The Arkansas River looks stunning, even from the highway, and it’s a big relief from the arid stretches of land we’ve been riding through. Pueblo is often called “Colorado’s Second City,” but it’s not because of population. At a little over 100,000 people, it’s currently the ninth most populous city in Colorado. But for a long time, it’s been the economic center of southern Colorado and northeast New Mexico, and is still a hub for the steel and aviation industries.

With only two hours to go to Denver, now’s a good time to take a quick look at the Colorado healthcare system. Unlike New Mexico, where 40% of the physician workforce practiced in rural areas, Colorado is much more stratified -- with a whopping 89% in urban and suburban areas and only 11% in rural areas. This makes some sense in terms of population distribution, since 85% of Coloradans live in cities and 15% live in rural areas. But it means rural physicians have a lot of ground to cover! They also have a lot more to do -- the largest portion of Coloradans who are over 65 live in rural areas.

Despite the concentration in cities, the inner-city communities are still considered underserved -- a problem for cities like Pueblo, where 13.9% of families and 17.8% of the population lives below the poverty line.

We’re rolling through Colorado City right now. Contrary to its name, Colorado City is an unincorporated town of just over 2,000 people.

Going back to Dr. Winters’ story, the Colorado Health Institute released a comprehensive profile of the “working uninsured” in Colorado in 2004. Given that most people get their insurance coverage from their employers, you might think that there would be stark differences in the profiles of the insured and uninsured.

What’s more striking about the numbers, however, is how similar the profiles of the insured and uninsured workers are. The percentage of uninsured workers who work full-time at least part of the year -- 78% -- is not much different than the percentage for insured workers -- 83%. The percentage of workers who only work part-time for part of the year is likewise similar -- 8.8% for the uninsured, 8% for the insured. And in terms of seniority, job security and experience in the workforce, there’s little difference -- at the time of the study, 84.2% of uninsured workers had the same employer for the previous year, and 86.9% of insured workers said the same.

So are there factors that help determine why one set of workers is likely to have health insurance while another is not?

We’ve just crossed the Colorado border, and are about halfway through our journey!

I’ve been talking with Dr. John Winters about the problems with healthcare access. It’s made him think about one patient in particular.

“I had one patient who was diabetic,” he says, “and it was highly advanced when he came into the ER. He spent four weeks getting antibiotics, and he had to have his foot amputated -- and he was a guy who worked 70 hours a week as a roofer. He hadn’t seen a doctor about his diabetes because he had no health insurance—he was working as non-union laborer in New Mexico. And all of that could have been avoided if he had access to a primary care physician at an age where he could have been appropriately screened for chronic diseases like diabetes, and if he had access to funding to treat his diabetes. You wind up spending so much more for that treatment in the hospital then you would have spent over his entire lifetime just treating his diabetes, and it’s a real frustration.

If you haven’t heard about Las Vegas, NM, you DEFINITELY haven’t heard of Springer. It’s has just under 1,300 people, with 15% of families and 17% of the population below the poverty line. Colfax County is one of the northernmost counties in New Mexico -- we’re clearly out of the urban areas of New Mexico. As such, there are disparities in access to healthcare between urban and rural communities which are pronounced.

Bernalillo County alone contains over half of the physicians in New Mexico, and 64% of active physicians live in urban areas like Albuquerque, Los Alamos and Santa Fe. However, 60% of the population lives in rural areas, like Colfax County. As a result, many counties lack an adequate number of physicians. The healthcare disparities by region amplify the effect of healthcare disparities by socio-economic standing -- after all, in New Mexico as in most of the nation, the rural areas tend to be poorer, with more uninsured patients and a more at-risk population.

As much as the physician shortage currently impacts the rural communities of New Mexico now, the population trends are even more concerning for those who care about access to quality healthcare.