In 2022, Denver Health was on the ropes, losing $35 million. Emergency state funds and donations from other health systems helped offset some of the losses in 2023, and city voters agreed to add a .34% sales tax in 2024, raising about $65 million to pay for uncompensated care and to expand services that aren’t money-makers.

At about the same time that Denver Health reached its lowest point, two of Colorado’s rural hospitals were also publicly struggling: Delta Health on the Western Slope and St. Vincent Health in Leadville. Both are doing better financially, but expect more challenges from the upcoming combination of changes to Medicaid.

Denver Health earned $49 million in 2025, for a roughly 3% margin. For many hospitals, a 3% profit would indicate a tough year, but for a safety-net hospital, any year that ends with a little bit extra to invest in services and take care of deferred maintenance is a good one, CEO Donna Lynne said.

Much of the improvement came from the new sales tax, she said.

Full information on hospital profits won’t be available for a few months, but expenses continued to grow faster than revenues for the industry as a whole, which likely cut into profit margins overall, said Tom Rennell, senior vice president of financial policy and data analytics at the Colorado Hospital Association.

Hospitals have had to staff up to handle increasing numbers of inpatients, and tariffs have pushed up the cost of supplies, he said.

“There’s just a lot of pressure on expenses,” Rennell said. “On the revenue side of things, nothing is getting better at all.”

If current trends continued, Denver Health would likely see similar results in 2026. Instead, Colorado will reduce Medicaid rates to most providers by 2% in the fiscal year starting in July, lowering the system’s revenue by about $15 million, Lynne said.

Lawmakers faced a $1.5 billion budget gap for the fiscal year starting next month and few options to close it without cutting Medicaid.

Almost half of Denver Health’s patients are covered by Medicaid, and it has fewer patients with relatively generous commercial insurance coverage to make up for the shortfall.

“It really hurts Denver Health more than it hurts anyone in the state,” Lynne said. “To do (cuts) across the board may have been expeditious, but it’s not fair.”

Other changes are coming at the federal level.

Starting in October, most legal immigrants without green cards will no longer qualify for Medicaid, which will likely leave at least 1,000 Denver Health patients without insurance, Lynne said. Work requirements under H.R. 1, known as the “big beautiful bill,” kick in Jan. 1, and state provider fee rates must drop starting in October 2027.

Colorado collects the fee from most hospitals, uses it to draw down a federal match, and then divides most of that money between covering the state’s 10% share of Medicaid expansion costs and compensating hospitals that see large numbers of Medicaid patients. The state hasn’t said how it plans to handle the mandated reductions to the provider fee, which makes it difficult to project how much hospitals might lose, Rennell said.

Lynne said she isn’t expecting an immediate surge in uninsured patients when the work requirements kick in, because federal officials allow states to take Medicaid recipients’ word that they met the requirement or qualified for an exemption in the first year.

Over the next five years, though, Denver Health expects about 20,000 patients will lose coverage, meaning they’ll likely only come in when their conditions are out of control, and they need expensive care — a situation that doesn’t benefit anybody, she said.

“I think every hospital in the state is looking at, ‘ Do I have enough (emergency department) staff,'” she said.

At the same time, Denver Health will need to spend more to assist patients with renewing their coverage every six months, and a separate change in the law means the system is less likely to get paid in full for treatment it provided to eligible patients who weren’t yet enrolled in Medicaid, Lynne said.

Overall, Denver Health projects losing about $65 million when H.R. 1 fully rolls out — roughly the same amount the sales tax brings in, she said.

Other hospitals that struggled in recent years also expect financial challenges, but said they’re better positioned to handle them than they were.

Bubba Bartlett, CEO of St. Vincent Health, said 2025 results aren’t finalized yet, but preliminary figures showed the hospital came out ahead by about $1.2 million.

At the end of 2022, Lake County had to make an emergency grant to help the hospital cover payroll. Since then, it has become more efficient and focused on growing the services that are most important locally, and appears to be on track for a similar profit in 2026, Bartlett said.

The number of uninsured patients likely will increase as changes to Medicaid roll out, but much depends on decisions the federal government makes about timelines and policies, he said.

“Like many rural healthcare providers, we are closely monitoring potential changes that could affect reimbursement, insurance coverage, and patient access to care,” Bartlett said in an email.

Delta Health had a tougher 2025, losing about $5 million, but appears to have finally turned the corner, with about a $500,000 profit in the first four months of this year, interim CEO Nicholas Colleran said.

The system saved money by not replacing administrators as they retired and by closing its labor and delivery unit, and is exploring whether it can share back office services with other small hospitals, he said.

Delta Health will face the same challenges as other hospitals, including increased uncompensated care and the need to hire another person to help patients get and maintain Medicaid coverage, Colleran said. But the bigger impact for them is that they’ll have a harder time qualifying for discounted prescription drugs, which are an important subsidy, he said.

The federal 340B program allows certain hospitals to buy medications at reduced costs and sell them at the typical price, keeping the difference. Whether hospitals qualify depends on the share of their inpatients covered by Medicaid, which varies more from year to year for a small facility like Delta Health than a bigger safety net hospital, Colleran said.

If people lose Medicaid coverage, that reduces the odds Delta Health will have enough covered stays to qualify, costing it $3 million to $4 million a year, he said.

Colleran said he hasn’t flagged any other services to possibly close, but can’t rule it out if the hospital is in the red in the coming years. Likewise, while he hopes the hospital remains independent, the most important thing is to keep it open and offering core services, he said.

“You are fighting every day (as a rural hospital) to stay open, not to get ahead,” he said.

Dr. Richard Dart joined the in 1992, after working at a poison center in Tucson, Arizona. Since then, the Denver-based Rocky Mountain Poison and Drug Safety, which includes the poison center and related research, grew from about 30 employees to 150, added a surveillance system to monitor prescription drug misuse, and led a clinical trial that changed how hospitals treat venomous snake bites.

The center’s staff, who are employed by Denver Health, answer calls from Colorado, Montana, Nevada and Hawaii.

Dart and the Rocky Mountain Poison Center have been leaders in expanding how centers contributed to health care and public safety, and quite a few younger toxicologists and poison center directors were trained there, said Dr. Alan Woolf, a professor of pediatrics at Harvard Medical School who has worked with poison centers since the 1980s.

Dart’s tenure coincided with technological advances that allowed poison centers to respond more quickly and to better use their call data, Woolf said. Before personal computers, they had to rely on microfiche records of the thousands of products people could ingest and kept call records on paper, limiting the ability to do research, he said.

“I think Rick can be very proud of the role he played over the last 30 years,” he said.

While most people know poison centers as resources to call if their child swallows something potentially dangerous, they also train toxicologists and produce research on what substances Americans are ingesting, intentionally or not.

One of the Rocky Mountain Poison Center’s biggest accomplishments during Dart’s tenure was helping to pull off a clinical trial for a new rattlesnake antivenom, which became the preferred option in the early 2000s, he said.

Studying antivenoms is difficult because any given hospital will only see a few rattlesnake bites each year, which the poison center overcame by involving 15 medical centers and ensuring those hospitals’ emergency room doctors knew to randomize whether patients received only the old antivenom, or the new one in addition. They quickly realized patients getting the new one had better outcomes.

“You have to make sure that when that patient comes, you’re ready,” Dart said. “Luck favors those who are prepared.”

Dart also oversaw Denver Health’s acquisition of the or RADARS, which tracks misuse of prescription drugs with data from poison centers, reports from about 200 law enforcement agencies and surveys of the general public and people entering addiction treatment.

The U.S. Food and Drug Administration requires drugmakers to conduct studies about misuse of their products, and most contract with RADARS to do that work, Dart said.

Purdue Pharma, the now-bankrupt maker of OxyContin, created RADARS in 2001, then sold it to Denver Health for $100 cash and $10 million worth of reports.

with advocacy groups including Public Citizen and Physicians for Responsible Opioid Prescribing, as well as some individuals who lost family members to overdoses, urging the FDA not to work with RADARS.

Advocacy groups, including Public Citizen and Physicians for Responsible Opioid Prescribing, have alleged that RADARS is too close to drug companies and provides scientific cover for their products. But Dart maintains that the system is entirely independent.

RADARS offered an early warning about misuse and addiction from prescription opioids, especially generic forms of oxycodone, Dart said. Purdue became one of the main villains of the opioid epidemic in the public mind because of their unethical sales techniques, but most people misused cheaper generic versions, he said.

“While Purdue did some very inappropriate things and are getting their just deserts, I think, OxyContin wasn’t the problem,” he said. “OxyContin never had more than a few percent of the market.”

In general, the data RADARS collected from people seeking treatment showed price, availability and purity matter most to those who use illicit drugs, which foreshadowed the shift from prescription opioids to heroin and fentanyl following a government crackdown on pill mills, Dart said.

They haven’t yet been able to answer how many people would have preferred to keep using prescription pills, if not for the crackdown, and how many switched to heroin or fentanyl because they offered a stronger effect for the same price or less, he said.

“There was this demand, and people are going to fill it,” Dart said.

It also tracked the rise of polydrug use. About half of people who reported using one recreational drug also said they used others when Denver Health purchased RADARS in 2006, but now 80% to 90% take two or more drugs, Dart said.

That suggests people aren’t especially particular about seeking one experience, he said — they just want to feel something different than they would without drugs.

“State government, federal government, they focus on one drug at a time,” he said. People who use drugs “just go to something else.”

Expenses grew faster than payments in 2022 and 2023, narrowing hospitals’ margins on patient care, while a stock market downturn cut into the value of their investments. In 2024, the trend reversed, according to the new reports, with insurance payments growing slightly faster than the cost of providing care.

Still, Colorado hospitals say their finances aren’t on a solid footing as the next challenge looms: Medicaid work requirements will kick in Jan. 1, and people who lose coverage will almost certainly become uninsured. Medicaid doesn’t cover most hospitals’ full costs, but they collect little or nothing from patients without insurance.

The state’s hospitals made about $101.6 million on patient care in 2024, up from $11 million in 2023, according to the .

That translates to roughly $99 in profit per patient in 2024 — up from $11 per patient in 2023, but far from the pre-pandemic level of $1,367 per patient in 2019.

Counting investment income, hospitals came out ahead by about $1.9 billion in 2024, with most of the profit going to large facilities. Total profits were about $407 million higher than in 2023, but still about $381 million below 2019 levels.

The releases two legislatively mandated reports, which lag by one year, on hospital systems’ finances each January. A third report, on , lags two years, so the data only covered 2023.

The overall profits conceal significant variation.

Out of 85 facilities reporting data, 22 lost money overall, down from 32 in 2023, according to the . Overall profit margins ranged from a high of 33% at in Fort Collins to a low of -182% at , which opened in Colorado Springs that year.

Smaller and independent hospitals were more likely to lose money.

Hospitals didn’t perform as well without investment income included, however.

When looking at patient care and related operations, 45 hospitals lost money, and only 28 made 4% or more, which the considers a sustainable profit margin.

Which method generates a better picture of hospital finances is a perennial bone of contention. State officials describe reserves and investments as important for understanding facilities’ total wealth, while the hospital association likens them to retirement accounts that no one wants to tap for daily expenses.

Kim Bimestefer, executive director of the Department of Health Care Policy and Financing, described 2024 as a time of stabilization for hospitals, because payments started growing faster than expenses for the first time since 2021. Both have roughly doubled over the last decade, she said.

“At the other side paying all of this are consumers and employers, so we’ve got to recognize the sustainability of that, how do we work together to get it down, but also recognize where the hospitals are struggling,” she said.

Complete data from 2025 isn’t yet available, but the numbers from the first nine months of the year suggest hospitals continued “treading water” last year, said Tom Rennell, senior vice president of financial policy and data analytics at the hospital association.

Inflation remains high and the cost of uncompensated care is increasing, so 2024 was a challenging year, he said.

“Everyone’s just kind of hanging in there,” Rennell said.

Uncompensated care, which is the sum of charity care hospitals provide and bills they can’t collect, increased by about $171.7 million, or close to one-third, from 2023 to 2024.

The department attributed the increase to the end of the COVID-19 public health emergency, when states had to start verifying Medicaid eligibility again and recipients lost coverage. The Census Bureau estimated the uninsured rate in Colorado rose from 6.7% in 2023 to 7.9% in 2024.

, the city’s safety-net hospital, provided $174.7 million in uncompensated care, or about one-quarter of all unpaid services in the state, followed by , in Aurora, at $76.1 million and , in Colorado Springs, at $24.4 million.

The cost of uncompensated care will almost certainly increase in the coming years.

Medicaid work requirements under H.R. 1 — known as the “big beautiful bill” — will take effect in January 2027, and people who can’t navigate the process won’t have another option for health insurance, said Jennifer Tolbert, deputy director of the Medicaid and uninsured program at , a nonprofit that does health policy research, polling and journalism.

States will have some control over the resources they put into finding data so that fewer people have to file their work hours manually, but an increase in the number of uninsured people is inevitable, she said.

“Regardless of how much data-matching states are able to do, people are going to fall through the cracks,” Tolbert said.

Donna Lynne, CEO of Denver Health, said the state’s plans to hold Medicaid rates flat for the next few years, combined with cuts under H.R. 1, will force difficult choices in hospitals that serve large numbers of low-income people.

Colorado faces a budget gap approaching $1 billion, and Medicaid accounts for one-third of state spending.

“We’re not crying wolf. The bottom is going to fall out,” she said during a on Feb. 11. Denver Health lost about $20.5 million on patient care and related services in 2024, and had a 0.2% profit margin with investments.

The coming increase in the uninsured rate means that hospitals will need to do more to help patients navigate the Medicaid enrollment process and to provide the assistance their communities need most, said Sophia Hennessy, policy and research lead coordinator at the .

Federal law requires nonprofit hospitals, which are exempt from most taxes, to spend money on “community benefit,” which can include free care, health-promotion programs and medical research, among other things.

The state’s community benefit report showed nonprofit hospitals spent about $1.4 billion on community benefits, exceeding the value of their tax exemptions.

Training and recruiting providers, mostly at the and , accounted for the largest share, followed by charity care and unspecified other programs.

“Hospitals are, net, doing strong, and we want to see more of an investment in Coloradans,” Hennessy said.

Rennell disagreed that hospitals’ overall position is strong. Most are financially shaky and expect the situation to get worse as more patients lose their insurance next year, which could force some to close or reduce services, he said.

“Our hospitals are taking that seriously, yet feeling the road ahead is going to bring difficult choices,” he said.

National Guard members will participate in exercises to “enhance coordination and readiness in the event Guard aircraft are ever needed to transport patients,” Denver Health officials said in a news release.

Pilots will conduct controlled landings of a UH-72 Lakota between 12:45 and 1:45 p.m. Friday at the hospital’s Pavilion A, 777 Bannock St.

There may be more noise and helicopter activity during the training, but patient care will not be impacted, hospital officials said.

Modisette, who owns a small construction business with her husband in Castle Rock, said they currently pay about $175 a month for insurance bought on the . When enhanced federal subsidies expire in January, the family’s monthly cost would jump to $430, which isn’t feasible, she said.

While she’s been in remission from thyroid cancer for 10 years, Modisette still needs periodic blood tests and medication to replace hormones her thyroid would have produced.

While their two children qualify for — which covers kids from families that earn too much for — Modisette and her husband don’t have a public coverage option and are contemplating going without insurance. Other small business owners she knows are in a similar position, since they don’t have job-based coverage.

“It’s real people that are working really hard to build something of your own,” Modisette said. “If something bad happens, are we going to go bankrupt?”

Monthly health insurance premiums are poised to double next month for hundreds of thousands of Coloradans who have been receiving enhanced pandemic-era subsidies on the individual marketplace, according to the state’s . About 321,000 people received those subsidies in Colorado last year.

The loss of those subsidies, which Congress has so far declined to extend, at the end of this month will force individual marketplace customers across the nation to shoulder a larger share of their premiums in 2026.

The Denver Post spoke to Coloradans facing large premium increases about the choices they face as their insurance costs increase.

People facing significant increases have three general choices: find another source of coverage, choose a less expensive plan within the individual marketplace – with the possibility of facing more out-of-pocket costs if they need care – or go without insurance, meaning they would have to pay the full price for any medical care they need.

Customers who wanted their insurance to start Jan. 1 needed to pick a plan by Monday. Those who haven’t could still choose Jan. 15 for coverage starting in February.

Congress adjourned without passing any bills to extend the subsidies, but the House of Representatives will take up the issue in January. , who wants to move on, and joined a Democratic “discharge petition” that will force leadership to hold a vote on a bill that would extend the subsidies for three years, with no major changes.

Such a bill would face challenges in the Senate. The chamber voted down a three-year extension earlier this month. A Republican alternative, which would have placed $1,000 into health savings accounts, with the sum increasing to $1,500 for people between 50 and 64, .

House Republicans passed a bill expanding coverage options for small businesses and self-employed people, but it where it would need at least some Democratic support to move forward. , though none yet have the support to pass.

If Congress extends the subsidies in January, the state-run marketplace, , would have to shut down temporarily to reprogram. Congress , protecting customers from the rate increase coming at the start of the year.

‘Health insurance is rapidly becoming my mortgage’

Roger Allbrandt, of Centennial, said that if Congress doesn’t act, the subsidy for the plan covering him and his wife Claudia will drop from $1,036 to $503, raising their monthly premiums from about $35 to $862.

About two-thirds of their increase in cost comes from reductions in subsidies, and one-third comes from an increase in the overall cost of the plan.

Claudia recently started a new teaching job that provides insurance, but adding Allbrandt to her plan would put the monthly cost over $1,000. He’s planning to rely on the in Aurora for primary care and any emergencies.

They liked their coverage through the , but the increase is more than their budgets can handle, he said.

“I never have an extra $800/month to pay for health insurance. No way we can even consider the DHMP plan,” he said in an email.

Kate Tynan-Ridgeway, a retired teacher who lives in Littleton, said she also is moving to a less-than-ideal coverage option. Her premiums on the marketplace would have risen from about $600 a month to $1,200, so she decided to buy insurance through the , at about $800 a month.

The PERA plan comes with a $4,000 deductible, which is about twice the amount her previous insurance required, Tynan-Ridgeway said. Patients pay a larger share of their health care costs before hitting the deductible, with lower-premium plans requiring patients to pay for everything other than preventive services they legally must cover until they hit the deductible.

“I’m making harder decisions about when to seek health care,” she said.

Her husband, Patrick Ridgeway, aged onto this summer, which reduced their insurance expenses, Tynan-Ridgeway said. But she’s still considering picking up some odd jobs to offset the increased cost, she said.

“I don’t have a mortgage, and I feel like health insurance is rapidly becoming my mortgage,” she said.

In a , about one-third of marketplace enrollees said they would shop for a different plan if their costs doubled, and one-quarter said they would consider going without insurance.

About half said they already have some difficulty affording premiums, and three-fifths said they have trouble paying their deductible.

‘I worked hard, I did what I needed to do’

Myshel Guillory, of Eagle, would have preferred to stay in the individual market, but determined she’ll probably be better off paying out of pocket.

She was counting on health care costs rising 5% to 8% annually when she retired two years ago, but the price of insurance more than doubling threw off her plan.

The most affordable plan Guillory found would cost about $1,000 a month and have a $12,000 deductible. If she had an injury or illness severe enough to meet the deductible, health care would eat up one-quarter of her budget that year, Guillory said.

She looked for jobs with insurance around Eagle, but hasn’t gotten any callbacks, and is planning to go without coverage until either the subsidies return or she qualifies for Medicare in 10 years.

Friends of hers who planned to retire in their early 60s and use the individual marketplace as a bridge to Medicare are now holding onto those jobs, which doesn’t serve them or people who’d like to move up in their careers, she said.

“I planned, I worked hard, I did what I needed to do,” she said. “Sure, I have $1 million in the bank, but that needs to last.”

Most people who will receive subsidies next year can still find an affordable option, particularly if they’re willing to consider a different company or to pay more if they need care, said Leah Denzel, an insurance broker and owner of . People earning more than , or about $62,000 for an individual, will no longer qualify for any assistance with their premiums.

The amount of the tax credit is based on the second-cheapest silver level plan available in each area, but customers can use it to buy any bronze, silver or gold plan, Denzel said. Bronze plans have lower monthly premiums and higher out-of-pocket costs for using care, while gold plans have the opposite design and silver plans land in the middle.

“For most people, there are options,” she said.

People near 400% of the poverty line have to make harder choices, though, particularly if their income can vary from year to year, Denzel said. The enhanced subsidies allowed people with incomes over that threshold to receive assistance for the first time.

In addition, the Trump administration has announced that people who received some level of subsidy, but then end up earning too much to qualify for it, will have to pay back the full amount, Denzel said. Anyone who might be close to the line will need to watch their income carefully, so they can claim subsidies if they qualify and drop them if their business picks up, she said.

While no one knows what Congress may do, Denzel said she’s recommending her clients choose an plan they can afford without the enhanced subsidies — and that they avoid short-term plans or health-sharing ministries that look cheaper, but .

“If they have any health conditions, they need an ACA plan,” she said.

As long as her mind is sharp and her fingers are flexible, Sellers, 90, plans to keep working. Even after reaching her 70th anniversary with the city this fall.

“No. 1, I do not want to retire, because I would not be able to stay here in this house and look at these walls 24/7,” she said. “And No. 2, as long as I can think and as long as I can use my hands, I am still willing to work.

“And, really, I enjoy working.”

Sellers celebrated her 70th anniversary on Oct. 17 with a party hosted by the Denver Department of Public Safety, where she works in the human resources office. She is Denver’s longest-serving employee in its 167-year history, so far as anyone knows.

For those keeping track, Sellers has been an employee for 42% of Denver’s entire history as a city.

Every Monday through Thursday, Sellers spends eight hours scanning police officer and firefighter personnel records into the safety department’s computer system as part of its conversion to an electronic system.

For many, it would be boring.

For Sellers, no job is too small.

“I enjoy doing whatever I’m assigned to do,” she said. “If it’s something new, show me what you want me to do and I’ll do it.”

Sellers arrives at her office in downtown’s Republic Plaza tower at 8 a.m. sharp, dressed in a suit and with impeccable makeup. She no longer drives, so another city employee gives her a ride every day.

Sellers is considered old-fashioned by many. She still sends thank-you notes, dresses up every day and quotes scripture on her home answering machine.

“I give thanks to God every day that I can still take care of myself, take care of my house and go to work every day,” she said.

Jinna Berry, Sellers’ supervisor in the safety department, said she was relieved when Sellers was assigned to her department. The safety department needs to scan personnel files dating back to the 1950s. Various people in the office were scanning when they had some extra time, but the project has dragged on for nearly 10 years.

With Sellers at the scanner, there’s noticeable progress.

“It would be really hard for me to find somebody else to fill that position that gets enjoyment out of it,” Berry said. “It’s a very dull task, day after day.”

Sellers enjoys knowing her assignment each day. She’s good at organizing the paperwork, which often comes in a pile with nothing in order, Berry said.

“At the end of the day, her desk is all cleaned and picked up,” Berry said. “You can tell she still takes pride in work even after being here for 70 years.”

The safety department colleagues know not to mention the word “retirement.”

“She will give you a look,” Berry said.

Friends marvel at Sellers’ determination to keep working.

“Her life has been really successful,” said Annette Housely, a former coworker who has remained a trusted friend. “Just to watch her and her faith and her consistency in getting up every day to go to work, even when she’s not feeling good … I’m just amazed at her.”

Sellers arrived in Denver in 1954 as a 19-year-old high school graduate from Mississippi. Nuns at her Catholic school had recommended she give Denver a try to escape the Jim Crow South and made arrangements for her to find housing in the city.

Sellers got her first job with Denver in October 1955, when she was hired to work as a nurse’s aide in the men’s medical ward at the city-owned Denver General Hospital, now Denver Health Medical Center.  She also worked in the newborn nursery and then earned a promotion at the hospital after passing a clerical exam. She worked there for 25 years.

In 1980, she transferred to Denver’s Employment and Training Agency and then dodged a layoff in 1982 by transferring to the Career Service Authority. She’s also worked for Denver Human Services.

Employment at the city has not always been easy for Sellers, especially as she aged and felt that some managers intentionally made life hard to try to force her into retirement.

But determination and a strong faith in God keep Sellers motivated.

In August, Sellers survived the city’s most recent layoffs. But barely.

A human resources manager came to speak to her about the pending cuts, and Sellers, fearing she would be on the list, said she quoted Bible verses:

Galatians 6:7, which tells people they will “reap what they sow.”

Romans 12:19, which says: “Vengeance is mine; I will repay, saith the Lord.”

Sellers did not want to lose her job. So she offered a solution, suggesting the city reduce her to part time.

Now she works 32 hours per week and still has benefits.

Still, the layoffs were painful, Sellers said, knowing that good people who were supporting their families were forced out the door.

“It really hurts my heart when I think about it,” she said.

Sellers has long been known as a strong advocate for herself.

In 2015, Sellers famously shamed then-Mayor Michael Hancock when the city failed to buy a 60-year service lapel pin and instead gave her a 15-year pin as a placeholder.

Hancock personally awarded her a 60-year pin in a ceremony 17 months later.

This year, city officials had learned their lesson and a 70-year pin was ready in time for Sellers’ party. The Denver Department of Transportation and Infrastructure made her a commemorative street sign, and she soon will receive a framed American flag that flew over the Colorado Capitol.

At the party, Sellers gave a speech. She closed with a mic drop.

“I said, ‘In closing’ — and I had a mic — ‘I do not plan to retire!’ ” she said. “Everyone bust up clapping and laughing.”

Now 19 years old, Bayley is one of hundreds of metro Denver teenagers who benefit every year from  known as STEP.

STEP therapists and psychiatrists work with young people at the uniquely challenging intersection of mental health and substance use struggles, medical director Mario Lintz said.

Teens often come to STEP through school referrals or their parents seeking help, or because they were seen in the emergency room or referred through a diversion program for juveniles in the court system.

Like many program graduates, Bayley found it during one of the lowest points of his life. He attempted suicide by overdose when he was a sophomore in high school and was treated at Denver Health, where he connected with a doctor who told him about STEP.

The swirl of developmental changes that happen in adolescence already makes it a prime time for teens to develop anxiety and negative thinking, Lintz said. Those changes, added to while they’re trying to figure out who they are, can be a volatile combination.

“With kids who have a traumatic past, substance use becomes something they use regularly to deal with those things,” Lintz said.

And it might make them feel better at first, until they start experiencing withdrawal symptoms and worsening side effects, and are now struggling with a substance use disorder along with an untreated mental health disorder.

To make it even more challenging, it����ap hard to find a provider who will treat both, whether in Colorado or across the country, Lintz added.

“As much overlap as there is between substance use and mental health disorders, they’re often viewed separately, and there’s not a lot of providers who feel comfortable treating both. It can make the picture unclear, from a mental health standpoint, of what����ap going on,” he said.

STEP fills that need with ongoing therapy, medication management and an for teens and their families.

The program also goes the extra mile to remove barriers that often prevent people from accessing care.

STEP isn’t just in one location — providers meet with their patients at the Bannock Street offices as well as at 11 Denver-area high schools. The program pays for transportation for about 40 young people to get to appointments every week. And there are always plenty of snacks and beverages on hand for those who need them.

Five years after he first started STEP, Bayley is now working toward an associate’s degree in business with the goal of completing a bachelor’s in marketing and becoming a marketing or brand director. He plans to move to New York City this summer to further his career goals.

It����ap a dramatic difference from where he was, Bayley said — from wanting to give up to loving himself and feeling comfortable in his skin.

“I was a 13-year-old who smoked weed all day and thought college was stupid,” Bayley said. “Now I’m going to college. I care more about my life. Before I was fine dying before 18, and now I’m 19 and I want to live.”

Denver Health STEP program

Address: 660 Bannock St., Denver, CO 80204

In operation since: 2003

Number of employees: 10

Number of volunteers: 0

Annual budget: $1,178,147

Number of clients served: 5,310 total visits in 2024

The health care provider paid $5.5 million last week, according to public records, for a 0.7-acre site along Bannock Street just south of Sixth Avenue. That works out to $180 a square foot.

Denver Health didn’t respond to requests for comment about the purchase. It hasn’t submitted any development plans to the city for the site, which is made up of multiple parcels zoned C-MX-8. That generally allows for up to eight stories and a mix of uses.

The bulk of Denver Health’s operations are north of Sixth Avenue. But the system has a paramedic training facility across Bannock Street from the site it just bought, and a parking garage behind that along Acoma Street.

In early 2022, Dallas-based developer Mill Creek Residential submitted plans to Denver proposing an eight-story, 219-unit apartment building at the site, which is at the north end of the Baker neighborhood.

But Mill Creek never bought the site. The parcels were sold by Bannock Properties LLC, an entity managed by Thomas Barenberg.

In 2022, two dilapidated homes sat on the southern end of the site. But those have since been demolished.

This is Denver Health’s second real estate deal south of Sixth Avenue since August. That month, the system sold a parking lot at 155 W. Fifth Ave. to developer Jeff Shanahan of Shanahan Development, who plans to build an income-restricted housing project.

That deal happened because Shanahan sold a site he’d been planning to develop near Burnham Yard to the Denver Broncos, who intend to build a new stadium at the former railyard.

Initially, pharmacies couldn’t administer the updated shots in Colorado unless a patient had a prescription. The state allows pharmacists to administer vaccines recommended by the Centers for Disease Control and Prevention’s advisory committee, but not other shots.

Dr. Ned Calonge, chief medical officer for the state health department, responded by issuing a standing order — essentially, a prescription for every resident – allowing them to get vaccinated at retail pharmacies.

But that order doesn’t guarantee insurance will cover the shots or that pharmacies will choose to stock them. Last year, fewer than half of people over 65 nationwide received an updated COVID-19 shot, with uptake dropping further in younger age groups, raising questions about whether health care providers will believe demand is high enough to justify buying the vaccine.

“The standing order provides accessibility. It doesn’t necessarily provide availability,” Calonge said Tuesday.

The last week that would require state-regulated plans to cover COVID-19 vaccines without out-of-pocket costs for people of any age, assuming the division passes it as written. Insurance cards from state-regulated plans typically have CO-DOI printed in the lower left corner.

The state’s rule doesn’t apply to federally regulated plans, which account for about 30% of employer-sponsored insurance plans in Colorado, Calonge said. Typically, however, those plans try to offer competitive benefits, since they mostly serve large employers, he said.

“My hope would be they would want to keep up with other insurers,” he said.

This isn’t the first time that people on state-regulated plans have had benefits not guaranteed for people with federally regulated insurance.

Colorado capped the cost of insulin and epinephrine shots to treat severe allergic reactions in state plans, but couldn’t require the same for plans the state doesn’t oversee. In those cases, it offered an “affordability program” requiring manufacturers to supply the medication at a lower cost for people who aren’t covered by the state caps, Medicare or Medicaid.

At least two Colorado insurers surveyed by The Denver Post said all of their plans will cover COVID-19 vaccines, while others hedged.

Select Health, which sells Medicare and individual marketplace plans in Colorado, said its plans currently cover COVID-19 vaccines without out-of-pocket costs for everyone. Kaiser Permanente Colorado said in a message to members that it will pay for the shot for anyone 6 months or older.

Donna Lynne, CEO of Denver Health, said the health system’s insurance arm is waiting on clarification about when it should cover the vaccines. Denver Health Medical Plan offers multiple plan types, some state-regulated and some under federal rules, she said.

“It’s less of a decision on our part than understanding what the health department and the insurance department are saying,” she said. “You can’t have one insurance company saying they are doing it and one saying they aren’t doing it.”

Anthem said it considers immunizations “medically necessary” if the American Academy of Pediatrics, American Academy of Family Physicians or the CDC’s vaccine advisory committee has recommended them, but didn’t specify whether it would charge out-of-pocket costs for medically necessary vaccines.

If those bodies stated that certain people could get a particular vaccine — but not that they should — Anthem would decide about coverage “on an individual basis,” . The other groups have recommended the shots for people over 18 or under 2, with the option for healthy children in between to get a booster if their parents wish.

The state’s Medicaid program is still waiting for guidance from federal authorities about whose vaccines it can cover, according to the Colorado Department of Health Care Policy and Financing, and .

For most of the COVID-19 vaccines’ relatively brief existence, they were free and recommended for everyone 6 months and older. In 2024, the federal government stopped paying for them, which meant uninsured people no longer could be sure they could get the shot without paying.

Almost all insurance plans still were required to pay for the shots, though, because the CDC’s Advisory Committee on Immunization Practices recommended them.

In previous years, the committee recommended updated shots within days of the U.S. Food and Drug Administration approving them. In late August, the increasing their risk of severe disease, including asthma, obesity and diabetes.

Doctors still could prescribe the vaccine “off-label” to healthy people, in the same way that they prescribe adult medications for children when an alternative specifically approved for kids isn’t available.

This year, however, , and may not recommend the shots when it does. Secretary of Health and Human Services Robert F. Kennedy Jr. dismissed all of the committee’s members earlier this year and replaced them with new appointees, most of whom oppose COVID-19 vaccines.

The committee’s decision also will determine whether the Vaccines for Children program can supply the shots for children who are uninsured, covered by Medicaid or are members of American Indian tribes, Calonge said. If the committee decides not to recommend the vaccines, those children likely won’t have another option to get the shots, he said.

When states and the federal government passed laws linking coverage to the committee’s recommendations, they did so expecting that it would also remain an apolitical arbiter of the evidence for vaccinating the population or specific subgroups, said Cathy Bradley, dean of the Colorado School of Public Health.

Now, that premise is in doubt, and states are looking for other ways to ensure access, she said.

Allowing anyone who wants a COVID-19 vaccine to get one from the provider of their choice is an important first step for Colorado, because the vaccines remain effective in preventing severe illness, Bradley said. As the situation develops, the state will likely need to come up with other partial solutions to preserve access, she said.

“It’s a different path for everyone, depending on what your coverage is,” she said.

CEO Donna Lynne recently told the that the hospital expects a $64.2 million annual loss, mostly because patients who currently have Medicaid will lose coverage, but keep coming for care.

“This is going to create a big problem for us,” she said.

Starting in 2027, people covered under the Medicaid expansion, which raised the maximum income to 138% of the poverty line, at least 80 hours each month.

The work requirement exempts people who are pregnant, “medically frail,” disabled veterans or parents of children under 14. In the few states that attempted to add work requirements, thousands of people became uninsured, including some who had jobs but struggled to navigate the paperwork.

providers would lose a combined $10 billion over five years due to provisions of Congressional Republicans’ tax-and-spending law H.R. 1, known as the “big beautiful bill.”

AdventHealth, CommonSpirit Health, HCA HealthOne and Intermountain Health said they hadn’t calculated the bill’s effects, but would work to protect vulnerable patients.

UCHealth said it hasn’t estimated an impact, because the state’s decisions could blunt or worsen the effects. Four of its hospitals are in the top eight Medicaid providers, by dollar amount of care provided, and all provide significant uncompensated care, spokeswoman Kelli Christensen said.

Children’s Hospital Colorado, which consistently ranks near the top of the state’s hospitals by share of patients covered by Medicaid, didn’t say what the cut’s financial impact could be, but said it could be “hugely disruptive” to children’s access to care in the state.

The city projects the sales tax Denver voters approved in 2024 will bring in about $65 million in its first year, though the amount could change, depending on whether economic conditions cause residents and visitors to spend more freely or to close their wallets. The tax adds 34 cents to a $100 purchase in the city.

The wording of the ballot question doesn’t allow Denver Health to simply replace any Medicaid revenue it loses with sales tax dollars. The tax proceeds must go to emergency and trauma care, primary care, pediatrics, mental health care, and addiction treatment and recovery services.

Denver Health roughly broke even in 2024, with about a 1% profit margin. It narrowly lost money in 2023, despite receiving $5 million from the state. It ended 2022 about $35 million in the red.

While patients becoming uninsured will have the biggest impact on hospitals, H.R. 1 also limited the “lookback period” to 30 days, Lynne told the council committee on Aug. 21.

If a person who is eligible for Medicaid, but not enrolled, gets care and enrolls within 90 days, the hospital or clinic that cared for them can get paid retroactively. Shortening that period will increase uncompensated care, because the state can’t always process the paperwork to determine someone is eligible within a month, she said.

Denver Health serves an unusually high number of people covered by Medicaid. In June, about 47% of patients had Medicaid as their insurance, and 10% were uninsured, Lynne said. Roughly one in 10 uninsured patients last year was a newcomer or migrant, she said.

The hospital system declined to discuss how it would close a new budget hole.

“Denver Health is committed to working closely with the state to mitigate some of these impacts on both us and our patients during this unprecedented time,” Denver Health said in a statement.