focusing on what's "big enough to matter but small enough to solve."

Unfortunately, too often our approach toward long-term services and supports (LTSS) is unnecessarily tethered to a costly and unsustainable "medical model" rather than a community-based approach.

According to the U.S. Department of Health and Human Services, almost 70 percent of people 65 and older will require some form of LTSS. Meanwhile, Colorado's 65-plus population is expected to be three times larger by 2030. In short, this means up to 930,000 older Coloradans will need LTSS in 2030 and beyond.

Such care would likely include informal family care-giving as well as paid assistance, including short-term stays in nursing homes and home and community-based care. The portion of the aging population that qualifies for Medicaid-funded LTSS will have major implications for the state's Medicaid budget.

The important question is not whether we'll spend enough on long-term care, but whether people using LTSS are happier and healthier.

I'd argue that helping the elderly and the disabled live to their full potential doesn't mean pouring more money into the system or building more elaborate bureaucracies. In my experience as a nurse and as the president and CEO of Hilltop Community Resources Inc., I've learned the opposite can be true.

For example, at Hilltop, we tried an experiment with other community partners. We vowed to keep people on Colorado's Western Slope out of nursing homes and off Medicaid by simply providing what they needed in their homes. By the end of the first year, we kept more than 100 individuals out of nursing homes and off Medicaid (even those who qualified). If we allowed them to go to nursing homes and enroll in Medicaid, the average costs of care would have totaled $70,000 per-person, per year. By contrast, the community collaboration cost an average of $70 per person per year.

Through this experiment, we learned that it often takes very little in the way of cash resources to keep people in their familiar surroundings. People were inspired to work harder and to stay healthy to continue to receive the love and support of a community-based network.

We also reinforced the notion that social isolation is the mortal enemy of the elderly. Once isolated, loneliness and depression set in, meds get mismanaged, meals are forgotten and chronic illnesses flare up.

We were able to avoid such costs through sweat equity and by providing a lot of different services that were already available. Some patients needed someone to come in twice a week or take them to the grocery store. Or they needed someone to come in and clean their house. Mostly, they just needed caring human connections.

Frankly, the way we approach LTSS is too complicated. Instead, we need to look at how to get people what they need. That's why the Colorado Health Foundation has launched a special funding opportunity to help Colorado design a high-quality, cost-effective and person-centered LTSS system.

This special funding opportunity will provide $6 million for innovation grants to build an LTSS system that will ensure people with disabilities, chronic conditions and age-related challenges have choice, control and access to a full array of quality services that assure optimal outcomes, such as independence, health, quality of life and community integration.

Though Colorado's LTSS system ranks No. 7 in the nation, according to a scorecard sponsored by AARP, the Commonwealth Fund and the SCAN Foundation, Colorado has an opportunity to become a true innovator that could improve individual lives and the quality of care – all while reducing costs.

Again, doing so doesn't require a great deal of money. We simply need the will to do things differently.

With health and health care for all

Anne Warhover is president and CEO of the Colorado Health Foundation.

Editor's note: This piece originally appeared in the winter 2013 edition of Health Elevations, the Foundation's quarterly journal.

No matter where you live in America, you are entitled to what Thomas Jefferson eloquently called life, liberty and the pursuit of happiness. And what can be more fundamental to those unalienable rights than health and health care?

Like education, good health and health care ought to be considered a birthright of every American. During the past century, we have closed disparities in our public education system with laws intended to give every child – regardless of his or her ZIP code – the opportunity to become educated, contributing members of society. While there is still much work to be done, we have identified a good education for all as an ideal worth attaining.

Yet the ideal of attaining the highest level of health for everyone is often fraught with sensitivities. In fact, when the Colorado Health Foundation made health equity the theme of its 2012 Colorado Health Symposium, we expected to generate controversy since many Americans believe that good health is a personal responsibility, not a right per se. I would argue it is both, but more about that later.

Wherever you stand on the debate, it's indisputable that stark health disparities exist in Colorado and nationwide. Study after study shows that your neighborhood, ethnicity, education and income levels determine the quality of and access to the health care you receive, your access to healthy food, your ability to engage in physical activity and ultimately your life expectancy – for better or for worse. Should people from affluent neighborhoods live longer and healthier lives than people who reside in a poor subdivision? I'd like to think that most Coloradans would answer "no."

The latest edition of Health Elevations explores the issue of health equity while looking at how innovative thinkers are bridging the divides by improving health and health care for all. We ask experts (including speakers from the 2012 Symposium) to examine why and how these divides affect individuals' lives and the economy.

As I said earlier, the question about whether health is a personal responsibility or a right isn't an either/or proposition. But taking personal responsibility is more challenging when communities lack the resources where people can practice healthy living; obtain health coverage; and gain access to quality, coordinated care.

In Colorado, I'm encouraged by the work that safety-net clinics and other nonprofits are doing to bridge these health divides. But despite innovative programs and growing public will, the goal of true health equity remains elusive statewide and nationwide.

We live in America, where everybody is entitled to aspire to a quality of life that includes health. Why should we aspire to anything less?

By making health equity a shared value, we can improve life and the pursuit of happiness for hundreds of thousands of Coloradans.

Policy Speakout: Medicaid expansions will help Colorado's economy

Editor's note: This posting original appeared in Health Policy Solutions.

Charles Brown is president of Charles Brown Consulting, a public policy and economic consulting firm, and director of Colorado State University's Colorado Futures Center.

When the Colorado Health Foundation commissioned my team to study the economic and budgetary impacts of expanding eligibility for the Medicaid program, we looked at the issue objectively through a dollars-and-cents lens. From a pure economics perspective, we needed to determine how the Colorado economy would be affected by expansion or no expansion.

In conducting the assessment, we used a wide range of data to calculate detailed projections on the costs, savings and economic impacts associated with expanding or not expanding Medicaid through fiscal year 2025-2026.

The results of our analysis, highlighted in the just-released Colorado Health Foundation report, "Medicaid Expansion: Examining the Impact on Colorado's Economy," show that the Colorado economy will grow more with Medicaid expansion than without it. In short, expansion will have a net positive impact on the Colorado economy.

Among the findings:

• Colorado will gain 22,388 new jobs by 2026 (including 14,357 in the first 18 months of implementation) if Medicaid eligibility is expanded.

• Medicaid expansion would stimulate $4.4 billion in economic activity and increase average annual household earnings by $608 a year by 2026.

• Over the period of the analysis, the cumulative costs of Medicaid expansion are less than the costs of no expansion.

• Medicaid expansion will reduce the number of uninsured non-elderly Coloradans by 189,000 by 2026.

• Economic growth from Medicaid expansion will generate more state tax revenues – an estimated $128 million more by the end of 2026 – without increasing state tax rates. These added revenues, coming from new jobs and other economic drivers, should defray the gradual cost of expansion to the state.

Established in 1965, Medicaid has functioned as a jointly-funded federal and state government health program. Currently, more than 670,000 Colorado citizens are enrolled in Medicaid, with 60 percent being children and 18 percent being the aged or individuals with disabilities. Medicaid expansion would enable Coloradans to qualify for Medicaid coverage provided they fall under 138 percent of the federal poverty level (FPL). The level equates to an annual income of $15,415 for a single individual and $31,809 for a family of four.

Though expanding Medicaid eligibility for those under 138 percent of FPL will have budgetary implications for the state over time, the report makes clear that the economic gains from the expansion will offset those costs.

More details about the economic impact, state budget implications and policy options are available in the report, which makes clear that Medicaid expansion is the right move for Colorado's economy.

Check out this infographic for a visual representation of what expansion would mean for Colorado.