Hey there, ʹڲַ, and welcome to another edition of The Temperature.
I’ve been thinking a bit lately about — specifically the sliding doors at the entrance to the Children’s Hospital ʹڲַ emergency department in Aurora. About two weeks ago, they slid open when my wife and I carried our infant inside for a check on his oxygen levels as he dealt with that made it hard for him to breathe and put a cannula up his nose.
He was ultimately fine then and is fine-r now. About two hours after we entered the ER, we left, and the doors slid closed behind us. Four hours later, the doors slid open and in came a child contagious with measles, potentially exposing people in the ER to infection — including any infants like my own who are too young for vaccination under normal circumstances.
I think of the faces of the other families we saw waiting in the ER that day: the kids who were sick or injured; the parents and siblings who sat anxiously beside them. Who was in the ER that evening? What were they already struggling with?
This is not meant to criticize the family of the infectious child, especially during what must have been a terrifying time for them. There is much we don’t know about their circumstances, and across human history, viruses — especially those as contagious as measles — cannot always be avoided.
Nor is this meant to be a plea for vaccination, which of course, , is a personal decision.
But it is a reminder that in health care, personal choices often don’t stay personal. Viruses, nonsentient as they are, understand that. So as we weigh our choices in the micro and macro senses, it’s worthwhile for us to consider the same.
Ready for some news? Let’s hit it.
Reporter
TEMP CHECK
EPIDEMIOLOGY
Here’s what we know about how measles spread on a Turkish Airlines flight and at DIA
Two vaccinated adults who contracted measles from an infectious passenger on a Turkish Airlines flight to Denver last month sat in rows immediately in front of or behind the passenger.
But a child who was unvaccinated and also contracted measles on the flight sat farther back, Dr. Ned Calonge, the chief medical officer at the ʹڲַ Department of Public Health and Environment, said in an interview.
His comments provide new insight into the investigation of ʹڲַ’s largest measles outbreak since at least the mid-1990s, and they also show how the highly infectious disease traveled through the plane’s cabin.
Calonge said CDPHE’s role in the investigation has been limited to focusing only on the infections in ʹڲַ residents. The federal Centers for Disease Control and Prevention is taking the bigger view, reconstructing the plane’s seating chart to map where the infectious and infected travelers were sitting.
The flight, Turkish Airlines flight 201, took off from Istanbul and landed at Denver International Airport on May 13. Calonge said at least four people on the flight became infected with measles — two vaccinated adults from Arapahoe County, an unvaccinated child from Arapahoe County, and a passenger who lives in another state.
Calonge did not have more information on that last passenger or where they live. Their infection would be counted in the case tally for the state where they reside, not ʹڲַ’s.
The infectious traveler then stayed overnight at a hotel near the airport before flying out of DIA the following day. That is when CDPHE believes two unvaccinated adults from El Paso County were infected — Calonge said the two appear to have crossed paths with the infectious person on Concourse B, though it’s not clear exactly where.
Calonge said the CDC has a protocol for tracking infections on flights that involves identifying everybody who sat two rows in front or two rows behind the infectious person — who is known as the “index case” in epidemiology-speak.
The two vaccinated adults from Arapahoe County were within those borders, he said. But the child, Calonge said, was “farther back.” That could speak to the measles virus’s ability to travel around the plane cabin during a long flight. have documented instances of passengers on flights being infected by measles spread by someone sitting farther than two rows away.
Or it’s also possible the child went to the bathroom after the infectious person or walked up and down the aisle past them.
“It hangs in the air for up to two hours after a person’s been there,” Calonge said of the measles virus. “It’s a remarkable virus. That’s why you really need high vaccination rates to protect the population.”
As for the infections in vaccinated people, Calonge said it is possible that the close proximity to the infectious person and the length of the flight played a role, but that’s not certain.
People who have been infected with measles following vaccination are typically less infectious and get less sick, Calonge said. That’s why CDPHE and other public health authorities are continuing to encourage people who have not received the MMR vaccine to do so.
“We need to stress the fact that we have within our ability an effective way of addressing this, and so we should do that,” Calonge said.
People who have been vaccinated already should talk to their doctor about whether to get a booster dose if they or that is experiencing ongoing community transmission of the virus. Infants at least 6 months old traveling to such places are eligible to receive an early dose of vaccine — which is typically not given until after a kid turns 1.
Despite the high number of measles cases ʹڲַ has seen so far this year — 10, more than any year going back decades — Calonge said there remains no evidence of ongoing transmission of the virus occurring within ʹڲַ.
Section by John Ingold | Reporter
WATER
The giant reservoir beneath our feet is drying up
42.4 million acre-feet
The amount of groundwater storage lost in the ʹڲַ River Basin between 2002 and 2024
The ʹڲַ River Basin’s groundwater supply is shrinking — rapidly.
Groundwater, stored in the cracks in rock and spaces between soil and sand below our feet, is the oft-overlooked stepchild of the basin. Policymakers, journalists (yes, us), water managers, politicians and more spend much of their time talking about the basin’s shrinking snowpack and rivers to gauge what the future water supply of 40 million people could look like.
Meanwhile below our feet, more than a Lake Mead-worth of water has disappeared.
Researchers at Arizona State University used satellite data, on-the-ground information and models to look at the ʹڲַ River Basin’s groundwater storage between 2002 and 2024. Overall, the basin lost 42.4 million acre-feet during that time period.
For comparison, the basin’s total above-ground storage capacity in federal reservoirs is 58.48 million acre-feet, most of which is held in Lake Mead and Lake Powell.
Denver Water’s 17 storage reservoirs can hold up to about 700,000 acre-feet of water. You’d have to empty all reservoirs 60 times to reach the level of groundwater depletion, wrecking rural, mountain and urban economies along the way. That would mean saying goodbye to Dillon, Williams Fork, Cheesman, Gross, Chatfield reservoirs and many more.
“We know groundwater depletion is happening. We’ve known it for a long time,” said James Famiglietti, global futures professor at Arizona State University. “The part that surprised me is the changes that happened over the last 10 years.”
The above-ground water in rivers and lakes is highly regulated so that it can be shared among seven states, 30 tribal nations and Mexico. The below-ground water — not so much. Some areas are already reliant on groundwater, and some see it as a vital alternative when surface water gets too low.
Watch ʹڲַSun.com in the coming days to learn more about the study’s implications both near and far.
Section by Shannon Mullane | Water Reporter
HEALTH INSURANCE
Why did Kaiser Permanente cross the road? “More choice,” says its local president.
Kaiser Permanente’s market-changing decision to expand into new ʹڲַ hospitals and, potentially, away from some long-time partners was driven by a desire to give KP members more choice, its regional president said in an interview.
“The consistent feedback that we got from our members was, ‘Hey, we want more choice. We’d like to see some different product offerings,’” Mike Ramseier, the president of Kaiser Permanente in ʹڲַ, said. “And so we made the strategic decision to add facilities into our network.”
Kaiser, famously, operates as a nonprofit integrated care model — kind of a mashup of an insurance company and a medical provider. That means KP members typically see KP doctors, whether visiting a Kaiser clinic or, often, when being treated in a hospital that KP partners with.
But, as part of the effort to give KP members more options, Ramseier said Kaiser has launched which acts like a PPO and allows members to see KP doctors or go outside the system to see non-KP providers while remaining in-network. Kaiser employs about 1,200 physicians in ʹڲַ, Ramseier said, but has contracted with more than 20,000 non-KP physicians.
“For me to offer a more comprehensive PPO option, I had to bring more hospitals into the network,” Ramseier said.
The ongoing transition is seeing Kaiser docs moving out of Intermountain Health’s Saint Joseph Hospital in Denver and Good Samaritan Hospital in Lafayette, though the hospitals will remain in-network through at least 2026. Kaiser docs are moving into HCA HealthONE’s Rose and Presbyterian St. Luke’s medical centers in Denver and CommonSpirit’s Saint Anthony Hospital in Lakewood and Saint Anthony North Hospital in Westminster.
Foothills Hospital in Boulder and Longmont United Hospital have also become in-network options but won’t have Kaiser doctors stationed there.
Ramseier said the transition is not driven by concerns about quality or patient experience at the Intermountain Health hospitals, and he said KP would negotiate with Intermountain about possibly keeping the hospitals in-network beyond 2026.
“This was more about a strategic decision,” he said.
Section by John Ingold | Reporter
MEDICAL DEBT
New report explores medical debt lawsuits by “stealth intermediaries”
25,000
The number of lawsuits a new report found that were filed by debt-collection companies working with UCHealth
A new report by researchers at the George Washington University Law School, the Stanford University School of Medicine, and the group PatientRightsAdvocate.org has confirmed the findings of a joint ʹڲַ Sun/9News investigation that looked into UCHealth’s practice of using debt-collection companies to sue patients on its behalf without including its name on the cases.
The report, which heavily cites The Sun and 9News’ reporting, found that two debt-collection companies working with UCHealth filed nearly 25,000 lawsuits over purported debts. The cases resulted in judgments of nearly $68 million, plus more than $7 million in attorney fees and court costs. Many of these were what are known as “default judgments,” which occur when the person being sued does not respond to the case.
(Because one of the companies, Credit Service Company, typically sealed certain documents in its lawsuits, it’s not confirmed that all of its cases were filed on behalf of UCHealth, which the report notes “reflects the broader lack of transparency in medical billing and debt collection.”)
The debt-collection companies often sought garnishment against patients — meaning it sought court orders to remove money directly from a patient’s paycheck or bank account to cover judgments.
“Moreover, the lawsuits themselves inflicted mental and financial distress on UCHealth patients, exacerbating struggles to make rent, afford prescriptions, pay other bills, and missing work for court hearings,” the researchers wrote in the report. “One patient sued by UCHealth through one of its intermediaries called the experience a ‘nightmare’ and said the collection efforts put his family through ‘hell.’”
Section by John Ingold | Reporter
MORE ENVIRONMENT AND HEALTH NEWS
CHART OF THE WEEK
Imposing work requirements on certain Medicaid members would increase ʹڲַ’s administrative costs for the program by $57 million a year, the head of the state’s Medicaid agency said in an interview with The Sun last week.
Kim Bimestefer, the executive director of the ʹڲַ Department of Health Care Policy and Financing, said the number comes from an analysis the agency did of work requirements in Arkansas. HCPF also that counties — which are on the front lines of the Medicaid enrollment process in ʹڲַ — could require as many as 3,700 new case managers to handle the extra work of verifying work status for enrollees.
HCPF’s analysis comes in response to a proposal by Republicans in Congress to impose work requirements on childless adults up to age 65 who qualify for Medicaid because of low income. The agency says roughly 377,000 ʹڲַ Medicaid recipients could be subject to those requirements.
“We appreciate the opportunity to work collaboratively with our Congressional delegation and all in Congress to make sure that the efficiencies that are put forward actually achieve a goal that we all would share,” Bimestefer said. “I think we all sign up for efficiencies. We don’t sign up for administrative burden that actually doesn’t provide the outcome that you want, but actually impedes people who really need the safety net from getting coverage.”
Supporters of the proposal say parents, pregnant women and people who are disabled do not need to worry about work requirements taking away their coverage.
“It benefits you by preserving these resources,” U.S. Rep. Gabe Evans, a Republican who represents ʹڲַ’s 8th Congressional District, said at a news conference last week.
HCPF estimates that, of the people in ʹڲַ who would potentially be subject to work requirements, 56% are currently working.
This number, however, fails to capture some of the other ways people would likely be able to hang onto Medicaid coverage if the work requirements became law. For instance, under the giant domestic policy bill that has passed the U.S. House with work requirements included, would also count toward the requirements.
People with certain chronic medical conditions — such as substance abuse disorders — or who are caregivers for people not covered by Medicaid — like, say, an older relative — .
The nonpartisan health policy think tank KFF of 2023 data to better understand work status for Medicaid members across the country. It limited the analysis to people under the age of 65 and those who are not receiving benefits from various federal disability programs — so it approximated the pool of people who could be subject to work requirements under the House proposal.
As seen in the chart above, it found that roughly 64% of Medicaid recipients nationwide in its study group were working either full-time or part-time. An additional 29% said they weren’t working due to school, illness or disability, or because they were acting as a caregiver for another. The remainder were not working due to retirement, inability to find work or another reason.
Bimestefer said more precise projections for how work rules would impact ʹڲַ require more information than what is available about the proposal right now.
“We need the rules to come out on work requirements, and we need to understand … who it would impact, how often we need to apply those work requirements, who is eligible for an exception, and what those exceptions are,” Bimestefer said. “So, obviously, there is a lot to be determined, but we’re definitely concerned.”
Section by John Ingold | Reporter
Hey, we made it through the entire newsletter without a Samuel L. Jackson-esque reference . High-five to us!
And high-five to you for supporting local journalism. You are the wind beneath our wings as we track the dangers within our air ducts.
See ya next week, friends.
— John & Michael
ʹڲַ is part of . Read our policies.
Corrections & Clarifications
Notice something wrong? ʹڲַ has an ethical responsibility to fix all factual errors. Request a correction by emailing corrections@coloradosun.com.