Evaluating the Premium Sponsorship Program
Colorado hit historic health insurance milestones in 2017, with over 5 million lives covered and a historically low uninsured rate of 6.5%. Meanwhile, high premiums continued to be a consistent barrier to coverage, with nearly 350,000 Coloradans remaining uninsured. Help was coming. That same year, a clinic in South Denver piloted a Premium Sponsorship Program that would grant access to care for thousands of these Coloradans.
It became clear in 1988 that Denver Health was no longer able to support services for 20,000 uninsured patients living in suburban metro areas. Unwilling to let care lapse, the 129 physicians of the Arapahoe Medical Society formed Doctors Care, a nonprofit that, 34 years later, continues to provide access to health care for low-income individuals. With an experienced clinical staff and a robust volunteer network, thousands in South Metro Denver are able to come to one location and receive primary care, behavioral health, women’s health, and many more services each year.
Sponsoring Health Insurance Premiums
Though grant support from Centura Health, Doctors Care created the Premium Sponsorship Program, which covered premium costs for underserved individuals enrolling in a Silver Level Qualified Health Plan for up to one year. Eligible individuals met these criteria:
- Qualified for an Advanced Premium Tax Credit (APTC)
- Had a household income 134%-401% of Federal Poverty Level (FPL)
- Were ineligible for Medicaid or Medicare
- Had financial barriers to accessing health coverage and care.
In 2017, 1,227 individuals received enrollment assistance, 86% secured some form of coverage, and all were screened for Premium Sponsorship and psychosocial barriers to care. Upon the program’s completion four years later, over 80% of participants reported it was easier to afford care, and over 90% reported it was easier to manage their health and access to needed care.
To help assess the cost impact of the program, Doctors Care turned to Center for Improving Value in Health Care (CIVHC) and the Colorado All Payer Claims Database (CO APCD). Using an identifiable data set, they analyzed the services their program participants utilized as well as the payments related to those services, and learned that participating providers who typically would have had to provide services to these patients through charity care or self-pay, had a 41% increase in payments through insurance reimbursements.
The Premium Sponsorship Program ended in 2021 due to financial constraints, however it still made a tremendous impact for many of the program’s participants. Doctors Care continues its mission and as of 2022, has served more than 45,000 low-income residents and provided more than $70 million worth of medical services to those in need.
Photos courtesy of Doctors Care