Healthcare headwinds Part 3:

One-payer concept looks for funding

By Katherine Nettles

Editor’s note: This is the third and final installment of our healthcare series. However, the Crested Butte News will continue to follow and cover this dynamic and ever-evolving subject of healthcare costs from different angles as federal, state and regional developments occur. Stay tuned! 

As the Crested Butte News has explored over the past few weeks, major shifts in healthcare coverage and costs appear imminent across the U.S. with federal cuts and changes to existing health insurance programs, subsidies and tax credits. Such changes are predicted to have bigger impacts in the rural mountain west of Colorado and Gunnison County, where healthcare services and infrastructure are spread thinner. Some citizens and professionals are advocating for Colorado to adopt healthcare reform, and a new law directs a state-backed study on how to do it. 

Nationally, 23 states are pursuing universal healthcare at the individual state-level or national level.  In the Gunnison Valley, two voices in particular have joined the chorus: Marsha Thorson and Laird Cagan.

Organizations such as One Payer States (founded in 2009) and the Colorado Foundation for Universal Health Care (CO4UHC) are part of this movement. Thorson serves on the CO4UHC board of directors working with advocates and policymakers nationwide to promote reform. She says the single greatest barrier to getting such a public program is for-profit insurance companies outspending public advocates in campaigning against such reform. 

“Progress toward universal health- care depends on overcoming the immense influence of the (for-profit) insurance industry,” she says.

A one-payer system would be run through a single public agency and provide healthcare for all residents, funded through taxes, while healthcare would continue to be delivered by private entities or a mix of public and private entities. 

Thorson got involved with the reform movement through her own career in healthcare research, working in public health, and working with her husband, local physician Eric Thorson, to open a primary care clinic when they moved to Crested Butte in 2010. 

CO4UHC’s initiative for establishing universal health for Colorado was defeated on the ballot in 2016 but as Thorson points out, insurance companies spent $8 million lobbying against the initiative, versus the budget of less than $800,000 to educate the public about it. 

One Payer States held its national conference in Denver last month.

“I was thrilled to attend in person and meet people across the nation who are working on the same effort to change/replace the U.S. healthcare system that is only working for the top tier of management and shareholders of for-profit insurance companies,” reports Thorson. 

She describes in more detail the past 15 years of working closely with insurance companies in the private practice with her husband, and then with the former Gunnison Valley Family Physicians (GVFP) office. It was an extremely challenging bureaucracy that is only expected to get worse.

A system in crisis

“I have had the personal experience of running two separate independent family practice offices in this valley, both doing everything possible to survive within the American healthcare system,” says Thorson. She worked with public insurers like Medicaid and Medicare, and 15-20 private or commercial insurers like Cigna, Anthem Blue Cross Blue Shield and United Healthcare. 

Thorson also helped others in the valley navigate the healthcare exchange when the Affordable Care Act passed in 2014, helping determine if they qualified for Medicaid and linking them up with local brokers or the Gunnison Health and Human Services resources. Then in 2019 she describes having been “the lone rural voice on the Colorado Primary Care Payment Reform Collaborative fighting for a changed healthcare system and fighting for greater investment in primary care.”

Thorson describes the difficult decision to close GVFP in fall 2024. The practice had operated for 82 years in the valley. 

She says the costs of offering benefits as a small business (particularly health insurance) and the cost of living were drivers (wage competition, staff recruitment/retention), but the biggest problems were related to the ongoing technology upgrade requirements and maintenance, fights with multiple insurance companies to get claims processed, “and the nail in coffin for GVFP was related to the all of these issues in combination with the cyberattack to the clearinghouse of Change Healthcare (owned by United Healthcare Group),” says Thorson. 

The cyberattack occurred in February 2024. “This system was integral to the claims and payment processing of our healthcare system,” she says. “We were forced to close seven months later. We couldn’t make the insurance companies process claims faster or pay us in a faster or more timely fashion.”

The latest changes and cuts to the healthcare industry through the Big Beautiful Bill are expected to make things worse, according to industry leaders.

Thorson describes that the practice worked closely with Jason Amrich, CEO of Gunnison Valley Health (GVH), to take on the majority of its workforce and keep primary care in the valley. “We felt blessed to have had a great working relationship with GVH,” she says.

However, the process has deepened Thorson’s conviction in insurance reform. “The insurance companies ensure that you pay your premiums to have an active insurance policy, but the providers of healthcare (doctor’s offices, hospitals, etc.) end up serving as a bank providing interest free loans to insurance companies and patients. We might get copayments upfront, but otherwise weeks to months and sometimes even years go by before claims are fully resolved between dealing with the insurance companies and patients to receive payment based on how the insurance processed the claim,” she explains. 

Thorson also describes many other practices across the state that have closed or ceased specialized services in the past year, in Denver, Pueblo, Fort Collins, Loveland, Fruita, Grand Junction, Pagosa Springs, Delta and more. 

“In our own valley we saw multiple changes in the orthopedic clinics with Griggs Orthopedics closing, Alpine Orthopedics closing and joining Vail Summit Orthopedics (VSON) and then the additional change to VSON leaving the Valley, Dr. Elfenbein scaling back his private practice,” she adds.

Thorson has additional concerns about the healthcare workforce who face mental health challenges, housing affordability, increasing violence directed at them, the increasing paperwork burden and the declining reimbursement amounts that insurance companies “allow” for primary care providers to be in network.  

“It has been appalling to see and experience the complete dysfunction of the U.S. healthcare system. Things will absolutely worsen with recent legislative actions of the One Big Beautiful Bill Act (OBBBA) and ongoing pressures of the current system,” says Thorson. “More clinics and hospitals will close or be forced to join larger and larger entities or maybe private equity will come in and run healthcare into the ground — which they did in Fort Collins earlier this year.”

Reformation?

This year, Colorado legislators passed a new law mandating a study on what it would take to reform the state’s healthcare payment system. The Colorado School of Public Health (CSPH), a school of public health representing University of Colorado, Colorado State University, and the University of Northern Colorado, has been assigned the work as the first (established in 2008) and only accredited school of public health in the Rocky Mountain region.

Governor Jared Polis signed this healthcare payment system analysis legislation into law in May 2025, but because of state budget cuts the school must obtain sufficient gifts, grants, and donations to enable the analysis. If it secures enough funding, CSPH is to draft model legislation to implement a single-payer, nonprofit, publicly financed and privately delivered universal healthcare payment system for Colorado that directly compensates providers. It must submit a report detailing its findings by December 31, 2026.

Local resident Laird Cagan has been a physician for more than 45 years and says he has seen the system get worse over time. “And I believe everyone should have access to healthcare,” he says. He advocated for the initiative in 2016 that failed and has a long history of involvement with what he recognizes seems like a fringe movement.

However, he believes it is worth pursuing and educating voters about it as he sees the new Medicaid/Medicare cuts combined with drastic predicted insurance premium rate increases (see his letter on page 4.)  

“Compared with the profit mode that everybody focuses on, many people think this is socialism,” he says. “But in the single-payer proposal, government would collect the money, but they wouldn’t own any of the systems or practices.” He too notes the dozens of other capitalistic countries that have universal healthcare. Cagan believes public support has increased but sees some hesitation among leaders to step forward into a controversy that involves their livelihood. 

“People avoid healthcare,” he laments, with many stories to illustrate his point. “Because it is the leading cause of bankruptcy in the U.S.” 

Cagan hopes to see the public health study get the funding to conduct its research and share the analysis of whether universal healthcare is feasible financially. 

He echoes Thorson’s belief that the healthcare system is filled with “promise and peril.” 

GVH’s Jason Amrich, who has called the current situation a true healthcare crisis, says he has an open mind about bigger solutions beyond GVH’s control. “As for the one-payer system, it seems hard to comment on that based on the complexity of variations. It’s so hard to understand what a healthcare system like GVH would be able to do,” he says. “Without understanding what the whole program could look like, if we could figure out a way to decrease cost, then I’m up for any solution that does that.”

In the meantime, local experts and politicians are urging everyone to be prepared to see some dramatic and expensive changes to healthcare in the next year…

More information about the new health-care payment system analysis law can be found at leg.colorado.gov/bills/sb25-045 and information about the reform movement can be found at www.onepayerstates.org and couniversalhealth.org.