Cutting the federal Medicaid program by $800 billion over a decade and the federal food stamp program by nearly 30 percent are key pieces of a budget plan released by President Donald Trump this week.

Those are big policy goals. If carried out, the effects would be sharply felt in Pueblo County and other communities in Southern Colorado.

State officials report an average of 41 percent of Pueblo County residents -- 67,561 people -- received monthly Medicaid payments in the 2015-16 fiscal year. They also say that of those on Medicaid, 75 percent are working but still qualify due to their low incomes.

The numbers are tracked on a monthly and annual basis by the Colorado Department of Health Care Policy & Financing.

Pueblo County's most recent monthly count was in February 2017, when 70,822 people or nearly 43 percent received Medicaid insurance.

"I didn't know the exact numbers, but I knew our Medicaid use is high, like many rural areas in the state," said state Rep. Daneya Esgar, D-Pueblo. "We talk about this at the Legislature, how Pueblo and our region haven't caught up to the economic recovery that Denver and other areas in the state are experiencing."

And Pueblo County doesn't have the highest Medicaid percentage in this region.

Both Alamosa and Huerfano counties report an annual average of 44 percent of their populations get Medicaid. At the lower end, Fremont County reports 28 percent, while El Paso County shows 26 percent.

In dollars, Medicaid sent $405 million to Pueblo County during the 2015-16 fiscal year, a flow of money that touches the county's economy from individual health costs to overall hospital payments.

For example, Parkview Medical Center said recently that nearly 30 percent of its patient visits last year came from people using Medicaid.

One reason for the high Medicaid numbers is because President Barack Obama's Affordable Care Act gave states the option of raising the qualifying income rules and Colorado did so -- with the federal government covering the cost of the new clients for an initial three years.

In Pueblo County, that policy change added 20,191 people to the Medicaid rolls -- essentially a 43 percent increase.

One way to measure that increase is to compare the Medicaid rolls with county residents who receive food stamp assistance. Last year, there were roughly 35,700 county residents getting the monthly food assistance, according to the Colorado Department of Human Services.

That's compared to the 67,500 residents on Medicaid health insurance. Raising the income guidelines also is reflected in the fact that 75 percent of Medicaid recipients work, according to state officials.

The goal of the ACA was to get as many people covered by health insurance as possible. Nationally, the Medicaid expansion was credited with adding 20 million people to the rolls of the insured. It did that by raising the income bar so that a single person earning $16,000 a year or less could qualify, as did a family of four with an income of $32,700.

According to the Census Bureau, only 9 percent of Pueblo County residents said they had no health insurance in 2015.

Republican critics of the ACA, including the Trump administration, argue the Obama plan is unsustainable, and needs repeal and cuts in taxpayer-funded programs.

White House Budget Director Mick Mulvaney said this week the Trump plan puts "taxpayer interests first."

U.S. Rep. Scott Tipton, a Republican who represents Pueblo and the 3rd Congressional District, voted to repeal the ACA dozens of times in the past eight years. He endorsed the Trump plan this week and its shift in spending to the military and defense, but said he would work to "ensure our social safety nets are sustainable for those who truly need them."

A spokesman noted that Tipton also supports keeping current Medicaid recipients in the program.

U.S. Sen. Michael Bennet, D-Colo., said proposed cuts in Medicaid would have a "draconian effect" on Pueblo and other communities, especially the 427,000 children who receive Medicaid benefits.

"Abandoning the people who need these programs most -- from seniors to those receiving opiod addiction treatments -- is unacceptable," he said in a statement Tuesday.

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