A new Yale study projects that a national single-payer system could save $1 trillion a year. With local hospitals squeezed by Medicaid bureaucracy and residents skipping care over cost, here is how the debate lands in Mesa, Montrose, and Garfield counties.
A new Yale study has revived a familiar health care debate with an unusually large number: researchers estimate that a national single-payer system could reduce U.S. health spending by about $1 trillion a year while preventing more than 114,000 deaths.
The study is a projection, not a real-world test, and it has not yet been peer-reviewed. But the questions behind it are especially relevant on the Western Slope, where residents face some of Colorado's highest insurance costs, provider shortages remain common, and rural hospitals depend heavily on Medicaid and other public programs.
Colorado is now conducting its own analysis of universal health care using state data. The results are expected later this year and could offer a much clearer picture of what different financing models would mean for patients, employers and health care providers in Western Colorado.
Western Slope residents who buy their own insurance have repeatedly faced some of the highest premiums in the state. The expiration of enhanced federal Affordable Care Act tax credits at the end of 2025 made those costs even more noticeable.
Colorado Public Radio reported that a family of four earning about $128,000 could face an annual premium of nearly $21,000 for a standard silver plan in parts of Western Colorado, compared with about $14,000 in the Denver area.
Even people with coverage are still struggling to afford care. Mesa County's 2024 community health assessment found that 26.7 percent of residents had skipped needed medical care because of cost. Among people with private insurance, the rate was 28.8 percent.
That gap between being insured and being able to use that insurance is not unique to Mesa County. The Colorado Health Institute found that the statewide uninsured rate was 5.9 percent in 2025, while more than one in four residents still reported delaying or skipping care because of cost.
Access is another challenge. Mesa County's health assessment found significant shortages in specialty and behavioral health care, including an estimated need for eight additional full-time psychiatrists.
Those conditions make the health care debate here more complicated than simply lowering premiums. Any new system would also have to address whether patients can find providers and whether rural hospitals can continue offering the services communities rely on.
Medicaid is one of the largest sources of health coverage in the region. State fiscal year 2024 data show average monthly Health First Colorado enrollment at about 28.6 percent of Mesa County's population, roughly 45,900 people. Enrollment was about 29.3 percent in Montrose County, 22.6 percent in Garfield County and more than 30 percent in Delta County.
In Mesa County, the administrative side of Medicaid has become part of hospital operations. In May 2026, the county Department of Human Services began placing eligibility specialists inside Family Health West in Fruita and Community Hospital in Grand Junction. The specialists help patients apply for Medicaid and other assistance while they are already receiving care.
The arrangement reflects how closely public benefits and local health care have become connected. For patients facing illness, transportation barriers or financial hardship, completing eligibility paperwork can determine whether care is covered at all.
That reliance also makes federal Medicaid changes particularly important for the Western Slope. New requirements scheduled to begin in 2027 include more frequent eligibility checks and documentation requirements for some recipients.
The Bell Policy Center estimates that about 63,000 people in Colorado's 3rd Congressional District are among the 377,000 Coloradans at risk of losing Medicaid coverage because of the new administrative requirements. The district includes most of the Western Slope.
Hospitals are also watching changes to Colorado's hospital provider fee, which helps draw federal Medicaid funding into the state. The Colorado Hospital Association projects a $10.4 billion reduction in funding associated with the program over five years.
The financial outlook varies significantly from one Western Slope hospital to another.
Grand River Health in Rifle has pushed back on reports suggesting it faces an immediate closure risk. CEO Jim Coombs has described the hospital as financially stronger than it has been in years, with more than 180 days of cash on hand.
Delta Health has faced more persistent financial strain. CEO Jonathan Cohee has also rejected claims that the hospital is at risk of closing, but has acknowledged the possibility of service reductions. The hospital had about 23 days of cash on hand after several years of operating losses.
In Montrose, the pressure has appeared in other ways. S&P Global Ratings lowered Montrose Regional Health's credit rating in March, citing weaker balance-sheet metrics. The hospital also stopped participating in Humana Medicare Advantage plans at the beginning of 2026 after reporting more than $1.5 million in unpaid or underpaid claims.
That dispute offers a local example of one of the problems highlighted by the Yale study: administrative complexity. Researchers argue that a single-payer system could reduce spending by simplifying billing and insurance administration. Hospitals like Montrose Regional Health are already dealing with the opposite problem, spending significant time and money resolving payment disputes with insurers.
The Yale researchers modeled a national public insurance system similar to Medicare for All proposals introduced in Congress. Using 2024 spending, insurance and mortality data, they estimated annual savings of about $1.04 trillion.
The study attributes those savings to lower prescription drug prices, reduced administrative overhead, lower provider payment rates, less fraudulent billing and fewer avoidable emergency visits. Even under more conservative assumptions, the researchers estimate savings of at least $663 billion per year.
The study also projects that universal coverage could prevent more than 114,000 deaths annually.
There are important limitations. The paper is still a preprint and has not been peer-reviewed. It is also national in scope, so it does not show what would happen to a hospital in Delta, a clinic in Montrose or a family buying insurance in Grand Junction.
Some of the assumptions that produce national savings could also create difficult tradeoffs in rural areas. Lower hospital reimbursement, for example, may reduce overall spending while putting additional pressure on facilities with smaller patient volumes and fewer financial reserves.
Colorado's study may provide more useful answers for Western Slope communities.
Under Senate Bill 25-045, the state created a collaborative to examine universal health care options, including a proposed publicly financed single-payer system. The work involves the Colorado School of Public Health, the Department of Health Care Policy and Financing, Connect for Health Colorado and representatives from hospitals, employers, labor, health care professions and consumer groups.
Researchers are using Colorado's All Payer Claims Database, giving them access to detailed information about what public and private insurers actually spend on health care in the state.
The analysis is expected to examine how different models would affect premiums, taxes, employer costs, provider payments, patients and rural communities. That should allow researchers to address questions that a national study cannot, including whether proposed payment rates would be sustainable for smaller hospitals and clinics.
The collaborative has public meetings scheduled for September 8 and November 19, with findings expected later this year.
Colorado is also receiving about $1 billion over five years through the federal Rural Health Transformation Program, including more than $200 million in the first funding period.
The money can support workforce development, telehealth, emergency medical services, shared records and technology improvements. It is not designed to replace lost Medicaid revenue or cover routine hospital operating deficits.
Colorado Rural Health Center CEO Michelle Mills told KUNC that the funding would not make up for expected Medicaid cuts.
For Western Colorado, that means rural health systems are entering a period of significant change from very different financial positions. Some hospitals are relatively stable, while others are operating with narrower margins or cutting services.
The Colorado analysis will not settle every argument over universal health care, but it should provide a clearer picture of the tradeoffs than national projections alone.
For Western Slope residents, the most relevant questions are practical. Would families pay less overall for care? Would people who already have insurance find it easier to use? Would rural hospitals receive enough reimbursement to maintain services? And would changing the financing system do anything to address shortages of doctors, specialists and behavioral health providers?
Those questions are already playing out across Mesa, Montrose, Garfield and Delta counties. Colorado's study should provide a better sense later this year of whether a different health care model could improve that picture, and what it might cost to get there.
