Almost every one knows someone who doesn’t have health insurance. Or perhaps they have insurance, but it barely covers even basic health care.

But if you think those people don’t affect your health insurance, think again.

Premiums rise to cover those who can’t pay for care.

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In the end, we are all paying for the uninsured, and the underinsured.

Although Grand County residents are less likely to be unemployed and living in poverty compared to the rest of the state, the median household income is slightly lower than the median income statewide.

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In fact, a study by the Northwest Colorado Council of Governments compares Grand County with seven other counties ” including Pitkin, Eagle, Garfield and Summit counties ” and lists it as one of the three lowest in terms of average wages, median family income and median household income. The average wage in 2005 for Grand County was $23,712 a year, and the average family income was $55,217.

Most families or individuals who struggle with health care coverage are right in the middle: Not quite rich enough to afford quality care, but not quite poor enough to qualify for Medicaid or CHP+.

“We see people avoid going until they have to go to the emergency room,” said Brene Belew-LaDue, Grand County’s public health director.

Emergency rooms have programs to help financially off-set the high cost, but patients end up being charged more. The hospital end up absorbing the extra cost, and the insured pay higher premiums. “We all end up paying for it, no matter what,” Belew-LaDue said.

Stuck in a cycle

The Colorado General Assembly created the Blue Ribbon Commission for Health Reform in 2006 to identify ways to expand health care coverage in the state and reduce costs for residents.

In the study, it states that a key contributor to rising health care costs is the cost of caring for the uninsured. When people without insurance don’t pay for all of part of their care, the remainder of the bill is passed on to the insurance companies, who pass the costs along to their members.

The average cost for health insurance for employees in Colorado has increased by more than 100 percent between 1996 and 2005 for single coverage, according to the study. And for employers, health insurance premiums to cover employees have doubled during that same time period.

Therein lies the main reason why many employers do not offer health insurance, or only offer minimal insurance that doesn’t cover family members or dental care.

And so the cycle continues.

People avoid doctors and dentists so they can still afford to pay for the roof over their head, and when they finally decide to seek medical treatment, their illness or injury has progressed to a very expensive point.

Someone who goes skiing, for example, and sprains their shoulder, may not schedule a doctor’s appointment because their insurance won’t cover the visit. A month down the road, the sprain becomes a tear, and what could have been a quick fix turns into major surgery.

A 2004 survey conducted by the Grand County Public Health Department showed only 45 percent of local children have ever seen a dentist.

Studies show tooth decay can happen as soon as a child gets his or her first tooth. Left untreated, what could have cost hundreds to fix, ends up costing thousands of dollars.

A local solution is underway

The Blue Ribbon Commission for Health Care Reform plans to reduce the number of uninsured Coloradoans by 88 percent, extending coverage to 694,500 people who do not have insurance.

But government plans move slowly, and many feel that in order to solve problems in their community, there also needs to be a local solution.

“The doctors and nurses are here because they care about people in their communities,” said Eric Murray, public relations for Kremmling Hospital. “In the spirit of the health care environment, you have to do you best to develop heath care locally.”

Belew-LaDue and Jen Giacomini, community health program coordinator for the Grand County Rural Health Network, already have a program for children, called A.C.H.E.S. (Advocacy for Children’s Health and Education), which provides medical, dental and mental health vouchers to uninsured children who qualify financially.

But the recent survey conducted by the Grand County Rural Health Network affirmed what they already knew: Adults need affordable care as well.

“We get calls from adults saying, ‘What can I do? Where can I go?'” said Belew-LaDue. “Am I going to be able to pay for my rent? My family?”

In response, Giacomini and Belew-Ladue helped start a program for uninsured adults, called P.A.I.N.S. ” Partners for Adults In Need of Services. It is a voucher program that will provide non-emergency medical services for people who qualify financially, modeled after the A.C.H.E.S. program.

Giacomini said the program is set to begin this spring.

To qualify, one must be an uninsured resident of Grand County, screened by a public health nurse beforehand, and be considered 200 percent or below the poverty line.

The programs offered by the Grand County Rural Health Network are short-term solutions, Giacomini and Belew-Ladue admitted, but they’re a step in the right direction.

“It’s a Band-Aid. But we just don’t know if we can depend on the state government to figure out a solution,” Giacomini said. “And I don’t think the federal government will be fast (enough) coming up with anything.”

Giacomini added that she and other medical representatives are also looking at more long-term solutions to go hand-in-hand with the proposed medical campus, which is planned to be completed by spring 2010, to be located next to the existing City Market in Granby.

One idea is to build some type of community care clinic on the campus that would help uninsured or underinsured patients get the care they need.

“We’re not sure what (that long term solution) looks like yet, but it’s definitely in our radar,” Giacomini said.

How to get involved

The Grand County Rural Health Network needs input in order to provide better services and find a solution toward better care.

They are looking for testimonies ” stories from individuals who are struggling with affordable care, or who can’t afford any care.

“For a long-term solution, we need to know what works up here. What works in Denver may not work up here,” Belew-LaDue said. “Call (970) 887-3064. We’d like to have someone who qualifies talk to us. Hard working people who are doing whatever they can and still are experiencing these issues. (That way) other people in the county understand it’s not just illegal immigrants or ‘users’ of the system, or ski bums.”