Over the past year, property taxes have dominated Colorado’s state politics like rarely before.

Public outcry over a 40% jump in homes’ taxable values spawned a multi-million dollar ballot fight, a special legislative session and a bipartisan commission to study tax relief for homeowners. And there’s more to come, with a number of property tax measures vying for voter approval on the November 2024 ballot. 

There’s just one detail that’s difficult to square with the political panic: Study after study from researchers across the political spectrum shows that Colorado’s property taxes aren’t all that high. In reality, they’re close to the lowest in the entire country.

They’re “extremely low,” says Sen. Chris Hansen, D-Denver, who chairs the study committee. “I think you get the rapid rate of change and it makes it look like it’s — in quotes — ‘out of control.’ ”

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Consider the $2,900 tax bill on the median-value Denver home.

In Los Angeles, a homeowner would owe around $6,400 a year on the same $550,000 house, or $10,900 on the median L.A. home worth $940,000, according to a Colorado Sun analysis.

A New York City resident would expect to pay $6,700 on a $550,000 home — or twice that on the median New York home worth north of $1 million.

It’s not just high-cost coastal states, either. In Dallas, the median homeowner pays a little over $4,000 a year in taxes on a home worth $300,000. In Salt Lake City, homeowners can expect to pay $300 more per year than their counterparts in the Mile High City on a similarly priced home.

So why do property taxes feel so high to so many Coloradans?

For starters, home values have increased rapidly in recent years. Residential assessed values in the state have risen nearly 150% since 2010, according to Colorado Legislative Council staff data. They’ve grown 55% faster than inflation in the period.

Colorado’s assessment cycle only exacerbates the sticker shock. Unlike the cost of goods, which tend to go up gradually over time, two years’ worth of home price increases hit taxpayers all at once when county governments reassess property values every other year.

“What our citizens are feeling right now is the dramatic increase,” said Rep. Lisa Frizell, R-Castle Rock, who serves on the commission. “It’s cumulative. Since the pandemic people just saw their cost of living increase and increase and increase. Buying bread or eggs, or milk. This is just kind of another punch in the face.

“The question is at what point is the breaking point for families in this state?” said Frizell, a former Douglas County assessor.

There’s another factor less discussed by policymakers. Property taxes in Colorado are wildly unequal — so much so that homeowners in some neighborhoods are stuck with bills rivaling some of the highest tax states in the country.

For most, taxes remain low. But that doesn’t tell the whole story.

The disconnect between the typical low tax bill in Colorado and what some homeowners face has put policymakers in a bind as they try to come up with promised reforms to the state’s property tax system.

State lawmakers are responsible for setting the residential assessment rate and exemptions, which determine how much of a home’s value gets taxed. But everything else happens at the local level: counties assess how much homes are worth and local governments set the actual tax rates, known as mill levies.

Colorado now has over 4,700 local governments and special service districts, that overlap in thousands of possible combinations to produce someone’s actual tax bill.

The corner of East Wesley Drive and South Ceylon Way in Aurora provides a potent illustration of the problem.

The homes there, valued at around $600,000 each, look almost identical. The children who live there attend the same schools. They receive the same city services, draw their water from the same utility and check out books from the same library.

But families who live on one side of the intersection pay thousands of dollars more in property taxes each year than those who live on the other.

Three vastly different tax bills in the same neighborhood

Your tax bill may not look the same as your neighbors’. Colorado has more than 4,000 local government entities that all charge different rates. Taxes can vary greatly in metropolitan districts in particular.

Editor’s note: Tax rates are often expressed as a mill levy. A mill is a $1 payment on every $1,000 of assessed value.

Home value: $621,300
Tax rate: 161.9 mills
Tax bill: $6,142.73

Taxing Authority	Levy
Aurora School Dist. #28J	71.331
Arapahoe County	11.206
Developmental Disability	1.000
City of Aurora	8.407
Iliff Commons Metro Dist. #2	68.954
Urban Drainage & Flood	0.900
Urban Drainage & Flood (S Platte)	0.100

Home value: $612,600
Tax rate: 92.9 mills
Tax bill: $3,472.29

Taxing Authority	Levy
Aurora School Dist. #28J	71.331
Arapahoe County	11.206
Developmental Disability	1.000
City of Aurora	8.407
Urban Drainage & Flood	0.900
Urban Drainage & Flood (S Platte)	0.100

 

Home value: $607,200
Tax rate: 138.0 mills
Tax bill: $5,104.02

Taxing Authority	Levy
Aurora School Dist. #28J	71.331
Arapahoe County	11.206
Developmental Disability	1.000
City of Aurora	8.407
Sterling Hills West Metro Dist.	45.014
Urban Drainage & Flood	0.900
Urban Drainage & Flood (S Platte)	0.100

Photos: Olivia Sun, The Colorado Sun via Report for America
Source: Arapahoe County Assessor’s Office

The culprit is two of Colorado’s 2,000-plus metropolitan districts, special taxing authorities set up to fund infrastructure.

Over 70 of them charge higher tax rates than the average Colorado county, city and school district combined, a Colorado Sun analysis of Department of Local Affairs data found. That leaves their residents paying twice as much or more in taxes than the typical Coloradan.

And that’s not the only way the national statistics on Colorado’s low tax rates can be misleading.

Colorado homeowners pay the third lowest tax rate in the country. But because home values are so high here, that results in a tax bill that’s just below average, ranking 29th nationally, according to the Lincoln Institute of Land Policy. As a share of personal income, Coloradans pay the 15th most in property taxes — a number that’s gone up dramatically since 2009, when the state ranked 26th.

Temporary tax cuts passed by the legislature and a number of local governments have blunted the latest increase for many homeowners. But that’s small comfort to those who live in communities where housing costs have gone up the most.

Mike Meehan, a retiree in Avon, told The Sun his property tax bill still went up 24.8% after the cuts.

“On the other hand, my Social Security payment went up 3% — a mismatch of 21.8 (percentage points), and I am not happy,” Meehan wrote in an email. “Ultimately, my choices are to dip into savings to fund the difference or sell my house.

“Neither choice is palatable.”

Cooling home prices give policymakers pause

The big jump has given way to a cooler housing market, with home prices receding from their summer 2022 peak. And state economists expect housing costs to grow more slowly in coming years. But people’s tax bills this year reflect what homes were worth at their height.

“There’s always a danger of what generals would say is fighting the last war,” Hansen told The Sun. “We need to make sure we don’t do that.”

Colorado’s property tax commission on Friday referred a handful of tax relief recommendations to the full legislature for consideration, but they stop well short of the large, across-the-board tax cuts that conservatives and business groups outside the Capitol have called for.

Further complicating matters, lawmakers in both parties and Gov. Jared Polis have been quick to take credit for the positives that have resulted from rising property taxes. Next school year, the state expects to eliminate its K-12 school funding shortfall for the first time since the Great Recession.

That’ll be top of mind for the legislature’s Democratic majority as they weigh how much relief to provide going forward.

“There’s a lot of talk about us paying off the (funding deficit) for education this year,” said Rep. Chris deGruy Kennedy, D-Lakewood, another tax commission member. “It’s almost entirely because of local district revenue.”

Graphics by Danika Worthington, The Colorado Sun

Let’s get something out of the way: Resort skiing is an expensive sport. A carload of specialized gear, a full tank of gas, a $20 burger and $6 Coors Light at the lodge. It starts to add up quickly — and that’s before you even get on the mountain. It’s no wonder that some feel like there’s a tradeoff between a day on the mountain and a month’s rent.

But here’s the thing. Used gear is easier to acquire than ever before. Most of those mountain lodges — the ones with the $20 burgers — also have microwaves. And skiers who plan ahead can ride chairlifts for some of the lowest prices in decades.

Until the early 2000s, ski area operators shouldered the risk of their snow-dependent business. When the snow piled deep, lift tickets sold quickly. When it didn’t, operators tightened their belts. 

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The introduction of discounted season passes in the early 2000s shifted more of the financial risk of resort skiing over to the skiers. By committing $600 to $1,000 for a season pass months before lifts start turning, skiers assumed the will-it-snow risk that used to haunt resort operators. As an incentive, skiers who buy early get the lowest prices, similar to the airline industry.

On the other hand, skiers who wait to buy lift tickets at the last minute are paying record-high prices, with window tickets at some of Colorado’s most well-known ski areas — Aspen, Winter Park, Telluride and Steamboat Springs — exceeding $200 for a single-day ticket, on average, between January and March. During holidays and weekends, those prices surge closer to $300 per day.

“It makes sense to lock in revenue when you’re a weather-dependent business — you have staff relying on you for their income, utility bills that don’t care when the snow falls, and future capital investments to plan for,” said Adrienne Saia Isaac, director of communications for the National Ski Area Association.

The bottom line is: if you don’t plan ahead, skiing has never been more expensive. If you do plan ahead, skiing has never been more affordable. 

The shift to season passes

Winter Park was the first to launch the so-called season pass war with a pack of four season passes for $800 in 1998, followed closely by Intrawest offering its Rocky Mountain Super Pass for Copper Mountain and Winter Park in the early 2000s. 

These days, it’s more cost effective to buy a season pass than day passes at all but eight Colorado resorts if you plan to ski more than eight days, or four winter weekends. 

In 2008, Vail Resorts introduced the Epic Pass and sold 60,000 of the passes for the 2008-09 season. The Epic Pass offered unlimited skiing at five Colorado resorts and Heavenly Mountain in California. They didn’t just add up the cost of six season passes and cut a percentage. The Epic Pass was — and still is — a solidly middle-of-the-road price for season passes to any single mountain in Colorado. This season, for example, the average season pass across all operating ski resorts was $858.70. Last year’s Epic Pass cost $859 for the early purchasers. The company sold 2.4 million Epic passes and early-purchase lift tickets.  

By giving skiers options paired with discounts, Vail Resorts pushed the pass war into new territory.

In 2018 the privately held Alterra Mountain Co. debuted the Ikon Pass, a $649 rival to Vail Resorts’ Epic Pass. The Ikon Pass offered access to 23 resorts across North America. It has since expanded to offer unlimited skiing at 16 ski areas and up to seven days at another 41 global ski destinations. The following season, Vail Resorts introduced advanced-purchase single-day lift tickets, with prices around $100 a day for buyers who purchased months before winter, creating a lower-commitment way to secure more skiers. An early-purchase Epic Day Pass for the 2023-24 season costs $113 a day.

In 2021, Vail Resorts doubled down on its advance commitment strategy, dropping the price of the Epic Pass to $783, the lowest price since the 2015-16 season, and about the only thing in the ski industry that got cheaper post-pandemic. 

Vail Resorts now generates close to $3 billion in revenue a year and hosts close to 18 million visits to its 37 North American ski areas, which include the largest and most trafficked on the continent: Park City Mountain Resort, Breckenridge and Vail. Last season, about three-quarters of those visitors were pass holders.

Last week Alterra Mountain Co. and Vail Resorts announced prices for the 2024-25 passes, with annual increases around 8%.

The Ikon Pass, with access to 58 ski destinations and April skiing for early-purchasers at several resorts including Steamboat and Winter Park, starts at $1,249 and the more restrictive Ikon Base selling for $869.

Vail Resorts’ Epic Pass is selling for $982 for 2024-25, with unlimited access to all 42 of the company’s ski areas, plus seven days at Telluride ski area and access to partner resorts in Canada, Europe and Japan. The company’s Epic Local is offered for $731 with holiday restrictions and unlimited access to 32 ski areas. Epic Day passes sell for as little as $52 for non-peak days at 22 resorts, up to $129 for unrestricted access to all 42 ski hills. 

But what about all of the resorts that aren’t owned by Vail?

The Epic and Ikon Passes combined only account for 9 of Colorado’s 30 operational ski hills and resorts (12 if you count Arapahoe Basin, Aspen and Telluride, where you can ski a limited number of days as a pass holder). 

In fact, 55% of US ski areas are considered small, and the majority of ski areas are independently-owned, according to Isaac of the National Ski Area Association.

The astronomical walk-up window prices at Epic and Ikon resorts opened opportunities for small ski areas, like Ski Cooper, Echo Mountain and Sunlight, all of which offer lift tickets for less than $100. If you’re really looking for a deal, seven of those 30 resorts offer tickets for less than $50.

Most of these are really ski hills (as opposed to ski resorts) that offer a rope tow up a local rise. These are great spots to learn how to ski or mess around in the terrain park. Lake City Ski Hill, for instance, includes equipment rental in its $30 day-pass price, making it a great option for someone who wants an introduction to the sport without the investment. 

The outlier in this group is the 11-lift, 100-run Purgatory, outside of Durango, which is owned by Mountain Capital Partners, the operator of 11 ski areas and a snowcat operation in Arizona, Colorado, New Mexico, Nevada, Utah and Chile. Day passes to Purgatory can dip as low as $35 — again, if you’re able to plan ahead. They also hit the laughably low price of $9 in April, which might be a direct correlation with snow conditions that time of year.

The Lake County-owned nonprofit Ski Cooper squeaks into the under $50 category one day per week. Their $30 Thursdays program in January and February offers skiers seven chances to snag a $30 lift ticket, $30 rentals and $30 off ski lessons.

There has also been a boom in season pass competitors. The Indy Pass, for example, offers two days at 180 different ski areas in the U.S. The Mountain Collective Pass also offers two days at 12 major ski areas in the U.S., with 50% off day-passes on subsequent days. And many smaller resorts have reported strong visitation and revenues as they find opportunities in the shadow of the dueling Alterra Mountain Co. and Vail Resorts. 

Across all 30 ski areas — from Lee’s (free) Ski Hill in Ouray to $290-plus a day in Aspen — the average cost of a day of skiing from January to March, not including major holidays, is $101. That’s also the exact price of an advanced-purchase day at Beaver Creek, Breckenridge and Vail, three of the five main Epic Pass Colorado mountains. Yes, all paths really do point to Epic.

Three Ski Freebies

Free RTD to Eldora

The discussion about better public transportation to ski areas has lasted eons, and Eldora is one of the few places that has really taken it seriously. On weekends throughout winter, skiers can take a free RTD bus or a free shuttle between Boulder and Eldora. The bus leaves from downtown Boulder station (the Park-n-ride garage above it is also free on weekends), and the shuttle picks passengers up at the Boulder County Justice Center. The bus and shuttle schedules alternate every hour from 6:10 a.m. to noon, and head down the mountain from noon until 5:15 p.m. Save on gas and get a guaranteed front-row spot. 

Free skiing at Howelsen Hill, Lee’s Ski Hill, and Ruby Hill Park

Howelsen Hill, also known as “town hall” and “the other Steamboat ski area” offers free skiing every Sunday. No caveats or reservations, just pick up your free ticket at the ticket office. If you’d rather hit Howelsen on a quieter day — free does mean crowded — the day pass costs $47, making it one of the cheaper Colorado options.

In Ouray you’ll find Lee’s Ski Hill, the smallest ski area in Colorado, and the only one that is consistently free of charge. Anyone can grab onto the rope tow, which operates from 3 p.m. to dusk on weekdays and noon to dusk on weekends. 

Park skiers in the Denver area can hit the Ruby Hill Rail Yard for free starting on Jan. 26 into March, weather permitting. Beginning Feb. 2, Ruby Hill offers free equipment rentals Thurs.-Sat. 

Free kids skiing

The easiest way to get a free day of skiing is to be a kid. Not only because your parents have to pay for everything anyway, but because almost all of Colorado’s resorts offer free skiing for kids under 5. Purgatory offers free skiing for kids up to 12 years old, and at Copper Mountain an adult season pass comes with a free season pass for anyone under 15.

So, really, why is skiing so expensive?

To put it simply, resorts want you to buy passes ahead of time rather than during the ski season.

Skiing is a high-overhead operation: lifts and lift maintenance, grooming, insurance, climate change resiliency measures and staff to run it all. Isaac of the National Ski Area Association said that when ski areas close, the most often reason they hear is lack of capital. “That’s a real issue for many areas, especially as infrastructure ages and guest expectations evolve,” she said.

Incentivizing guests to make their ski plans ahead of the season created “unprecedented stability for our industry, which had previously been ruled by weather,” said Laura Bonfiglio, senior manager at Vail Resorts. “We lock in revenue ahead of the season – which has allowed us to continually invest back into our resorts/guest experience, our employees, our communities and even the environment, no matter the winter we have.”

Financial stability allows resorts to invest in their equipment, employees and sustainability initiatives without having to worry about being smited by Ullr. (Getting bad press about long lift lines, though, is another story).  

To incentivize people to buy early, most resorts these days deeply discount passes before the season, and steeply mark-up in-season and day-of sales. 

“By getting people to commit to their skiing before the season, the skier gets a great deal, and the resort gets a great deal. There’s a partnership,” Bonfiglio said. 

But of course, there’s also something to be said for the danger of pricing out the casual skier. “I think about that a lot, and wonder how we can make it easier to bring a friend,” Isaac said. “I’m hoping ski areas can see the value in growing the pipeline this way, too.”

So, will we see you on the slopes next season? If so, you better start planning it now.

Graphics by Danika Worthington, The Colorado Sun.

Colorado’s largest private sector union violated federal labor law in its treatment of its internal, union-represented employees by refusing to bargain with them in good faith and by inviting workers to resign in response to their complaints about working conditions, an administrative law judge found.

National Labor Relations Board Judge Eleanor Laws also ruled that Kim Cordova, president of United Food & Commercial Workers Local 7, tried to persuade her employees to drop their association with their union — another violation of the National Labor Relations Act.

Laws’ findings are roiling some in Colorado’s union community, who fear how the report may reflect on the broader labor movement. They’re also notable given the wide reach and power of United Food & Commercial Workers Local 7, known as UFCW 7, which represents 23,000 people who work at grocery stores, meat packing facilities, food processing plants and other workplaces in Colorado and Wyoming.

The union and Cordova have been in the news a lot in recent years. They fought for meatpacking worker protections at the outset of the COVID-19 pandemic and then made headlines again in 2022 when King Soopers employees in Colorado went on strike to successfully persuade the grocer to increase wages — by up to $5 an hour for some.

But the 53-page report issued Feb. 8 by Laws, as well as Colorado Sun interviews with several UFCW 7 employees, reveal that trouble has been brewing behind the scenes between Cordova and her staff of a few dozen people.

“I could not work there another day, not with the way she is running that place,” Randy Blea told The Sun in an interview. Blea started working at UFCW in 2011 as a union representative but was fired in September in what he says was retaliation for his criticism.

Cordova, who is running for reelection this year to a sixth three-year term as president, and other members of the UFCW 7 leadership team didn’t respond to multiple requests from The Sun for an interview.

Pressure built around the King Soopers strike

The relationship between Cordova and some of her union-represented staffers started souring in January 2022, toward the end of the nine-day King Soopers strike, according to Laws’ report and the UFCW employees interviewed by The Sun.

The union’s staffers had been putting in long hours on the picket line in the cold. They commented about their exhaustion and frustration with how the strike was going during a Zoom call with local and national union leaders.

Cordova wasn’t present during the Zoom gathering, but she called a staff meeting on Feb. 7, 2023, where she said she was embarrassed by what her employees had said on the call. She also suggested they were well compensated and could leave their jobs if they were unhappy, according to Laws’ report.

“Regardless of the precise words Cordova uttered,” Laws wrote, “the employees at the meeting were essentially presented with two choices: Either suck it up and deal with the adverse working conditions or work elsewhere.”

“My whole life I would have never allowed anybody to speak to me like that,” Blea told The Sun, “but it was just normal there with her.” 

The King Soopers strike and the Feb. 7 meeting marked a turning point for Zack Lewis, a UFCW 7 worker who also alleges he was fired for speaking out against Cordova and her leadership team.

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“I can tell you that when I first started working for Kim Cordova, I highly respected her,” Lewis said in an interview with The Sun. “But as we got to the strike, and the pressure started to mount, there was a change.”

Lewis, who began working at the union in 2020 and was fired in December 2022, said planning for the strike was minimal and when it began, the picketing was disorganized. There were problems getting striking workers paid out of the union’s strike fund.

“It was a nightmare,” he told The Sun. 

Among Laws’ other findings, UFCW 7 violated federal labor rules by:

• Requiring employees to return their work equipment because they might strike and also by requiring that they check in and check out their equipment, like computers and keys, each day
• Disparaging or denigrating the UFCW 7 workers’ union, the Federation of Agents & International Representatives Union, or FAIR. Laws found UFCW leadership also violated federal labor rules by falsely telling employees that during a bargaining session FAIR told Cordova to discipline and fire staff.
• Failing to continue the grievance procedure in the FAIR collective-bargaining agreements after they expired
• Failing and refusing to bargain in good faith, “including by insisting as a condition of reaching a successor collective-bargaining agreement that FAIR consent to a nonmandatory bargaining proposal”

Judge orders corrective action

As part of her report, Laws ordered UFCW to stop its unfair labor practices and required the union to take actions to prevent further violations, including bargaining with FAIR before making any changes in wages and/or work hours. 

The judge also required UCFW to post a notice at the union’s Wheat Ridge office explaining that it had violated federal labor law and listing all of the violations.

But in the wake of the dust-up, a wave of the union’s employees, many of them longtime staffers, have left or were fired. 

Blea said the reason he was given for his termination was that he didn’t follow up with a client. Meanwhile, Lewis said he was told he was fired for failing to turn in a doctor’s note about a leave of absence caused by emergency back surgery. 

Both men argue their firings were unfair and unwarranted.

“I loved what I did,” Blea said. “I loved that job, absolutely. You get paid to help people.”

Lewis said he just wants Cordova to lead by example.

“I would like her to practice what she preaches,” Wilson said. “She makes a living calling out the CEOs of these companies, but she uses the same tactics.”

Cordova has been the president of UFCW 7 since 2010, after longtime president Ernie Duran Jr. was voted out of the position. According to UFCW filings, Cordova is paid more than $200,000 annually.

Cordova is up for reelection in the fall. Each term as the union’s president lasts three years.

Brea, who now works for King Soopers, said he plans to run against her.

AURORA — The ring sparkled: 18-karat white gold, double-banded, with a 1.5-carat diamond at its center.

It was the ring that Cathy Woods-Sullivan’s late husband had given to her on their wedding day, a family heirloom. Other than their two teenage daughters, it was the most precious thing she had left.

She handed it forward to the pawnbroker feeling sick to her stomach.

He looked at her, then at the ring, then back up at her.

“I’m going to hold onto it for a little while,” he said.

“Diagnosis: Debt Colorado” is a reporting partnership among KFF Health News, the Colorado News Collaborative, The Colorado Sun, 9News, Colorado Newsline and The Sentinel exploring the scale, impact, and causes of medical debt in Colorado. The ongoing series branches from KFF Health News’s award-winning reporting on medical debt in the United States.

But Woods-Sullivan knew she wouldn’t be back.

She needed the money to pay off a debt to UCHealth, Colorado’s largest hospital system, one that collects more than $6 billion a year in revenue from patient care. 

“We improve lives,” UCHealth touts in its mission statement.

But this same system sues thousands of its patients like Woods-Sullivan every year, according to a 9News/Colorado Sun investigation done in partnership with the Colorado News Collaborative and KFF Health News. 

What’s more, many of these lawsuits are shielded from public scrutiny through a system in which collection companies working with UCHealth file lawsuits in their own names. Taken together, UCHealth and these companies filed 15,710 lawsuits from 2019 through 2023, UCHealth revealed in response to questions from 9News and the Colorado Sun. That is an average of 3,142 lawsuits per year, or more than eight per day.

In the last four years, virtually none of the lawsuits have been filed in UCHealth’s name.

“They are essentially deliberately using those third-party collection agencies to obscure the fact that they are the ones suing the patients,” said Adam Fox, the deputy director of the Colorado Consumer Health Initiative, a consumer-advocacy group that helps patients in disputes over medical bills. “It makes it really hard for the patient to untangle.”

One of these debt collection companies working for UCHealth sued Woods-Sullivan over a debt from an emergency visit for chest pains. She tried at first to fight in court, then eventually entered into a payment plan to settle the case.

But when the stress of arguing with the debt collector over how much she still owed after every check was too much, she decided she just wanted to be done.

She looked through her house for something she could sell.

“It was beautiful, beautiful,” she said of her ring. “But I had to do what I had to do. I was tired of getting the runaround.

“It was all I had.”

Woods-Sullivan owed UCHealth $1,634.34.

The health system, which as a nonprofit community institution is exempt from paying taxes, recorded $839 million in total profits last year.

“It would look like UCHealth was filing these suits.”

In a given year, UCHealth’s network of 14 hospitals and more than 200 clinics treats almost 3 million patients — a number equivalent to roughly half the state’s population.

From those patients, UCHealth estimates that 99.93% of bills are resolved without involving the courts.

“Our job is to stay out of the courts,” said UCHealth’s chief legal officer Jacki Cooper Melmed. “That is the very last resort.”

And yet, hundreds of new lawsuits are each month filed against UCHealth patients for debt the hospital system claims it is owed, making UCHealth among the most litigious systems in the state, according to consumer advocates.

Until now, no one outside UCHealth knew how many lawsuits the system had actually filed, though, due to the collections practice UCHealth has adopted. The hospital system “assigns” the debt to a debt collector without relinquishing ownership of the debt. The debt collector — UCHealth currently uses two and has used a third in the past — then files the lawsuits against the patients in its own name, which is often nondescript. Credit Service Company. CollectionCenter, Inc.

The debt collector gets a cut of whatever money comes from the lawsuit — Cooper Melmed did not say how much — with the rest going back to UCHealth.

Most often, no publicly available court document contains UCHealth’s name, making the system’s involvement in these suits invisible to lawmakers, to state regulators and to the public at-large.

Woods-Sullivan said she initially had no idea who was suing her.

“After I called the creditors, they told me it was University, so I went to University Hospital to try to get some help, to get some clarification,” she said. “I spent two days trying to reach out to people … just going through the process of trying to resolve the issue with the bill. I was willing to pay, but it’s just so many people I have to talk to.”

The amount UCHealth collects from lawsuits is about $5 million per year, according to the health system. That represents 0.07% of the net patient revenue that UCHealth reported receiving last year.

UCHealth officials argue the lawsuits are an unfortunate necessity in the health care business. Hospitals need money to continue operating, and sometimes bills go unpaid.

I had to do what I had to do. I was tired of getting the runaround. It was all I had.

— Cathy Woods-Sullivan, on the diamond ring she pawned to help pay off debt owed to UCHealth

At a time of rising costs and budget crunches, they said they are providing more uncompensated care — which UCHealth defines as charity care that it has decided to provide for free, as well as so-called bad debt, which is care that the system wanted to be paid for but wasn’t, and shortfalls in Medicare and Medicaid payment rates. The amount was $580 million in the most recent fiscal year, a more than $200 million increase over 2019 numbers. They said the money collected annually from lawsuits is enough to pay for the salaries and benefits of approximately 60 health care workers.

Cooper Melmed, the chief legal officer, said the large number of lawsuits simply reflects the large volume of patients UCHealth sees in a year.

“I can tell you it is a common practice,” she said. “I don’t think UCHealth is an outlier here. We’re not an outlier in the number, and we’re not an outlier in the way to go about this.”

But not all large hospital systems in Colorado choose to pursue patients this way. The second-largest hospital system in the state, for-profit HealthONE, says it does not sue patients over debt. AdventHealth and Banner Health, two other large nonprofit hospital systems operating in Colorado, also said they do not sue patients.

SCL Health, which is a nonprofit like UCHealth, had sued hundreds of patients in Colorado per year under its own name, according to an analysis of court records. But when the system merged with Intermountain Health in 2022, it stopped.

“This was done to better align with our mission,” Intermountain spokeswoman Sara Quale wrote in an email.

Debt collection lawsuits are among the most devastating products of a medical debt crisis that now burdens some 100 million people in the U.S., threatening patients’ homes, their savings, even their health. 

An investigation by KFF Health News in 2022 found that about two-thirds of hospitals across the country have policies that allow them to sue or take other legal action against patients, including garnishing wages. But in recent years, major hospital systems in other states have chosen to stop suing patients over medical debt, often following negative publicity.

One way to avoid that publicity is to sue under a debt collector’s name.

The nonprofit Pew Charitable Trusts, which has researched debt collection litigation across the country, found third-party collectors suing on behalf of creditors in Oregon and Utah.

The Sun and 9News found at least two other hospital systems in Colorado — nonprofits CommonSpirit Health and Children’s Hospital Colorado — that admit to using debt collectors to file lawsuits on their behalf but not under their name. Because of this, it is unclear how often they sue patients.

Some hospitals are more transparent in their litigation. A spokesman for National Jewish Health wrote in an email that, “If a lawsuit is deemed necessary, we use our own name in all matters.” 

Cooper Melmed defended UCHealth’s use of collections vendors and the system of having them file lawsuits under their names. She said she believes there is “complete transparency” with patients about where the suits are coming from, and she said having the lawsuits in UCHealth’s name would confuse patients.

“It would make less sense, honestly, to do that because the debt at that point is assigned to the vendor,” she said. “So the real party who has control over the suit is the vendor.”

“We are not hiding anything. There is no mystery about what’s going on here.”

There was a time, though, that UCHealth did use its own name in its debt lawsuits. A 9News analysis of court filings found thousands of debt cases in 2018, 2019 and the early months of 2020 where UCHealth was the named plaintiff.

Cooper Melmed said UCHealth paused all debt-collection lawsuits for about six months when the COVID-19 pandemic hit. When that pause ended, UCHealth’s debt lawsuits no longer listed the hospital system as the plaintiff, according to the analysis. Cooper Melmed did not offer a clear explanation for the change, other than to reiterate that she believes suing under the debt collector’s name is less confusing to patients.

But this isn’t the only comment UCHealth officials have made about the litigation strategy.

In 2022, a UCHealth manager was deposed in a lawsuit challenging the legality of how UCHealth collects its debts. An opposing attorney asked the manager whether it benefitted UCHealth to not be named as the plaintiff in the debt lawsuits. The manager said it did.

“Why?” the attorney asked.

“It would be optically bad,” the manager responded.

“Why would it be optically bad?” the attorney pressed.

The manager responded: “It would look like UCHealth was filing these suits.”

After grief came debt

The knock on her door came while she slept following an early-morning shift at work, and Cathy Woods-Sullivan’s daughters answered fearfully. When Woods-Sullivan later asked them why they had opened the door, she said her girls, then 16 and 14, told her it was because the process server said, “I’m from the courts.”

This was in January 2019. Two-and-a-half years earlier, Woods-Sullivan’s husband of 22 years, Rodney, had died after a long battle with kidney failure. During his last years, his medical care had totaled more than $800,000, Woods-Sullivan said. And though it was covered by Medicaid, she said the bills still arrived at their house.

In the fog of grief after Rodney’s death, more medical bills arrived. Some were for one of her daughters, and one was for her, from a day in 2018 when she went to the University of Colorado Hospital ER thinking she was having a heart attack but was told it was a panic attack.

The bills seemed to swirl around her — from the hospital, from different doctors, pay this, don’t pay that.

“I was getting so many medical bills,” she said.

When she called UCHealth, she said she was told the bills would be covered. She wondered why she was even receiving bills for her own care, since she had insurance and thought she had reached her deductible.

We are not hiding anything. There is no mystery about what’s going on here.

— Jacki Cooper Melmed, UCHealth’s chief legal officer

It wasn’t until she was sent a letter by one of UCHealth’s collections vendors, Credit Service Company, that she said she finally saw an itemized list of what UCHealth claimed she owed them. And even then it didn’t seem right. Three of the bills that were included in the letter were for her daughter, who Woods-Sullivan believed was covered by Medicaid at the time.

Woods-Sullivan said she twice went to University of Colorado Hospital, hoping to talk with someone who could help her receive financial assistance or come to a resolution.

“They told me there’s nothing they can help me with,” she said. “It was turned over to a credit collection agency.”

After she was sued, Woods-Sullivan enlisted the help of Colorado Legal Services, a nonprofit that works with low-income Coloradans. That, alone, makes her case unique, as the vast majority of people facing medical debt lawsuits don’t have legal representation.

But once her lawsuit was settled, Woods-Sullivan did something else. She became one of the lead plaintiffs in the lawsuit against Credit Service Company that alleges that the company’s work on behalf of UCHealth violates state law.

“It is our position that if UCHealth wants to sue people for unpaid medical debts, then UCHealth has to put its name on the lawsuit,” said David Seligman, an attorney and the executive director of Towards Justice, the nonprofit legal organization that is representing the plaintiffs in the case.

Lawyers for Credit Service Company contend that once CSC has decided to initiate a lawsuit, its agreement with UCHealth says the system “irrevocably assigns all rights, title and interest” in the debt to CSC. Citing the lawsuit, a representative of CSC declined to comment for this story.

The lawsuit, which was filed in 2020 and is seeking class-action status, remains pending in Denver District Court.

Recently, Woods-Sullivan said, she was involved in a car accident with a semi truck off of Interstate 225 in Aurora. Paramedics arrived and asked if she wanted to go to the hospital. And, though she was in pain, she said no.

“I’m scared to go to the hospital,” she said. “I’m scared of the debt and to go back through what I’ve been through. I never want to ever feel that way, ever again.”

7 letters, 4 bills and 2 phone calls

UCHealth was formed in 2012 when the University of Colorado Hospital — which is overseen by a quasi-governmental entity called the University of Colorado Hospital Authority — merged with Poudre Valley Health System.

The resulting nonprofit soon began a campaign of mergers and new construction that has created a system with more available hospital beds and more revenue in Colorado than any other, according to one recent report. UCHealth’s latest merger, with Parkview Health System in Pueblo, gives it a presence in every major population center on the Front Range.

Today, UCHealth says it is the largest provider of Medicaid services in the state. 

UCHealth is also the state’s largest provider of what is known as “community benefit” — that is, positive contributions that nonprofit hospitals make to their communities in order to justify their tax-exempt status. According to UCHealth, it provided $1.2 billion worth of community benefit in the most recent fiscal year, some of that in the form of education to medical students and more than half of that in the form of care to uninsured or underinsured patients. (A recently released state report put UCHealth’s community benefit value lower, at $564 million for 2021, though that still ranks it first in the state.)

I’m scared to go to the hospital.I’m scared of the debt and to go back through what I’ve been through. I never want to ever feel that way, ever again.

— Cathy Woods-Sullivan

“With every patient that walks through our door, our No. 1 concern is patient care,” Cooper Melmed, the chief legal officer, said.

According to UCHealth, patients receive information about prices and available financial assistance even before their scheduled visit. They then receive as many as seven financial assistance letters, four billing statements and two phone calls before the bill is sent to collectors, who then conduct their own outreach efforts.

Even if the hospital never hears from a patient, Cooper Melmed said, UCHealth also checks publicly available databases to screen them for eligibility for financial help. Cooper Melmed said if at any time during the process a patient contacts UCHealth to work out a payment solution, they should be removed from the collections process.

Dan Weaver, UCHealth’s vice president of communications, said last year’s number of lawsuits — 1,610, the smallest annual total in the last five years — is evidence that the hospital system’s practices are working to reduce bills going to the courts.

Of those who get sued, Cooper Melmed said: “We are talking about the tiniest fraction of patients that we simply cannot partner with earlier in the process.”

At least, that’s how UCHealth says it’s supposed to work.

“It’s the system.”

The pickup truck zipped down Interstate 25 just north of Colorado Springs at 75 mph early one morning in January 2021.

Lorena Sanchez, her husband, her mother-in-law and her sister-in-law were on their way to the Mexican state of Zacatecas, where they planned to visit relatives and spend time at the graves of Sanchez’s parents, part of an annual tradition. The deer, she said, leaped from the shadows.

The animals collided violently with the vehicle and sent the truck into a spin. The truck’s airbags exploded open to cradle those inside the vehicle. When the truck came to a stop, Sanchez remembers thinking, “We were lucky to survive that kind of accident.”

But what came next would prove far more stressful and more devastating.

When the paramedics arrived, Sanchez, who moved to the United State from Mexico decades ago and is now a U.S. citizen, said she told them she was uninsured and didn’t want to go to the hospital. But her chest hurt from where the seat belt squeezed her tight and she felt light-headed, so she relented.

At UCHealth Memorial Hospital North, doctors performed an X-ray and a CT scan, according to medical paperwork she showed The Sun and 9News. She remembers the visit lasting no more than 90 minutes, though her paperwork shows a longer duration — about three hours. Regardless, with no major injuries noted, she was soon on her way.

Later that spring, she said, she received a bill for more than $24,000.

She was shocked. Sanchez, who lives in Aurora, said she drove twice to the hospital in Colorado Springs to ask if she qualified for financial assistance or reduced charges as a self-pay patient. Eventually, she was given a phone number to call so she didn’t have to continue showing up in person.

“I called lots of times, tons of times,” she said.

Finally, in March 2022, more than a year after the accident, Sanchez received a letter from UCHealth.

“According to federal poverty guidelines and the documentation that we received, your application has been APPROVED for Charity assistance,” the letter stated.

It told Sanchez that she was entitled to a 73% discount on hospital charges. Her $24,000 bill had just become $6,000. It was still a lot of money — more than she could afford without entering into a payment plan — but it was massively less daunting.

Then, two weeks later, a new bill from UCHealth arrived in the mail, demanding $24,528.87. When she called for clarification, she was told she owed the lower amount. But the next month, another bill for the higher amount arrived. Round and around she went.

In July 2023, almost two-and-a-half years after the accident, there was a knock at her door, and on the other side stood a man serving her with a lawsuit by Credit Service Company. The amount allegedly owed: $24,528.87.

“I said there’s a misunderstanding,” she said. “There’s something going on.”

It’s not the doctors or the nurses. It’s the system. It’s being organized for this.

— Lorena Sanchez, who was mistakenly billed for over $24,000 for care received following a car crash

She said she made a payment on the debt in July after having been told that doing so meant she wouldn’t need to show up in court. But, when she didn’t show, the attorney for CSC filed a motion in August for default judgment against her, though now with a lower amount listed as being owed: $6,120.79, plus some court costs and attorney fees. The judge granted the motion.

When Sanchez learned of this, she said she was devastated. She filed a hand-written motion with the court, stating, “Please know that I have been sued because of (a) misunderstanding. … I apologize to you! I would like to continue making small payments, please!”

When 9News and The Sun told UCHealth officials about Sanchez’s story, Cooper Melmed called it concerning.

“That’s not at all what we strive for,” she said.

After questions from The Sun and 9News, Weaver, the UCHealth spokesman, said Sanchez’s experience was the result of billing errors.

The hospital originally sought payment from her auto insurance carrier, which denied the claim. That put Sanchez into the “self-pay” category, but her financial assistance discount didn’t transfer with her. The hospital’s system showed that the financial assistance application had been accepted, but it didn’t apply the discount to her bill.

“We have since corrected the issues that caused those errors,” Weaver wrote.

Weaver said a UCHealth billing expert conducted a review of Sanchez’s account, noticed the error and told CSC, which caused the company to change the amount it was seeking in the lawsuit.

Today, Sanchez is still making payments — $150 a month, a rate that will see her pay off the debt around the start of 2027. She said her blood pressure and anxiety levels have skyrocketed since the accident, largely, she believes, tied to the debt and billing issues. But she refuses to go to a hospital to seek care, instead preferring to seek alternative medicine treatments in Aurora or to drive to Mexico to visit doctors there.

She said she tells friends to avoid hospitals as much as possible, “unless you can’t breathe or you are bleeding.”

She has, in short, become an example of a particular kind of health care failure: A patient who says her treatment made her sicker. A patient who believes the hospital causes more injury than the accident.

“It’s not the doctors or the nurses,” she said. “It’s the system. It’s being organized for this.”

Noam N. Levey of KFF Health News and Anna Hewson of 9News contributed to this report.

When Drew Dummit’s mental illness worsened in 2017, he was admitted to Mind Springs Health in Grand Junction, the largest behavioral health services provider on the Western Slope.

Three days later, staff deemed him stable enough to go home.

Soon after, Dummit’s hallucinations worsened, he attempted suicide twice and began assaulting his mother, Sandra Sharp, more severely and frequently.

“If I could have afforded inpatient care at the time, he would have gone,” said Sharp, who lives in Denver.

But the type of care Dummit needs is expensive. Sharp was quoted about $30,000 per month when she looked for help for her son in 2017 at several inpatient care facilities.

Over the past decade, Dummit has struggled to get the care he needs, because his parents simply cannot afford it.

 Dummit has Medicaid, Sharp said. But the insurance plan doesn’t cover long enough stays in inpatient care and it doesn’t cover all of the medications Dummit needs.

For many Colorado families struggling to balance their budgets, the cost of mental health care is increasingly out of reach. In some cases, young Coloradans find their private insurance doesn’t cover the cost for services that address their mental health and emotional problems.

Low reimbursement rates from insurers have pushed many mental health care providers to only accept clients who can afford to pay out of pocket. And those who can’t afford private pay can face long wait times at the clinics that do accept their insurance.

These hurdles can be so difficult and expensive for a person with an untreated mental health condition to navigate that it’s causing some to forgo care.

The trend, mental health professionals and people with mental health conditions said, is creating devastating effects for Coloradans struggling to get care, their loved ones, their neighbors and the economy.

Sandra Sharp’s son, Drew, pictured at numerous snowboarding competitions, skateboarding and attending a Congressional Youth Leadership Council. Drew, who is now in his early 30s, has schizophrenia. He had his first psychotic break two weeks into starting college. He was 19 years old then, and has since cycled in and out of hospitals, sometimes experiencing homelessness for weeks. (Olivia Sun, The Colorado Sun via Report for America)

The high cost of mental health care 

The high cost of mental health care has long influenced who can get the care they need and who cannot, perhaps since its origin, said Vincent Atchity, president and CEO of Mental Health Colorado. 

When it originated, for example, psychotherapy was mostly accessible to wealthy Americans who could afford to pay hundreds of dollars per hour to those professionals, who would spend hours examining their life experiences to identify root causes of distress and discomfort, he said.

“It’s always been kind of a culture of the rich,” Atchity said, “and for folks who are not rich but also not poor, there still are these access issues because what your insurance will cover is so limited in terms of what’s accessible and you could sign up for care and it could take you months to get in there.”

In 2022, the median payment a Colorado patient and their commercial insurer paid to a mental health provider for a 60-minute outpatient psychotherapy visit rose to $107, up from $79 in 2018, according to a data analysis by the Center for Improving Value in Health Care.

The median price Colorado Medicaid paid for the same service was $89 in 2018 and increased slightly to $93 in 2022.

The median reimbursement rate a Colorado patient and their commercial insurer paid for an outpatient psychiatric diagnostic evaluation was $104 in 2018 and $114 in 2022.

The median reimbursement rate Colorado Medicaid paid a mental health provider for the same service in 2018 was $108 and $107 in 2022 per visit.

A sample of about 60,000 visits at Colorado Psychiatry Center showed patients paid on average $71 in 2019 for a mental health visit and their insurer paid the remainder of the cost, said Dr. Ron Morley, medical director at the practice, which serves children, adolescents and young adults age 5 to 25 in Denver and elsewhere on the Front Range.

In 2020, the average price for the patient dropped to $52. In 2021, the average price was $43. In 2022, the average price rose to $63. And in 2023, the average price for a visit was slightly higher at $64, according to the center.

“The changes are because of changes in deductibles and co-pays, which vary over time,” Morley said. “Over the last several years, this has gone up a lot after being brought down by COVID.”

At the Colorado Mental Health Hospital at Fort Logan — one of two state psychiatric hospitals serving people with severe mental illness and offering court-ordered inpatient restoration treatment — the daily cost of a bed to the Colorado Department of Human Services was $1,013 in 2023, up from $868 in 2018 and $802 in 2014, according to a spokeswoman for the Colorado Department of Human Services.

The average length of stay there was 24 days in 2018 and increased to 95 days in 2023, meaning, the average person’s length of stay cost $20,832 in 2018 and cost the state $96,235 last year.

At the other Colorado Mental Health Hospital, in Pueblo, the daily cost to the state for a bed was $1,476 in 2023, up from $808 in 2018 and $830 in 2014. The average length of stay increased from 108 days in 2018 to 152 days in 2023, meaning, the average length of stay cost $87,264 in 2018 and cost the state $224,352 in 2023.

What patients pay varies widely and is sometimes covered by Medicaid or private insurance. No patient is denied admission to the state hospitals because of their ability to pay, the spokeswoman said. 

A bigger bill for people with behavioral health concerns

People with behavioral health conditions tend to have higher health care costs than those who don’t, according to a report by Milliman, a risk management, benefits and technology firm.

People with a behavioral health condition had an average annual health care cost of $12,272, about 3.5 times higher than Americans without a behavioral health condition, who paid about $3,552 per year, according to the report, which included 21 million people age 2 to 64 who had commercial health insurance coverage for the entire year in 2017.

From 2009 to 2019, spending for mental health treatment and services increased 52% nationwide, while the U.S. population increased 7% in that same period, according to Open Minds, a business solutions firm helping health and human services organizations.

In 2019 alone, national spending on mental health services such as therapy, medications and stays at psychiatric or substance use rehabilitation facilities totaled $225 billion and accounted for 5.5% of all health spending, according to the organization.

But even with all the spending, Coloradans are still struggling to afford and access the mental health care they need.

More than half of all people with a mental health disorder in the U.S. did not receive any treatment in the past year, according to a 2021 analysis by NAMI Colorado. 

Of the 328,000 adults in Colorado who did not receive needed mental health care, 37% said they were not seen by a provider because of the cost, according to the analysis.

Meanwhile, Coloradans are nine times more likely to be forced out of network for mental health care when compared to primary health care, according to the NAMI analysis. And almost 65% of Coloradans ages 12 to 17 who have depression did not receive any care in the year before the survey was compiled.

In 2022, Dummit was living at an assisted living facility, where he wasn’t receiving sufficient care. Staff eventually evicted him because they said he disrupted other residents when he screamed and paced around the facility during psychosis from schizophrenia, his mother said.

Sandra Sharp attends a statewide virtual support meeting of family members of adults with serious mental health conditions Jan. 17. The weekly virtual group has about a dozen others, all seeking more access to quality mental health care. The same day, she reviews a House bill regarding the sharing of patient health care information between institutions and family members. (Olivia Sun, The Colorado Sun via Report for America)

“And so he walked off,” she said. “What neighbors say is they saw him walking down an alley, he jumped a fence into a person’s yard, he played with a dog there for about 30 minutes, he followed the dog into the person’s home, put the owner’s clothes and jewelry on, had something to eat and drink and then the police arrested him.”

Dummit was arrested in August 2022 for burglary, and has been incarcerated at Denver County Jail awaiting trial since then in a pilot program with 12 beds for people with severe mental illness, who were on a long waitlist for the state’s psychiatric hospital. 

He has a team of mental health specialists, he’s been on medication since his first week there, his hygiene has improved and he reads books again, his mother said.

He faced up to 26 years in prison but recently entered a plea agreement that ends his sentence on March 29.

“People in Colorado who are dealing with a severe mental illness, if they don’t have access to pay out of pocket for residential care at whatever level they need, their option is to be arrested,” she said. “But they need to be arrested for a felony, because with a misdemeanor, they don’t get enough mental health help. You go through stages as a mom, and eventually, you realize you’re not going to get help for them unless they get arrested.”

But Sharp said her dilemma will not be over when Dummit is released from jail. He will still need inpatient treatment and she still will not be able to afford it, she said.

Colorado’s unmet needs

Colorado ranked far below the national average, or 48 out of 51 of all states and Washington, D.C., for its percentage of adults with a mental illness who reported an unmet need for treatment, according to the 2022 State of Mental Health in America Report, which uses 2018 and 2019 data, the most recent accurate data available.

In other words, nearly 1 in 3 Colorado adults with a mental illness could not get the mental health care they needed, according to the report. 

Almost 46% of people who were asked why they weren’t able to get mental health treatment in Colorado said it was because they couldn’t afford it, according to the Substance Use and Mental Health Services Administration.

Colorado also ranked far worse than the national average, or 40 out of 51 states and Washington D.C., for its prevalence of young people ages 12 to 17, who had private insurance that did not cover mental health treatment, according to the Mental Health America Report.

Insurance

The 2008 Mental Health Parity and Addiction Equity Act works to ensure that people seeking mental health and substance use disorder treatment do not face greater barriers than others seeking care for medical and surgical conditions.

In 2019, Colorado codified parity into law, and since then, it has had additional capacity and enforcement options. But despite the law, people seeking behavioral health care still face greater barriers than those needing medical or surgical treatment. 

When compared with other states, Colorado had the sixth highest rate of out-of-network care for behavioral health office visits versus primary care office visits, according to another Milliman research report.

In 2017, the same year Dummit was admitted to Mind Springs Health in Grand Junction, more than half of the people receiving behavioral health services at residential treatment facilities nationwide were paying out of pocket, according to the Milliman report.

Low reimbursement rates for mental health providers is also driving those professionals into other specialties and causing them to not accept insurance — further complicating a shortage of behavioral health care workers. 

In 2017, 17% of behavioral health office visits were to an out of-network provider compared with 3% of primary care providers and 4.3% of medical/surgical specialists, according to Milliman.

The growing demand for mental health services, a shortage of mental health providers and an increase in out-of-network participation means people with higher incomes are able to afford care.

Mental health and substance use disorder care must be covered in health insurance plans in Colorado and across the country under requirements from the 2008 Mental Health Parity and Addiction Equity Act and the Affordable Care Act of 2010.

“Where that gets challenging is whether or not you can find a provider who can meet your needs in-network with your insurance company and that is something we’re looking at and we really want to mitigate the reasons why providers don’t take insurance,” said Cara Cheevers, director of behavioral health programs at the state Division of Insurance.

In 2020, the division found some insurance companies were overcharging consumers for co-pays, coinsurance and deductibles, anywhere from a few dollars to thousands. Those companies were “massively fined,” she said, and consumers who were overcharged received refund checks. “There’s still a lot more work to do and we know that.” 

While the division mostly works to address and reduce consumer harm, the health care provider’s experience is also crucial to consider when closing health equity gaps, Cheevers said.

There’s still a lot more work to do and we know that.

— Cara Cheevers, director of behavioral health programs at the state Division of Insurance

The division has launched a complaint portal to track and identify trends and issues that make it hard for providers to participate in commercial insurance. The agency also publishes commercial insurance resources for providers to increase their likelihood of taking insurance and to help reduce the number of Coloradans paying for care out of pocket.

The division is also working to increase health care affordability, drive down premiums and ensure people can access affordable, quality health insurance products, she said.

“Mental health care can be a serious economic justice issue and we want to make the reasons why providers don’t participate in local markets no longer a problem,” Cheevers said. “People pay a lot for insurance and they should be able to use it to get mental health care too.”

Community implications of unmet care

The implications of forgoing mental health care are vast and numerous for the person struggling and others in the community.

Untreated mental illness often worsens and the person could be at risk of losing their job, housing and close relationships, said Ray Merenstein, executive director of NAMI Colorado.

The resulting isolation and reduced quality of life can increase their risk for self-harm or suicide and can cost them more financially, over time, if they’re seeking more expensive care at an emergency room or if they’re increasingly taking unpaid sick days, he said.

Another consequence of untreated mental illness is a depressed economy, he said.

As Coloradans appear to be heading into harder times amid growing inflation, and as millennials and younger generations who care about mental wellness age and become leaders across the state, it will become even more important to meet people’s mental health needs at a lower cost.

“It sounds terrible to say it, but there may need to be more self-reliance and team-reliance as the viable solution to a population facing scarcity of care and dominance of crises,” Atchity said. “I’m concerned that people who need care and aren’t getting care aren’t making a practice of doing other self-care things and that’s where I feel like there’s an opportunity for us.”

Maintaining a healthy diet, staying hydrated and movement — especially outside in the sun — are fundamental to maintaining good health, Atchity said, but clinicians rarely include these suggestions in a patient’s health plan.

“Another key thing in your toolkit is engagement and connection with people who you feel a sense of belonging and acceptance,” he added. “Even a five-minute phone call and a couple texts with your personal safety net can shore up your sense of strength and well-being.”

Charts by Danika Worthington

They try their best to divvy up the little that remains for a long list of other living expenses: utilities, credit card payments, car insurance, health insurance and medical appointments.

“Those expenses, especially when you are just getting into the adult world, can really rack up sometimes,” said Wilson, 22, a junior at Colorado State University Pueblo majoring in psychology. 

Sticking to their budget is a precarious, penny-by-penny balancing act. When their dollars simply won’t stretch far enough, Wilson’s boyfriend’s grandma gives them money to fill in the gaps. And the young couple uses government assistance through the Supplemental Nutrition Assistance Program to stock their pantry and fridge.

High Cost of Colorado

Our new ongoing series put reporters with all kinds of Coloradans to talk about their challenges, their fears and their solutions to the rising costs of living here. READ MORE

Their struggles as renters reverberate far across Colorado, where increasing rent costs have burdened many tenants, stretching them beyond their means and even forcing some to give up health care or cut way back on groceries. A younger generation heeds their elders’ calls to go to college, but then graduate with tens of thousands of dollars in debt and few resources to pay an apartment deposit.

Since 2020, when the pandemic escalated financial hardship for many households across the state and country, rents have increased as much as nearly 30% in some Colorado cities. The most dramatic rise came in 2021, with rents jumping at double-digit rates as landlords dialed up pricing after a year of a pandemic eviction ban. They’ve largely eased up on rent increases this year, with some cities even seeing rents cheaper than last year.

Still, trying to make rent is a monthly battle for many young people across the state, often leaving them “feeling pretty stilted by their opportunities here,” said Natasha Berwick, political director at New Era Colorado, a nonprofit that seeks to involve young people in public affairs. 

Berwick worries about whether communities will be able to maintain their vibrancy should they lose young residents she said are a big part of powering local economies.

“You lose a vision of the future for your community,” Berwick said. “You lose an investment in that community. Young people are the driving force behind cultural change.”

For Wilson, housing has repeatedly determined whether she could continue on with school. She started classes as a freshman at CSU Pueblo in fall 2020 but had to suspend her studies the following spring, when she couldn’t afford to pay tuition, largely because of the thousands of dollars her room and board cost her.

She has since had to prioritize working while paying for school with her own money and scholarships. During summer 2021, she was selected to be a resident assistant on campus, supervising first students living in campus apartments and later a dorm floor in exchange for free housing. This school year, Wilson spreads herself among three campus jobs, at least 15 credits of classes and leadership roles for multiple student organizations. She also squeezed in substitute teaching during the first half of the year, picking up shifts that fit her schedule at a nearby elementary school to bring in more money for rent and food.

LEFT: Wilson and Rogers tackle schoolwork in their one-bedroom apartment Dec. 14. The students can barely afford rent on top of their other monthly expenses. RIGHT: Government assistance cards that Wilson uses to buy food hang on a bulletin board. (Erica Breunlin, The Colorado Sun)

Meanwhile, her boyfriend, Daniel Rogers, 27, also juggles a handful of campus jobs and leadership positions while working toward a master’s degree.

Wilson said they both feel pangs of guilt when they have to ask Rogers’ grandma for financial help.

“We should be doing this ourselves,” she said, noting that it’s easy to see why more people have found themselves without housing.

“Wow, if I can’t even afford to live by myself out here,” Wilson said, “no wonder there’s so many people on the street.”

Renting in Colorado right now is “pretty abysmal,” said Berwick, of New Era Colorado, which hears a refrain among young renters that they simply cannot afford monthly rates.

“It makes me feel sad that I know that people across the state are working really, really hard in order to maintain a living and they can barely afford to keep a house over their head,” Berwick said. “And it makes me feel angry because this has clearly become a mandate for people in positions of power to solve.”

“How do we decide how much suffering people have to go through before we do something?” she asks.

Colorado lawmakers did step forward with $30 million in financial assistance for tenants during a special session convened in November after a ballot measure aimed at easing rising property taxes failed. Additionally, municipalities can pour funding into emergency rental assistance.

“But that’s really more of a stopgap solution for renters who are facing eviction at that point to help bridge the gap so they can stay housed but not a long-term solution to the challenge of landlords increasing rents at whatever rate they wish,” said Alex Georgiadis, co-chair of the policy and research subcommittee within Colorado Homes for All Coalition.

The statewide coalition is made up of 23 groups that joined to advocate for affordable housing and is pushing for three major policy changes to better the lives of renters. The group aims to repeal the decades-long statewide ban on rent stabilization, which prevents individual communities from controlling local rent rates, as well as then work with individual municipalities to pass local rent stabilization policies. 

“We know that our folks are struggling to keep up with oftentimes what we would name are egregious rent increases and that wages are lagging behind the cost of rent, especially for working-class families,” said Cesiah Guadarrama, co-chair for Colorado Homes for All Coalition.

Rents have dramatically outpaced wages over the past few years, Georgiadis said.

Colorado workers earning minimum wage, $14.42, would need to work 94 hours per week to afford a two-bedroom apartment at fair market rent and not pay more than 30% of their income, she noted, citing information from the U.S. Department of Housing and Urban Development and the National Low Income Housing Coalition. 

Minimum-wage employees looking for a one-bedroom apartment would need to work 77 hours a week, she said.

And in order for a tenant to be able to afford a two-bedroom apartment at fair market rent without paying more than 30% on housing, they would have to make an hourly wage of $32.13.

Meanwhile, about 350,000 renters — nearly half of Colorado’s renting households — pay more than 30% of their income on rent, qualifying them as house burdened, Georgiadis said, citing data from the Colorado Housing and Finance Authority.

Nathaniel Addison, who rents the basement of a home in Greeley for about $900 a month, often feels like they have to relinquish all control to their landlord and sometimes their upstairs neighbors. Addison can’t adjust the temperature of their apartment and must ask the neighbors to crank up the heat.

“You don’t have full autonomy over your own space,” said Addison, who is queer and uses they/them pronouns. “It is very frustrating. I feel very powerless. I feel very much like I have to deal with it because of my financial circumstances, that this is the best I got.”

Addison, 28, works three jobs to cover rent and other living expenses — bartending, coordinating events for Fort Collins nonprofit The BIPOC Alliance and trying to sell homes as a newly minted Realtor.

They also find little ways to pare down expenses, including by sticking to the same meals every day, foregoing real estate classes that would advance their career and scaling back on seeing friends to prioritize work.

Each sacrifice inches Addision closer to one day owning a home, where they can have a design studio where they can sew costumes for queer and drag artists — a passion that bloomed during the pandemic. But with such a limited income, the reality of homeownership is a long way off.

It’s doubly hard because of the longtime discriminatory housing practices against people of color that are still visible in neighborhoods today, said Addison, who is Black and Japanese. Homes of Black people have often been appraised for significantly less, they noted, while real estate agents in recent years have steered people toward or away from certain neighborhoods because of their demographics.

“The makeup of your neighborhood is by design,” Addison said. “If there isn’t any person of color in your neighborhood, that is the system. If people of color aren’t able to move into your neighborhoods, it’s meant to be that way.”

For now, renting is the only option.

Sometimes, the idea of leaving Colorado feels easier to Addison, who previously struggled to get by while living in Texas and Washington.

“I jokingly say, ‘What state should I move to to experience being poor next?’” Addison said.

Design by Danika Worthington.

By almost any measure, health care is becoming more expensive, in some cases by a lot. For instance, payments by patients and health insurers in Colorado for prescription drugs increased 97% between 2013 and 2020, according to the Denver-based Center for Improving Value in Health Care.

Overall, health care payments in 2020 averaged $7,200 per person, a 27% increase from 2013. The portion of that actually paid by patients — what is known as out-of-pocket costs — was $870 per person for folks with commercial insurance, a 22% increase from 2013.

But this isn’t the only narrative about rising health care costs in Colorado, because “health care” is not a single product or even a single system. What you pay for it rests on thousands of individual circumstances and decisions — some of which you can control to help mitigate what you pay and some of which you can’t. How those combine together determine whether health care is actually more expensive for you.

“There’s so many moving parts to the health care industry,” said Priya Telang, the communications manager for the Colorado Consumer Health Initiative.

And this brings us back to that pricey popsicle.

High Cost of Colorado

Our ongoing series put reporters with all kinds of Coloradans to talk about their challenges, their fears and their solutions to the rising costs of living here. READ MORE

In 2021, my daughter, then 2 years old, came down with a fever. A bad one.

The thermometer hit 103, then climbed to 104 and above. Tylenol did little to slow it down. My wife tried to make a same-day appointment with the pediatrician, only to be told there were no slots available. Urgent care wasn’t an option because there was no guarantee of being seen by a pediatric specialist.

So, at a nurse’s urging, off to a nearby pediatric-specific hospital emergency department we went.

At the ER, a nurse hooked my daughter up to the usual machines. The doctor checked her over without much alarm.

They gave her some Motrin and told us to start rotating it with the Tylenol every three hours. They administered a test for a urinary tract infection. (Negative.) They gave her a Zofran as a precaution for nausea. And they brought her a Bomb Pop.

It was the last medicine that seemed to help the most — a delighted smile emerging on her sullen face because she had not heretofore known that doctors can prescribe popsicles. After an hour or so, the fever subsided to less-alarming levels and we were discharged, no diagnosis in hand. (It later revealed itself as roseola, a common childhood viral infection.)

A few weeks later, the bills arrived:

Amazed but not surprised, my wife and I laughed at the bill. How could a couple very common medications plus a routine test cost that much? As a health journalist, I knew the answer: The bill was so hefty because of the hospital facility fee, which hits especially hard in an ER visit. But, embracing the dark humor of the situation, we settled on a different answer.

And thus in our house was born The Legend of the $2,000 Popsicle.

Falling into the high-cost funnel

If you have a pulse in America, you probably have a similar story of a ridiculously expensive medical bill.

In our case, the bill stung but was not financially fatal — we had enough in a health savings account to cover it. Not everyone in Colorado is so fortunate, though. In 2021, 11.3% of people surveyed in the large Colorado Health Access Survey reported difficulty paying a medical bill.

But our experience in the ER does illustrate how easy it can be for health care expenses to balloon beyond your control.

We knew that the ER is the most expensive place you can receive care. But our efforts to avoid going there hit up against a brick wall of availability, and this is not uncommon.

The Colorado Health Access Survey found that nearly 19% of people in 2021 reported not being able to make a primary care appointment as soon as was necessary. This lack of access funneled us into more expensive care.

Once there, our choice to enroll in a bronze-tier health insurance plan — one with a lower monthly premium but a higher deductible — left us exposed to paying the full cost of the visit. And this, too, is an increasingly common situation.

As insurance costs have risen, more and more individuals and families who receive insurance through their work have chosen to drop into this lower-up-front-cost coverage, which are formally known as high-deductible health plans. In 2009, the federal Bureau of Labor Statistics found that 15% of workers nationwide were enrolled in high-deductible plans. By 2018, that percentage had climbed to 45%.

These plans provide coverage against catastrophic health expenses, but for smaller bills — say, a fairly uneventful ER visit — the burden falls solely on the patient to pay until they have spent enough to hit their annual deductible. That can mean spending many thousands of dollars before insurance kicks in anything.

This creates a new affordability crisis in health care. People with high-deductible plans are less likely to seek medical care. They are more likely to be hit with bills they can’t afford. And these high-deductible plans have become a big driver of medical debt for patients and uncompensated care for hospitals.

In 2021, an estimated 12.3% of people in Colorado skipped needed primary care because of the cost, according to the Colorado Health Access Survey, which is conducted every other year by the nonpartisan Colorado Health Institute. (Data for the 2023 survey should be available in February.)

Of those who reported difficulty paying medical bills, more than half took on credit or credit card debt, and more than a third said their medical bill meant they struggled to pay for food, heat or rent.

The insight from the invoices

None of this really answers the question: How much more expensive has health care become in Colorado?

There’s a good amount of data on this because the aforementioned Center for Improving Value in Health Care maintains what is known as an all-payer claims database for Colorado — that is, it oversees a massive collection of medical bills that can be used to estimate health care spending in the state.

Between 2013 and 2020, the per capita amount paid to doctors and other medical providers increased by 27% in Colorado. The per capita amount paid for outpatient services increased by 33%. Both of those are roughly in line with or slightly above inflation for those years.

It should be noted that the 2020 cutoff — it’s the most recent year for which CIVHC has complete data — was before recent periods of rapid inflation. There’s evidence nationally, though, that health care costs rose more slowly than overall inflation in recent years.

One area, the per capita amount paid to hospitals for inpatient services, decreased by 9% between 2013 and 2020, in line with hospital efforts to treat more people in outpatient clinics.

But, of course, for most people, the pain of health care costs are filtered through — and sometimes lessened by — insurance or other forms of coverage. And here there are some bright spots.

Colorado’s rate of people without insurance hit a record low last year.

For people who buy insurance on their own, Colorado now has some of the lowest premium prices in the country. The average benchmark premium price in Colorado — a handy standardized way of looking at the cost of plans across different states — is $380 per month in Colorado. That’s nearly 40% higher than it was in 2014, but it’s $76 per month less than the national average.

Subsidies for those who buy insurance themselves have also increased and expanded, as have programs to help people pay out-of-pocket costs like deductibles.

These trends, part of the much broader impact of the federal Affordable Care Act, appear to be reducing the burden of health care costs on Coloradans, even as prices continue to rise.

For instance, the previously mentioned 11.3% of people who reported trouble paying a medical bill in 2021 is a major improvement over prior years. In 2009, that figure was 21.9%.

Bankruptcies due to medical debt have also fallen. In 2021, 3.1% of people in Colorado who had trouble paying a medical bill said they filed for bankruptcy as a result, according to the Colorado Health Access Survey. In 2013, the year before most of the major features of the Affordable Care Act were implemented, that percentage was 11.1%.

So where does this leave us? The United States is a clear outlier globally in having expensive health care. But that financial weight isn’t carried evenly.

The best you can do is be smart in selecting an insurance plan, choose wisely in how and when you receive care, fight bills that you think are unfair, and learn lessons that suit your family as you go.

Here’s one from mine: We buy our popsicles at the grocery store now.

The Colorado Sun reporters Jennifer Brown and Michael Booth spoke with speakers about the high cost of housing, evictions, affordable housing, rent control and more during its High Cost of Colorado event.

Speakers included:

• Zach Neumann, Co-Founder and Co-CEO of Community Economic Defense Project
• Cesiah Guadarrama Trejo, Colorado Executive State Director of 9to5

Richard Charles and Amy Adams sat in their truck queued up with dozens of others awaiting a slow roll through the meandering line at an outdoor pet pantry, a pop-up operation in the parking lot of a food bank in southwest Denver. 

One by one, more than a hundred vehicles opened their trunks or hatchbacks to accept free donated dog and cat food, plus other accessories of pet ownership — part of a program fueled by Colorado Pet Pantry that brings relief to 103 locations across the state. Charles and Adams, who live in nearby Englewood, registered with a volunteer to take advantage of the monthly event, though visitors are only eligible for the free food every other month. 

Still, it’s a budget buffer against the sledgehammer costs of pet ownership, especially during the lean days for these seasonal food workers who cater festivals and farmer’s markets. Food and veterinary care, they estimate, run them roughly $5,000 a year — and that’s just basics aside from any unforeseen issues. 

High Cost of Colorado

Our ongoing series put reporters with all kinds of Coloradans to talk about their challenges, their fears and their solutions to the rising costs of living here. READ MORE

The expenses are challenging, but like many Coloradans, they would rather do without small luxuries such as dining out — or even extra portions of their home-cooked meals — to provide for the two dogs and five cats that are more than just pets or companions.

“Before the (work) season starts, we definitely have to prioritize,” Charles says, noting that savings from the previous season can run low. “And they get the priority. They’re part of us. Part of our family.”

“Our kids,” Adams adds.

LEFT: Around a dozen Colorado Pet Pantry volunteers distribute free pet food and supplies via a drive-thru Dec. 21 in west Denver. RIGHT ABOVE: Cathy Hamlin, the owner of two dogs, a Basenji and Doodle mix, talks with volunteer Kimberly McNealy. RIGHT BELOW: Gary Gonzales, right, stands with his dogs, Woody, a Chihuahua mix and Sabrina, a Siberian husky. Each monthly donation drive typically draws more than 100 clients from the metro area. (Photos by Olivia Sun, The Colorado Sun via Report for America)

The couple are anything but outliers in a state that loves its pets. Poll after poll reveals Colorado’s love affair with its (mostly) dogs and cats — including one that ranks the state highest on a seven-point survey with regard to residents’ devotion to their canine companions. Some of the results revealed attitudes impacted by economics: 43.5% said they would spend $4,000 or more to save their dog’s life; and 11% said they’d stayed at a job they didn’t like because it was dog-friendly.

But it’s getting harder to absorb the costs that come with those pets that mean so much to so many Coloradans. And the problem extends across the country. And while precise costs can vary even from one ZIP code to another, the overall impact is consistent. Consider one survey that found 91% of respondents have felt some degree of stress over the costs of pet care, with two-thirds reporting that, like Charles and Adams, they have cut back on personal spending to accommodate their pets. One-third have sought to ease the crunch by taking a second job or exploring other ways to increase their income.

One analysis ranked Colorado 37th in annual expenses for dog ownership at $1,568.72, covering food, pet insurance, veterinarian office visits and vaccines plus spay/neuter. Prices can vary widely depending on a number of variables, but virtually all the analysis and surveys done on pet care — and there are a lot — point to a common theme: It ain’t getting cheaper.

In July of 2021, total pet-related costs hovered slightly below the national Consumer Price Index, which measures the average change in prices paid by urban consumers for a variety of goods. By July of 2023, not only had the CPI risen 19%, but total pet costs had surpassed the index by nearly 3 percentage points. Food and veterinary costs, in particular, had spiked — with food nearly 4 percentage points higher than the CPI and veterinary care nearly 9 percentage points higher.

The rising cost of dog food

62%

The percentage of the top 100 dry dog foods on Amazon that marked their highest historical price in 2023.

The largest increase by a single dry food product was Purina ONE Plus Healthy Puppy Formula High Protein Natural Dry Puppy Food with Added Vitamins, Minerals and Nutrients. That’s quite a mouthful, and a 16.5-pound bag cost 143% more than it did in 2020.

50%

Wet dog food saw an even steeper cost spike — 50% on average since 2020. Historical highs were recorded for 44% of the products analyzed.

The largest increase for wet food belonged to Pedigree’s 12-pack of 13.2-ounce canned Adult Wet Dog Food, Chopped Ground Dinner Chicken & Rice Flavor, which shot up 207%.

Source: Pet Age

Eileen Lambert, who founded Colorado Pet Pantry in 2013, notes the rapid rise in the numbers of dogs and cats served since its inception, when it helped feed 858 pets. And she says that while part of the increase reflects the organization’s overall expansion, the exponential explosion — in 2023 the nonprofit served an estimated 150,000 animals — also tells a story about the intersection of high costs and greater need.

And at the same time pet food prices have spiked, she adds, it has also become harder for her to obtain the surplus food that manufacturers often donate for reasons ranging from torn or mislabeled packaging to imminent “best by” dates. Although Colorado Pet Pantry doesn’t purchase pet food to distribute, that could change as donations scale back — in part, Lambert says, because the pandemic led manufacturers to discover efficiencies that result in less surplus product.

“The need is exceptionally high right now,” she says. “We’re seeing about 50% more people coming this year than we did last year because the cost of living is so high.” 

In large part the problem for pet owners is that food costs have outstripped the usual inflation-driven average. Last April, Veterinarians.org, a pet research and publishing organization, analyzed price histories for 100 of the top wet and dry dog foods among Amazon Bestsellers and found that on average, prices were up 45.5% compared with 2020. The roughly 15% annual increase was three times higher than the usual bump.

More than half of those surveyed said they’d canceled pet food subscriptions that automatically refill and deliver orders. Nearly a quarter of respondents found the economics so daunting that they at least thought about rehoming their pet or surrendering it to a shelter.

Michael Meyer, CEO of the I and Love and You “ultra premium” pet food brand based in Boulder, says that inflation impacted food prices — animal or human — inordinately owing to multiple factors: cost of ingredients, labor costs, interest rates, fuel costs and others. But the good news, he adds, is that after spikes in 2022 and ’23, costs seem to be leveling off.

“And I think we’re seeing a leveling off on people food as well,” he says. “So for all of our brands, it’s about navigating that and how do we manage that together? Because we want to make sure our food continues to be affordable. It’s premium, but it has to be affordable at the same time.”

The I and Love and You brand — yes, music aficionados, the name was inspired by the Avett Brothers song of the same name — is one of the companies that have partnered with Colorado Pet Pantry as a means of giving back. But it has also employed other strategies in the marketplace, such as packaging cat food in 12-packs at a discounted price and offering dry dog food in bags up to 23 pounds rather than 4 pounds.

“We’re looking at our cost structure now and talking about one line of products where we’re exploring reducing prices,” Meyer says. “We’re going to absorb some of that on our own, but we’re doing what we think is the right thing to do. Obviously we still have a business to run and you have to have balance. But I hope prices come down. They’ve definitely leveled off.” 

Cathy Hamlin, 65 and newly retired on Supplemental Security Income, drove to the pet pantry from Englewood to collect some food for Rihanna, her Labradoodle, and Chappie, her Basenji and Australian cattle dog mix (she did the DNA test). She can split a big salad with her 5-year-old iguana, but the dog food strains her budget.

“Your money doesn’t go up but the food prices do — same as humans,” she said. “Every time I get a bag of dog food it’s a couple bucks more. You know, it’s crazy.” 

Veterinary care

The waiting areas at the veterinary hospital — one devoted to cats, one to dogs — filled with a steady stream of clients on a crisp Saturday morning as two workers, one of them slipping easily between English and Spanish, welcomed the animals and their caretakers.

Catherine Lopez, 19, settled into a chair while Pabu, a 4-month-old male Chihuahua, curled up in her lap. They discovered an oasis of low-cost veterinary care in this sparkling facility tucked between the low-income Globeville and Elyria-Swansea neighborhoods of Denver — a haven of relief from the burden of caring for the newest addition to Lopez’s family.

The Dumb Friends League Veterinary Hospital at CSU Spur, near the Stockyards Events Center, offers a wide variety of donor-subsidized services — everything from urgent care to surgery to spay and neuter procedures to the reason that has brought Lopez.

Pabu, just adopted from a family friend, was due for his first round of vaccinations. Lopez, who finds herself at the intersection of the housing crisis — she lives with her dad while working in human resources for a construction company — and rising costs of pet care, budgets about $200 a month to feed and otherwise look after both Pabu and her 2-year-old cat, Nyx.

“To give them the best care possible so that they have a long life is kind of challenging,” she said, “especially when it comes down to food because food has gone up — especially food that’s beneficial for them, it’s kind of expensive. And for my cat the litter is expensive. The treats are expensive.”

Everything, it seems, is expensive.

When the attendant called Pabu’s name, Lopez carried him to an exam room where, in short order, vet techs administered the vaccinations and Lopez proceeded to a check-out area. She pulled out her credit card to pay the $25 charge — significantly less than she might pay at most private vet clinics.

Part of the reason the DFL set up the facility here is that it sits in the midst of a “veterinary desert,” says Rachel Heatley, director of advocacy for the organization. It seemed like an area where they could make a big difference, and 18 months after its opening, the response has confirmed that.

“We open at 7 a.m. every day by 7:30, our day is completely full,” Heatley says. “And that is every single day that we’re open. So there is need there, and there’s need specifically for the subsidized care that we provide.” 

Other data underscores the impacts of pet health care. When Colorado State University launched The Animal-Human Policy Center last spring, it dove into two detailed surveys: One asked more than 700 veterinary professionals for their perspectives on providing care and workforce challenges; the other polled pet owners to explore barriers to care.

LEFT: Patients and their pets wait Dec. 30 at the Dumb Friends League Veterinary Hospital at CSU Spur. RIGHT: Matt Martin, associate vet, performs spay or neuter operations on a cat. (Photos by Olivia Sun, The Colorado Sun via Report for America)

“From some of our conversations with policymakers and stakeholders here in Colorado,” says Rebecca Niemiec, the center’s director, “one of the first things that rose to the top as a key animal-human challenge is this issue of access to veterinary care and ensuring that people can care for their pets in the way that they would like to.”

The survey results didn’t define the rising expense of companion animals in dollars and cents, but it often saw those costs reflected in the responses — for instance, the prevalence of something known as “economic euthanasia.” The survey revealed: 

• 72% of veterinarians and technicians reported their team has had to euthanize an animal in the past year because the owner couldn’t afford recommended treatment — a choice they would not have made if they’d had greater financial resources.
• 55% of vets/techs said that, on average, at least once a week they’d had to decline care for animals because of the caretakers’ inability to pay.
• 57% of those responding said inadequate access to veterinary care is a moderate or significant problem in their practice area.

Pet owners’ responses defined the economic difficulties even more sharply, most notably among the nearly 300 respondents surveyed at pet food pantries and shelters for low-cost veterinary services:

• About 28% of respondents said they’d had to give away one of their pets to another person or a shelter, most often citing the costs of veterinary care as the reason.
• About 14% had never taken their pet to a veterinarian, again citing expense as the reason.
• And roughly 51% reported trying — unsuccessfully — to access veterinary care over the past two years. Unaffordable costs and unavailable appointments were the most common reasons given.

“One thing that is important to highlight here is we did find 8% of pet owners have never obtained veterinary care,” Niemiec says, “and for those pet owners, a veterinarian being too expensive was the primary reason why they had never obtained veterinary care.” 

On top of that, 28% of pet owners had experienced a time in the past two years when they’d tried to see a veterinarian but couldn’t, most commonly citing no available appointments, clinics not being open at times they could come in and, of course, high costs.

Lower-cost options like SpayToday — a Lakewood specialty clinic that focuses on spay/neuter, vaccinations and microchips — uses donor funds to keep their prices affordable or in some cases free. Their philosophy leans into the idea that the human-animal bond is crucial to a healthy community, especially among the most vulnerable populations.

“Those pets are an integral part of their family and help with their own mental health,” says Amira Watters, the executive director. “So it’s really heartbreaking if somebody has to decide: Do I feed my kids or do I get vaccinations for my pet?”

Even operations like SpayToday are at the mercy of market forces for vaccines, anesthesia drugs and other medications. For instance, Watters says, the cost of a heartworm test has doubled. “And so we really have no other choice,” she adds. “There’s only so many vendors that provide them. So it’s a challenge for sure.”

Rachel Heatley, director of advocacy for the Dumb Friends League, sees the impact of veterinary costs in her own home. Her cat suffers from kidney disease and asthma, and she pays about $500 every two months for medication. And that’s going the discount route through a Canadian pharmacy. She estimates those same drugs would cost her over $1,000 in the U.S.

“Which I cannot afford,” she says.

Heatley says veterinary costs are similar for dogs and cats, though with most cats being on the smaller side, that alone can reduce costs somewhat. Another consideration when it comes to expenses, she adds, is longevity. Pet owners who take full advantage of veterinary care — and Colorado’s tendency to treat their animals as family members is well documented — can also naturally count on a longer timeline of costs.

“How lucky we are to live at a time where we have such great veterinary medicine,” Heatley says. “But that is a double-edged sword because now there are all of these opportunities to help your animals — but they’re highly unaffordable for the majority of people. So those people are still facing the very difficult decision of turning over their animal to a shelter or a family friend, or opting for economic euthanasia.”

The worrisome shortage of vets

Driving some of the concerns about availability of veterinary care is a projected shortage of both veterinarians and techs. A study released in August estimated that by 2030, the U.S. will need up to 55,000 additional veterinarians and tens of thousands of veterinary nurses and techs to meet the demand for services to companion animals.

A move to create a new mid-level position — a veterinary equivalent to a physician’s assistant in human medicine that could perform certain procedures — as one means of increasing access to care so far hasn’t found legislative support in Colorado. (The president of the American Veterinary Medical Association has pushed back on the idea of a projected veterinarian shortage, blaming COVID for disrupting the usual supply and demand, and has opposed the idea of a mid-level position.) 

Veterinary care can notably be even harder to access in rural portions of the state. Anecdotally, the Dumb Friends League needed two years to fill a position in its Alamosa clinic and a year and a half to find a vet tech.

CSU’s Niemiec notes that while much of their Colorado survey results mirrored national findings, there was one area of wide discrepancy: pet insurance. For instance, one national study found 4% of dogs are covered, while in the CSU study 25% of Colorado respondents said they carried pet insurance.

“Maybe there is something unique about Colorado,” she says, “but that’s still like 75% of people who don’t have insurance. When we ask them why, the most common reason selected was they can’t afford the monthly cost, followed by they don’t think it’s worth the monthly costs, and then followed by, they haven’t heard about it or don’t know enough.”

Does pet insurance make sense for you? Forbes Advisor listed the monthly cost for a range of seven providers for plans with $5,000 annual coverage maximum, a $250 deductible and 90% reimbursement level.

Other barriers to pet ownership

Other expenses associated with keeping a pet can be embedded in the cost of rental housing. The Dumb Friends League notes that the number one reason animals are brought to the shelter has to do with housing situations — specifically, finding pet friendly housing that’s also affordable. Security deposits and other fees charged to tenants with pets can combine with the usual expenses to force some pet owners to surrender the animals.

“People are facing insurmountable costs when they want to move with their pets,” said DFL’s Heatley. “Finding pet friendly housing that is also affordable is out of this world. And so as a result, we end up with a lot of those pets.” 

The issue attracted legislative attention, which resulted in a law that went into effect Jan. 1 limiting pet security deposits to $300 and additional pet fees to $35 or 1.5% of the rent, whichever is greater. 

At the Colorado Pet Pantry event in southwest Denver, founder Lambert watched 63 clients cycle through the line in the first 40 minutes, heading toward the usual total of between 100 and 150. On average, each client cares for three animals, with about a 2-to-1 ratio of dogs to cats. On this day, the nonprofit distributed about 4,000 pounds of pet food.

Inching forward in the line of vehicles, Richard Charles framed the reason behind his search for affordable pet care in the simplest terms: “One of my favorite parts about being alive,” he says, “is having dogs and cats.”

Design by Danika Worthington.