Opinion

Colorado legislature’s budget decisions threaten to put the state’s small, rural hospitals at risk by pulling a funding source on which they depend.

Paying for health care for individuals who have neither insurance coverage nor the ability to pay for it is one of the most serious pressures on the health care system. The most recent attempt to repeal the Affordable Care Act failed, but it won’t be the last. Right now Anthem is considering pulling out of the state insurance exchange, leaving some communities in Western Colorado without an ACA option.

Now, the budget package before the state legislature includes a $264 million cut to the state’s hospital provider fee, which uses a fee collected from hospitals to help pay for care that would otherwise go unreimbursed. The state’s portion is matched dollar for dollar with federal funds, so the cut would mean $528 million less for Colorado’s hospitals next year.

That threatens small hospitals in rural counties where patients tend to have less income and less insurance coverage. Both Montezuma and La Plata counties have higher rates of uninsured patients than the state average.

The problem is that the hospital provider fee revenue pushes the state over the constitutional limit created by the Taxpayer Bill of Rights, triggering rebates to taxpayers. Those rebates cannot come from provider fee dollars, and paying them from the general fund triggers costs to other programs.

One proposal would turn the hospital provider fee program into an enterprise fund and remove it from the TABOR cap. That plan is part of Senate Bill 267, which also would allocate $300 million for roads in rural counties and $400 million for rural and small-enrollment school districts.

Those all are good things. Tying them all together might not be, especially in a bill that would use state buildings as collateral for a $1.35 billion bond.

The budget struggle is real, but the legislature must avoid harming hospitals and schools in the rural parts of the state. It especially must preserve the hospital provider fee at a time when so much else about how we pay for heath care is unsettled.