What your neighbor’s health has to do with yours

Every day, Stephanie Bell makes dozens of decisions to keep her family healthy and moving forward.

As a working mother of two, she balances work, parenting, housing costs, transportation, groceries, and childcare while doing what many Colorado families do: making sure everyone’s needs are met with the resources available.

The third-generation Huerfano County resident does contracted labor work while raising her children and maintaining an active role in the community she calls home. She volunteers with the Spanish Peaks Community Foundation on projects that preserve and celebrate the region’s cultural heritage and regularly supports community food security programs for seniors.

Bell’s paycheck has been stretched by rising costs. Housing, childcare, food, and transportation are difficult to cut, leaving little room for flexibility. Childcare makes employment possible, while housing provides the consistent foundation that work and parenting require.

When her budget cannot absorb every expense, it’s sometimes healthcare that has to wait. Despite a family history of heart disease, Bell has postponed preventive health screenings because the cost competed with more immediate needs. During her Medicaid renewal, Bell’s income placed her above the eligibility threshold, and because she works on contract, she does not have access to employer-sponsored health coverage.

“I know I need the screenings, but there are other things my family needs that have to come first,” Bell says. “When money is tight, you start deciding what can wait, and for me, that was something I thought could wait. If visits and screenings were more affordable, I could take care of it when I’m supposed to instead of having to decide what else has to get cut.”

She enrolled in a reduced-cost marketplace plan that lowers the cost of coverage but still requires copays she must carefully budget for.

Bell’s experience shows how even a modest medical charge can mean less money available for basic needs. That decision may look like an individual health choice, but it is shaped by factors that extend well beyond a doctor’s office: what Bell pays for housing and childcare, what it costs to feed and transport her family, what she earns, and what her health coverage leaves her responsible for paying herself.

Her health is personal. The conditions shaping it are shared. When the same pressures affect enough households, the consequences can turn up in workplaces, schools, clinics, and other institutions that entire communities depend on.

Bell’s experience reflects a statewide pattern. Across Colorado, the scale of that pressure is reflected in The Colorado Health Foundation’s 2026 Pulse Poll, in which 85% of respondents considered the rising cost of living an extremely or very serious problem, and 76% worried about whether they could continue living in the state.

The poll also found that 37% of respondents had postponed medical care during the previous year.

Kyle Legleiter, senior director of public policy at The Colorado Health Foundation, says health is shaped by far more than access to a doctor.

“I tend to think of good health and well-being as the product of many different things coming together,” Legleiter says. “One important piece of that is whether or not you have access to the kind of medical care that you need. But it’s also the conditions of what your own day-to-day life looks like, and what your broader community looks like around you as well.”

When coverage loss reaches the clinic

Mountain Family Health Centers serves Garfield, Pitkin, and Eagle counties, where rural geography intersects with resort economies and high living costs.

CEO Dustin Moyer says workers in hospitality, construction, and other service industries around Aspen and Vail may earn too much to qualify for Medicaid while lacking employer-sponsored insurance. It’s a phenomenon often described as a “benefits cliff,” where a relatively small increase in income can cause someone to lose public benefits before they can afford the alternative.

Mountain Family’s 2024-25 impact report lists 17,394 patients. Forty-five percent were uninsured and 25% were covered by Medicaid.

When Colorado resumed Medicaid eligibility reviews in 2023, following the end of the federal continuous-enrollment requirement, approximately 2,000 Mountain Family patients lost Medicaid during the first redetermination period, Moyer says. Those losses contributed to roughly $1.5 million in lost patient-service revenue.

“A lot of our patients weren’t even familiar with their coverage lapse, so they would show up and learn that their Medicaid coverage was no longer in effect,” Moyer says.

The need for care does not disappear when coverage does.

Mountain Family continued treating patients and helping them navigate coverage options. Moyer says the resulting financial pressure contributed to layoffs, the closure of two school-based health centers, and reduced behavioral health capacity.

“We have to make those decisions to close service sites or reduce service provision because we’re not able to realize revenue from this group of folks who lost coverage,” he says. “That still means loss of access for everyone – every other one of our patients.”

The financial pressure also affects what Mountain Family can maintain. “From our perspective, it just means that, one, we have to operate leaner, so we’re not able to offer as robust of services; and two, we have to make up a lot of that ground in philanthropy and fundraising,” Moyer says.

Here’s what that looks like: A person loses coverage. That person still needs medical care. The provider receives less reimbursement for providing it. When enough patients lose coverage, the financial pressure begins affecting staffing and services. And eventually someone whose own insurance never changed can encounter a clinic with fewer resources available to care for them.

The patient who loses coverage experiences the most immediate consequence, but the consequence does not necessarily end with that patient.

The same connections can carry stability

Stable coverage can work in the other direction. “When people have adequate coverage, they’re able to get care in a more appropriate setting that provides much higher value and a return on investment, if you will,” Moyer says, adding that stable coverage can benefit not only patients and providers, but also the state, employers paying health insurance premiums, and people purchasing coverage through the individual marketplace.

Affordable childcare can help a parent remain at work, supporting both the household and the employer that depends on that worker. Stable health coverage can mean that a clinic gets reimbursed for care it is already providing, rather than absorbing more of the cost itself.

It’s the same question Bell faces at home, playing out at a different scale: what becomes possible when there is enough stability to meet a need before something else has to give?

“We live interconnected lives with the communities and the people around us,” Legleiter says.

Bell’s household and Mountain Family show that connection from different points along the same chain.

Health is experienced by one person at a time. But the conditions shaping it – whether a family can afford childcare, whether a worker can get medical coverage, whether a clinic has enough resources to keep services available – do not stop at the edge of one person’s life.

The impacts are not experienced equally. The person directly affected carries the greatest burden, while effects can extend through the roles, relationships, and institutions connected to them.

The same is true when conditions improve.