Healthcare as a Right

The Problem

A single hospital stay in Denver can produce a bill of hundreds of thousands of dollars. Medical debt is a leading contributor to bankruptcy in America (Himmelstein et al., 2009; Dobkin et al., 2018 - see FAQ for discussion of methodology). Denver Health, a public hospital, still sends patients to collections and places liens on homes. The system generates debt, not health.

Meanwhile:

• Denver has insufficient mental health crisis services - police respond to mental health emergencies they’re not trained for, with predictable results
• Entire neighborhoods lack accessible primary care
• Prescription drugs cost 2-10x what they cost in other countries (RAND Corporation, 2021)
• Uninsured and underinsured residents delay care until emergencies, which costs everyone more
• Dental care is the most neglected health need in Denver. Dental disease is the #1 chronic childhood disease in America (CDC, 2024). Colorado’s adult Medicaid dental benefit covers only emergency extractions and limited services - not preventive care, fillings, or crowns. An estimated 35% of Colorado adults skipped dental care due to cost in the past year (CDA Health Policy Institute, 2023). In low-income Denver neighborhoods, there are fewer than 2 dentists per 10,000 residents. People go to the emergency room for toothaches because they have nowhere else to go - Denver Health’s ER treats over 3,000 dental-related visits annually, at 10x the cost of a dental office visit, and can only prescribe painkillers, not fix the problem
• Behavioral health is in crisis beyond what crisis response can address. STAR handles the acute emergencies. But Denver has a massive unmet need for ongoing outpatient mental health and substance use treatment. Colorado ranks 48th in the nation for access to mental health care (Mental Health America, 2024). Denver has approximately 1 mental health provider per 250 residents, but availability is far worse for Medicaid patients, Spanish-speaking residents, and communities of color. Average wait times for a new therapy appointment in Denver exceed 6-8 weeks. For children and adolescents, the shortage is worse: pediatric psychiatric beds are perpetually full, and families wait months for outpatient care while their children deteriorate

What Denver Currently Does

Denver Health is a public safety-net hospital, but it still sends patients to collections and places liens on homes. The STAR program (Support Team Assisted Response) launched in 2020 as a non-police mental health crisis response and expanded citywide in 2022. As of September 2024, STAR van teams have responded to over 23,000 calls, and a 2026 Urban Institute evaluation found STAR reduces subsequent arrests and police contacts by 16%, with even larger impacts for people experiencing homelessness (Gillespie et al., 2026). However, STAR operates limited hours with approximately $4.4M in total annual program funding and can only respond to about 45% of STAR-eligible calls due to insufficient van units. Denver has 9 Federally Qualified Health Centers (Clinica Tepeyac, Salud Family Health, Denver Health community centers, etc.) but significant coverage gaps remain in Montbello, Green Valley Ranch, and other underserved areas. Colorado expanded Medicaid under the ACA and has ~7.5% uninsured (Census ACS, 2023), but underinsurance remains a major issue.

On behavioral health, Colorado created the Behavioral Health Administration (BHA) in 2022 to coordinate the state’s fragmented system. Denver’s Mental Health Center of Denver (now WellPower) is the city’s designated community mental health center, but demand far exceeds capacity. The state’s 988 Suicide & Crisis Lifeline launched in 2022, but call volume has overwhelmed capacity. Colorado invested $550M in behavioral health through the Behavioral Health Transformational Task Force, but the provider shortage means money alone cannot solve the access problem - you cannot see a therapist who does not exist.

On dental care, Denver’s FQHCs provide some dental services, but waitlists stretch months long. Denver Health operates dental clinics, but capacity serves a fraction of need. Colorado’s Cavity Free at Twenty-One program provides school-based sealants in some schools, but coverage is inconsistent and does not reach most DPS students. There is no city-level dental access strategy.

Our Solution

1. Denver Medical Debt Forgiveness Program

• City purchases medical debt portfolios at pennies on the dollar (debt buyers typically pay 1-5 cents per dollar of debt)
• Cancel all purchased debt - no strings attached
• Estimated cost: $5M in city funds can forgive $100-500M in medical debt
• Partner with RIP Medical Debt (now Undue Medical Debt) for execution
• Ongoing program funded by hospital impact fees

2. Hospital Cost Transparency Act

• All Denver hospitals must publish real prices (not chargemaster fiction) for the 200 most common procedures
• Itemized bills required within 30 days - no more surprise charges appearing months later
• Price variation reports published by the city quarterly
• Penalties for price gouging: defined as charging uninsured patients more than 200% of Medicare rates

3. STAR Program (Support Team Assisted Response)

Denver’s STAR program is already proven to work. A January 2026 Urban Institute evaluation - the first study nationwide to measure individual-level outcomes following alternative response - found that STAR clients experienced a 16% reduction in subsequent police contacts and a 16% reduction in subsequent arrests, with two to three times larger reductions for people who had experienced homelessness. The program costs $237 per van response versus $1,011 for an average arrest. We expand it to meet its full potential:

• 24/7 coverage with sufficient van units to meet full demand (currently limited to one 12-hour shift with 6-7 van units responding to just 45% of eligible calls; 9-10 concurrent units needed per Urban Institute analysis)
• Mental health professionals + paramedics respond to mental health crises, substance use incidents, homelessness calls, and welfare checks
• Expand the STAR Community Partner Network, which provides culturally responsive case management and follow-up care - operating since April 2023 with over 1,200 clients served and nearly 12,000 case management encounters
• Police are NOT dispatched for non-violent mental health calls
• Address the significant underrepresentation of Hispanic and Latino/a/x communities among STAR clients through targeted outreach and culturally responsive service delivery
• Funding: Redirect 15% of police overtime budget to STAR expansion

4. Community Health Centers

• Federally Qualified Health Center in every Denver neighborhood (currently significant gaps in low-income areas)
• Sliding-scale fees based on income
• Primary care, dental, vision, mental health, and substance use treatment
• Prescription drug purchasing cooperative - Denver negotiates drug prices collectively for uninsured residents

5. Reproductive Healthcare Protection

Denver’s reproductive healthcare strategy is detailed in our standalone policy: Reproductive Healthcare Access. Key elements:

• Denver as a sanctuary city for reproductive healthcare access - bodily autonomy as a governing principle
• Provider sustainability funding to ensure Amendment 79’s Medicaid coverage translates to actual provider participation
• Medication abortion access expansion, including mifepristone contingency planning
• City-funded reproductive healthcare for uninsured residents
• Buffer zones around clinics, complemented by direct security funding for providers
• Non-cooperation with federal, state, or interstate enforcement targeting healthcare decisions protected under Colorado law - encompassing abortion, gender-affirming care, and other constitutionally protected medical treatment
• Reproductive healthcare explicitly inclusive of trans and nonbinary patients
• Data transparency on provider participation, wait times, and geographic access
• Cross-reference: Maternal & Infant Health Equity for comprehensive birth equity, NICU family support, and anti-discrimination accountability proposals
• Cross-reference: LGBTQ+ Sanctuary & Protection for the bodily autonomy framework connecting reproductive and gender-affirming healthcare

6. Dental Care for All

Dental health is health. The separation of dental coverage from medical coverage is an artifact of insurance history, not biology. Untreated dental disease causes chronic pain, systemic infection, heart disease, diabetes complications, and job loss. It is concentrated in the same low-income neighborhoods that lack every other form of healthcare access.

• Mobile dental clinics: city-funded mobile dental units rotating through every food desert and dental desert neighborhood on a weekly schedule - providing cleanings, fillings, extractions, and referrals. No appointment needed. No insurance required. Sliding-scale fees. Philadelphia, Boston, and San Antonio have demonstrated that mobile dental programs reach populations that brick-and-mortar clinics do not
• School-based dental sealant and prevention program: dental sealants in every DPS elementary school, every year. Sealants reduce cavities by 80% in treated teeth (CDC Community Preventive Services Task Force). Currently, school-based dental programs reach a fraction of DPS students. Our program covers every Title I school and expands to all DPS schools within 3 years. Includes fluoride varnish, screening, and referral for treatment
• FQHC dental expansion: fund additional dental chairs and dental hygienist positions at every Denver FQHC. Current dental waitlists at FQHCs stretch 3-6 months. Expand same-day dental access for acute needs (pain, infection, broken teeth) at all community health centers
• Emergency room dental diversion: when patients present to Denver Health’s ER with dental complaints, they receive immediate pain management AND a same-week referral to a dental provider - not just a prescription and a discharge. Partner with Denver Health dental clinics and FQHCs to guarantee follow-up slots for ER dental diversions. Every dental ER visit that converts to a dental office visit saves the system $1,500+
• Denture and prosthetic program: city-funded dentures and dental prosthetics for uninsured and Medicaid adults. Missing teeth affect nutrition, speech, employment, and dignity. Colorado Medicaid does not cover adult dentures. Denver fills the gap

7. Behavioral Health Continuum

STAR handles the crisis. The drug policy handles decriminalization and harm reduction. But between the emergency and the addiction, there is an enormous unmet need: the person who needs a therapist and cannot find one. The child whose anxiety is escalating and whose parents are told the next available appointment is in three months. The veteran, the trauma survivor, the grieving parent - people who need care now, not in eight weeks.

• Behavioral Health Access Guarantee: no Denver resident waits more than 2 weeks for an initial outpatient mental health or substance use appointment. City contracts with WellPower, Denver Health behavioral health, and private providers to guarantee appointment availability. The city fills access gaps with direct funding where the market fails
• Community mental health workers: a new workforce tier - trained, paid community members providing front-line behavioral health support in neighborhoods. Not licensed therapists, but people with cultural knowledge, language skills, and lived experience who can provide check-ins, group support, navigation, and connection to clinical services. Modeled on the Community Health Worker model that has transformed primary care access in Brazil and across Latin America. Deployed through FQHCs, schools, rec centers, and community organizations
• Children’s behavioral health: fund school-based mental health clinicians in every DPS school. Currently, school counselor-to-student ratios in DPS are roughly 1:450, far above the recommended 1:250 (American School Counselor Association). Our proposal places a licensed behavioral health clinician - not just a counselor, but someone who can provide therapy - in every school with more than 300 students, with shared clinicians for smaller schools. Prioritize Title I schools. Cross-reference: Education
• Perinatal and NICU behavioral health: specialized perinatal mental health services for pregnant and postpartum people, partners, and NICU/PICU families. Cross-reference: Maternal & Infant Health Equity for the full proposal
• Workforce pipeline: Denver faces a behavioral health provider shortage that cannot be solved by funding alone - there are not enough providers. City-funded scholarships and loan repayment for behavioral health students (social workers, counselors, psychologists, psychiatric nurse practitioners) who commit to 3+ years of practice in underserved Denver neighborhoods or with Medicaid populations. Partner with CU Denver, MSU Denver, and University of Denver graduate programs. Recruit from the communities being served - bilingual, bicultural providers are not a luxury; they are a clinical necessity
• Integrated care in every FQHC: behavioral health specialists embedded in every Denver FQHC primary care site. The evidence is clear: integrated behavioral health in primary care increases access, reduces stigma, improves outcomes, and lowers total cost of care (Collaborative Care Model; Archer et al., Cochrane Review, 2012). A patient who mentions depression to their primary care doctor should see a behavioral health consultant the same day, in the same building - not receive a referral to a 6-week waitlist

International Evidence: We Pay More and Get Less

Country	Model	Cost per Capita	Life Expectancy	Medical Bankruptcies
Germany	All-payer rate setting - all insurers pay same negotiated rates. No surprise billing.	$7,383	81.4 years	0
Japan	Government reference pricing for all procedures.	$4,691	84.8 years	0
Taiwan	Single-payer since 1995. Smart card system.	$3,047	80.9 years	0
UK (NHS)	Government-run. Free at point of use.	$5,138	81.4 years	0
France	Universal multi-payer. Government covers 70-100% of costs.	$5,564	82.5 years	0
USA	Market-based. Unregulated pricing.	$12,555	77.5 years	530,000/year

We pay the most and live the shortest. The US spends twice what Germany spends per person and gets 4 fewer years of life expectancy and half a million bankruptcies. A child’s NICU stay costs a family $0 in Germany. In Denver, it can cost millions.

Denver can’t implement single-payer unilaterally, but Denver CAN model what humane healthcare looks like: forgive debt, create transparency, expand community health, and replace police crisis response with medical professionals.

Denver For All also supports Colorado state legislation for all-payer rate setting (the German model) - requiring all insurers and hospitals to negotiate standard rates, eliminating surprise billing and the administrative waste that consumes 30% of US healthcare spending.

How We Pay For It

• Medical Debt Program: $5M/year (forgives $100-500M)
• STAR Expansion: Redirected from police budget ($15-20M)
• Community Health Centers: Federal HRSA matching funds + city investment ($10M)
• Dental Care Program (mobile clinics, school sealants, FQHC expansion, ER diversion, dentures): $8-12M/year. Offset: every dental ER visit diverted to a dental office saves $1,500+. Denver Health’s 3,000+ annual dental ER visits alone represent $4.5M+ in avoidable costs. School sealant programs return $2 in avoided treatment for every $1 invested (CDC)
• Behavioral Health Continuum (access guarantee, community workers, school clinicians, workforce pipeline, integrated care): $15-20M/year. Offset: untreated mental illness costs Colorado an estimated $2.3B annually in emergency services, incarceration, lost productivity, and homelessness (Colorado Health Institute). Every dollar invested in early mental health intervention saves $4-7 in downstream costs (WHO, 2022)
• Total city investment: ~$55-70M/year, offset by reduced emergency room utilization, reduced police costs, reduced incarceration, improved public health outcomes, and a workforce that can actually show up to work. Cross-reference: Maternal & Infant Health Equity for an additional $15-23M/year in birth equity, NICU family support, and home visiting investments

Frequently Asked Questions

“Why should the city forgive medical debt? People chose to go to the hospital.” People don’t choose to get sick or injured. A child’s cancer treatment shouldn’t bankrupt a family. And the debt is sold to collectors for pennies anyway - the hospital has already written it off. This program costs the city very little and changes thousands of lives.

“Isn’t healthcare a federal issue?” Federal solutions aren’t coming soon enough. Cities can act now - on mental health crisis response, on debt forgiveness, on community health centers, on drug pricing. We don’t wait for Congress to stop our neighbors from dying.

“How does this interact with the ACA and Medicaid expansion?” Colorado expanded Medicaid and runs Connect for Health Colorado, its ACA marketplace. These programs help the insured access care. Our proposals address what they don’t: medical debt for the insured (high deductibles and copays still bankrupt people), non-police crisis response, community health center gaps, and drug pricing for the uninsured and underinsured. This supplements state and federal programs, not duplicates them.

“Is medical debt really the leading cause of bankruptcy?” The commonly cited claim (Himmelstein et al., 2009, American Journal of Medicine: 62% of bankruptcies) has been debated. A 2018 study by Dobkin et al. in the American Economic Review found the effect was smaller but still significant: hospital admissions increase unpaid medical bills, reduce earnings by 20%, and raise bankruptcy risk, with uninsured non-elderly adults experiencing a 1.4 percentage point increase in bankruptcy over four years. Either way, medical debt is a leading contributor to financial catastrophe, and the US is the only wealthy country where this happens at all.

“Dental care is a luxury, not a medical necessity.” This is a dangerous myth rooted in the historical accident of dental insurance being separated from medical insurance. Untreated dental infections can become sepsis and kill people. Periodontal disease is linked to heart disease, diabetes complications, and adverse pregnancy outcomes (Sanz et al., Journal of Clinical Periodontology, 2020). Children with untreated dental disease miss more school, perform worse academically, and suffer chronic pain. Adults with missing or visibly damaged teeth face employment discrimination. Dental care is healthcare. The separation is administrative, not medical.

“Denver can’t solve the therapist shortage.” Not alone, but Denver can do more than wait. Community mental health workers expand the workforce without requiring graduate degrees. School-based clinicians reach children where they are. Loan repayment programs pull providers into underserved communities. Integrated care in FQHCs means existing primary care visits can include behavioral health without a separate appointment. And guaranteeing 2-week access for initial appointments forces the system to allocate capacity where it is needed rather than where it is most profitable. The shortage is real. Using it as an excuse to do nothing is a choice.

“Why not let the state’s Behavioral Health Administration handle this?” Colorado’s BHA is working on statewide coordination, and we support that work. But statewide systems move slowly, and Denver’s needs are acute now. Denver has home-rule authority to supplement state programs, fund community-based services, and set local access standards. The city can move faster and more precisely than a statewide agency managing 64 counties. We supplement and align with the BHA - we don’t wait for it.

References

• Himmelstein, D., et al. (2009). “Medical Bankruptcy in the United States.” American Journal of Medicine. (62% of bankruptcies involve medical debt.)
• Dobkin, C., Finkelstein, A., Kluender, R., and Notowidigdo, M.J. (2018). “The Economic Consequences of Hospital Admissions.” American Economic Review, 108(2): 308-352. (Hospital admissions reduce earnings by 20% and increase bankruptcy risk, with larger effects for uninsured populations.)
• Undue Medical Debt (formerly RIP Medical Debt). Program data and city partnership outcomes.
• Gillespie, S., Curran-Groome, W., Chen, B., & Hanson, D. (2026). “Aligning Crisis Response with Community Needs: Evidence from Denver’s Support Team Assisted Response (STAR) and Co-Responder Programs.” Urban Institute.
• OECD Health Statistics. (2024). Health spending per capita comparisons.
• Commonwealth Fund. (2023). “Mirror, Mirror: Reflecting Poorly.” (US vs. peer nation health system comparison.)
• HRSA Data Warehouse. FQHC locations and service areas in Denver.
• Colorado Division of Insurance. Uninsured rate data.
• CDC. (2024). Oral Health Surveillance Report. (Dental caries as #1 chronic childhood disease; untreated decay prevalence by income.)
• CDC Community Preventive Services Task Force. (2016). Dental Caries: School-Based Dental Sealant Delivery Programs. (Sealants reduce cavities by 80% in treated teeth; $2 return per $1 invested.)
• Colorado Dental Association Health Policy Institute. (2023). Colorado Oral Health Data. (35% of adults skipped dental care due to cost; dental provider shortage data.)
• Mental Health America. (2024). The State of Mental Health in America. (Colorado ranks 48th in access to mental health care.)
• American School Counselor Association. Student-to-counselor ratio recommendations (1:250; DPS actual ~1:450).
• Colorado Health Institute. (2023). Behavioral Health in Colorado: Cost of Unmet Need. ($2.3B annual cost estimate for untreated mental illness.)
• Archer, J., et al. (2012). “Collaborative care for depression and anxiety problems.” Cochrane Database of Systematic Reviews. (Integrated behavioral health improves outcomes and reduces total cost.)
• WHO. (2022). World Mental Health Report. ($4-7 return per $1 invested in early mental health intervention.)
• Sanz, M., et al. (2020). “Treatment of Stage I-III Periodontitis.” Journal of Clinical Periodontology. (Links between periodontal disease and systemic health conditions.)