Health Care for All

Header image by Ryan Hoffman on
By Ryan Hoffman on



De-stigmatize mental illness

Ensure Parity

Decriminalize mental illness and reform the M1 hold

Ensure effective treatment with comprehensive, wrap-around services

Expand access with community mental health centers

Create mental health districts that geographically align with existing judicial districts

Provide supportive housing for recovery from addiction, homelessness and incarceration

Expand mental health care options in rural Colorado

Promote mental health and wellness in schools


Support Medicare for all at the Federal level

Allow more Coloradans to buy into Medicaid

Expand and protect the state reinsurance fund

Protect and preserve Medicaid and CHP+

Collaborate with medical experts to increase quality, efficiency, and reach

Increase health care options for rural Coloradans


Lift constraints on businesses and innovation

Unlock jobs to improve options for workers

Address wage stagnation

Properly classify workers

Create meaningful change


Health care is a human right. Since 2010, Colorado has made significant reforms that have expanded access to health insurance for hundreds of thousands of people. Despite this progress, sharply rising costs have kept quality health care out of reach for many families. Lack of access to affordable health care is an obstacle to wellness and economic mobility. It creates costly societal burdens.

This is especially true for those with serious mental illness. The lack of access to mental health treatment in Colorado parallels staggering increases in homelessness, drug addiction, incarceration, and suicide.

Throughout the COVID-19 pandemic, it has become clear that Coloradans need affordable access to quality medical care now more than ever. My key health care priorities include:

1. Improve mental health care resources

2. Make quality health care affordable

3. Disconnect health care from employment status

I will support common sense reforms to make quality health care more affordable and available to all Coloradans.

Judy Amabile

September, 2020


One of my sons has a serious mental illness that developed at age 18 and has gotten worse over time. Finding treatment has been overwhelmingly frustrating. I’m one of a legion of parents who know the despair of trying to access mental health services in a system that seems designed for failure. The societal costs and consequences of a broken mental health care system are devastating to people, families, and society at large.

I will offer support and plans to improve Colorado’s resources for those with mental illnesses. Clearly we need a comprehensive approach to build on the progress of efforts underway, and expand care with urgency. My collaborative efforts will include:

De-stigmatize mental illness

Unfortunately, shame and stigma often surrounds mental health illness and can negatively impact a person seeking medical attention. An estimated 40% of people who suffer from depression or anxiety point directly to stigma as the reason they did not seek help.[1] This does not have to be the case and change begins with each of us.

One way to fight stigma is to openly talk about mental illness with respectful language. I hope that by sharing the impact mental illness has had on my family, I may help others to feel comfortable sharing their own stories. I will support initiatives like the 2019 Colorado SEE ME Campaign that provides a positive platform to share stories of mental illness, educates the public on mental illness, links people in need to resources, and advocates for mental health care.[2]

Ensure Parity

Parity for mental health not only requires equitable access to mental health care, but it also reduces stigma.[3] If mental health assessments were as common as an annual physical exam, the stigma surrounding mental health would decrease. I am excited for the time when going for a check up with your mental health provider for recent symptoms of depression is as common as getting a screening for potential strep throat.

Great strides towards parity were made in 2020 with HB20–1086, which would have required insurance companies to cover an annual mental health exam with a qualified mental health care provider.[4] Although the bill had bi-partisan support, it failed to make it to the Governor’s desk. Enacting parity laws will switch our system of care for mental health from one that typically cares for Coloradans when a mental health crisis occurs, to one that offers preventative mental health care throughout a person’s life.

I am dedicated to reviving HB20–1086 and seeing it passed into law. We have a chance to raise a generation of youth who understand that their mental health care is just as important and connected to their physical health. I am determined to lead the way for parity in mental health in Colorado. I believe this bill is critical to providing Coloradans with essential preventative mental health care.

Decriminalize mental illness and reform the M1 hold

Too often, well meaning family members are left with no other option than to dial 911 when their loved one is experiencing a mental health crisis. Law enforcement is frequently the first to respond to such a situation. The presence of untrained police officers can lead to unintended and tragic consequences. People with mental illnesses are more likely than the general public to be injured or killed when they encounter police.[5] In Colorado, people with mental illnesses are four times more likely to be jailed than to be provided the necessary services they need.[6] This must change.

The time is now to ensure that those who come into contact with law enforcement and the criminal justice system are diverted to the critical care they need instead of being penalized for their illness.

Crisis Intervention Teams (CITs) have proven to drastically change the initial contact between first responders and a person who is suffering from a mental health crisis. The National Alliance on Mental Illness has recognized the positive impact of the CIT model.[7] A CIT typically consists of a mental health professional and law enforcement who are specifically trained in mental health.[8] The purpose of a CIT is to assess the situation and divert the person in crisis to immediate and appropriate services.

Diversion programs work. In Miami-Dade, Florida, CIT training and teams have led to a drastic reduction in arrests and incarcerations while substantially increasing care for people in need of mental health services. The success of the Miami-Dade CIT program led to the closure of a prison facility, saving tax-payers millions of dollars annually. It reduced incidents of physical injuries and incarcerations, while ensuring critical care was delivered to those in need.[9] Proper treatment of mental illness benefits the entire community.

In Colorado, Arapahoe and Douglas Counties have already implemented CIT programs. Members of the Arapahoe and Douglas CIT program receive 40 hours of intensive training from mental health specialists.[10] When possible, members of the CIT respond to calls of potential mental health crises. I will work to expand and build upon diversion programs throughout Colorado.

I will be bold in fighting to update laws so that our loved ones can get the care they so desperately need before a crisis occurs. Access to preventative care is essential.

Currently in Colorado, the law requires a perceived threat of harm to self or others to be established in order for a judge to mandate treatment.[11] This antiquated requirement forces families to wait until a crisis exists, which increases the chance of harm or incarceration and reduces the person’s ability to recover from the episode.[12]

It is time to remove the prerequisite of ‘potential harm’ from the law so that involuntary mental health treatment may be secured by guardians or family members before a crisis occurs. A handful of states have already taken this bold action to increase early intervention. Updating the law has improved the opportunity for recovery and reduced the potential of permanent incapacity.[13]

Without the requirement to prove ‘potential harm,’ people in need of services can more easily access Assisted Outpatient Treatment (AOT). AOT is an evidence-based approach that has proven to reduce arrests and decrease harmful behaviors.[14] Assisted Outpatient Treatment is court ordered, community-based care that reduces hospitalizations, incarcerations, and homelessness while saving the taxpayers millions of dollars. I support the use of AOTs and will work to expand their availability across Colorado.

By expanding the use of CIT diversion programs, increasing preventative care by eliminating the ‘potential harm’ requirement for mandated services, and growing the availability of AOTs, my hope is to reduce the need for M1 holds through preemptive care.

An M1 hold is a mandated, 72-hour hospitalization of a person who appears to be suffering a mental health crisis and has been deemed an imminent threat. M1 holds are not an effective avenue of care.

When a person in crisis does necessitate acute care with an M1 hold, there should be a requirement for the patient to be seen by a mental health care professional within two hours of admittance. Care of the patient should be coordinated with the mental health professional who will be mandated to work with the individual within days after discharge. I am dedicated to reforming the standards surrounding M1 holds to better provide for the needs of those in crisis.

Ensure effective treatment with comprehensive, wrap-around services

Currently in Colorado, when someone has a mental illness crisis, such as a suicide attempt, they are frequently put on a 72-hour hold in a hospital. While the immediate symptoms may be addressed, what the patient needs is comprehensive treatment.

I would support legislation to mandate coverage, by both private insurance and Medicaid, for Medication Assisted Treatment, in-patient care for 60 days or longer, and intensive outpatient treatment. We also must provide supportive housing with wrap-around services. We know these programs are effective. Our decisions should be driven by research and evidence.

Expand access with community mental health centers

Community mental health centers are currently the primary source of care for outpatient services in Colorado. Community mental health centers strive to provide primary care and preventative services. They typically offer a wide range of individual and group services to both the insured and the uninsured.[15]

I support the NAMI Chapter of Boulder County’s assessment that community mental health centers need further development, streamlined funding reform, and increased access for community members.[16] Our state must strive to increase access to both psychiatric inpatient care and outpatient services. Having access to community mental health centers in multiple communities is essential.

Create mental health districts that geographically align with existing judicial districts

Unfortunately, when a person is arrested with a mental health condition they are often swept into a dysfunctional court system that can take months or longer to navigate. Sadly, this can lead to tragic consequences for the individual. I believe Competency Courts and Behavioral Health Districts are progressive and effective ways to solve this disastrous and unnecessary situation.

Competency Courts are staffed with judges, prosecutors, and lawyers who have additional training or expertise in mental health.[17] Competency Courts mainly deal with non-violent offenders who struggle with addiction disorders or mental illness. The goal of the Competency Court system is to save individuals from serving unwarranted and prolonged jail time and connect them with necessary services.

Behavioral Health Districts geographically align with judicial districts, but remain a separate entity to ensure localized, community care to individuals. NAMI of Boulder defines the purpose of Behavioral Health Districts to “provide person-centered, recovery-oriented services to adults, adolescents and children with serious behavioral health disorders to help them thrive in their own families and communities and prevent arrests, incarceration, institutionalization, and out-of-home placements.”[18]

Currently, Mental Health Centers receive funding from a complicated myriad of state funds, grants, and Medicaid. Behavioral Health Districts would help to streamline funding to these facilities. Making Mental Health Centers a priority within Mental Health Districts will not only simplify the funding problem, but allow for more community control over services and potentially increase access to care.

Together with Competency Courts and Behavioral Health Districts we can minimize interactions with the judicial system and directly link people in need with community resources.

Provide supportive housing for recovery from addiction, homelessness and incarceration

Adequate housing for those in recovery from addiction, mental health disorders, or incarceration is scarce and oftentimes results in homelessness. Studies show that the longer someone remains in a homeless situation, the more costly and difficult it becomes to re-house the person.[19] It is necessary to invest in supportive housing for these vulnerable populations.

The Substance Abuse and Mental Health Services Administration (SAMSA) identifies the availability of supportive housing systems as critical to helping stabilize individuals with mental health and addiction disorders. I will work to grow these essential facilities as part of a holistic plan that offers evidence-based, comprehensive, and community-based services.

Expand mental health care options in rural Colorado

Many in rural areas face barriers such as lack of providers in the area, transportation, language barriers, or lack of insurance. A recent article from the Journal of Mental Health Counseling highlighted the tragic connection between lack of access to a professional mental health provider and an increase in suicide.[20] Access to appropriate, professional mental health care can save lives and improve the resilience of Coloradans.

In these times of heightened stress due to the pandemic, Telehealth has emerged as a practical way for consumers to seek care or to remain connected to their providers. Telehealth reduces some of the barriers to care that many people encounter. Telehealth will be part of my plan to increase access to mental health care in rural areas.

Promote mental health and wellness in schools

Hundreds of thousands of Colorado students suffer from a mental health or substance use disorder.[21] This can manifest itself through anxiety, depression, suicidal ideations, or disruptive behavior which can negatively impact the student in many ways including absenteeism. There are steps that the state of Colorado can take to help provide early intervention, which increases a student’s chance of academic success and improves overall health.

Universal mental health screenings are already being done in some Colorado school districts.[22] The screenings help identify students who may benefit from resources for their mental health needs. Families and students can then be connected to appropriate services either at the school or from an outside provider.

Additionally, requiring mental health education for all students not only reduces stigma, but promotes healthy social, emotional, and behavioral development.[23] The academic success and overall health of our youth is intertwined with their mental health. I am dedicated to early intervention and will work to implement these initiatives throughout Colorado. This will not only create a safer and more effective learning environment, but will help students reach their fullest potential.


According to the Bell Policy Center’s report on middle class families, health care costs in Colorado between 2000 and 2016 increased by some 70 percent. Over the same time period, income for two-adult families rose by just 21 percent.[24]

That glaring deficit is exacerbated by two other trends. First, Colorado businesses have been steadily declining to offer their employees health care coverage due to rising insurance costs. Second, insurance policies offered in our state have set higher out-of-pocket costs for consumers than ever before.

Together these situations have created significant barriers to affordable health care, and even higher-income Colorado families are feeling the pain. Lack of affordability is especially detrimental to people at the lower end of the earnings scale. High costs are causing people to put off care, skip it altogether, or go into insurmountable debt.

Rural Coloradans are especially impacted. In Jackson, Gilpin, Grand, and Clear Creek Counties, residents have fewer insurance options and fewer medical providers.

The Colorado legislature needs to recognize these challenges and take action. Our goal should be to create stability in the Colorado health insurance marketplace that lowers overall costs and enables people to be healthier.

Support Medicare for all at the Federal level

I support a single-payer health care system at the Federal level. Until that time we must make improvements to aspects of the Affordable Care Act that impact our state. We must also initiate new, common sense reforms to make health care more affordable and available for all Coloradans. Some of the solutions I will support and champion include:

Allow more Coloradans to buy into Medicaid

Colorado’s Medicaid program, Health First Colorado, is public health insurance for Coloradans who qualify. The program provides health coverage to many who otherwise could not afford health insurance, including children, pregnant women, elderly adults and adults with disabilities.

Medicaid is funded jointly by the federal government and Colorado state government, and administered here by the state. The program provides coverage and access to care for about 1.3 million low-income Coloradans.

Medicaid, by nature of its primary health care model and critical mass, offers inherent efficiencies. We should allow more Coloradans the option to purchase affordable coverage based on the Medicaid model. Coloradans ages 55–65 have a particularly difficult time finding affordable insurance options. The opportunity to purchase Medicaid coverage would help to address this glaring gap.

In 2020, the Colorado House passed a bipartisan bill to study ways to improve affordability and competition in health insurance. Unfortunately, the bill died in the Senate.

I am committed to pursuing innovative ideas and exploring ways to expand options so Coloradans can access high quality affordable health care. Expanding more competition in our state through a supported coverage option like Medicaid, offers opportunities to decrease costs for many.

Expand and protect the state reinsurance fund

Many Coloradans are impacted by high insurance premiums, especially those in rural and Western parts of the state. By and large, consumers in these areas have seen high year-over-year price increases for more than a decade. For many Coloradans, insurance cost increases have far eclipsed any earnings increases they may have achieved.

In 2019, Colorado passed HB19–1168, the State Innovation Waiver Reinsurance Program, which helps health insurers pay their highest-cost claims. This stop-loss program helps to keep costs down. The program has helped Coloradans who purchase insurance on their own see significant price drops in premiums.

The program is in place through 2023, and has largely been seen as a success. But, there are challenges ahead with regard to funding, especially with the impacts of the pandemic on our state budget.

Additionally, although this reinsurance program largely has strong bipartisan support, the program has seen attempts by some Republicans to dismantle it.

I support Governor Polis’s reinsurance policy, but we need to do more. I will work with urgency to maintain this reinsurance fund, to find federal dollars to help offset its costs, and to create greater bipartisan support for its expansion.

Protect and preserve Medicaid and CHP+

CHP+ is a low-cost health insurance option for children whose families earn too much to qualify for Medicaid but cannot afford private insurance.

Together, CHP+ and the state Medicaid program (Health First Colorado, described above), improve health outcomes, reduce costs to our health system and are essential to the health and well-being of roughly 1.2 million Coloradans. But since 2017, enrollment in these programs has declined by 8%, or more than 100,000 people.[25]

Reasons for the decline are discouraging. The Trump administration has imposed new work requirements for Medicaid that are unconstructive and punitive. In doing so, they have initiated federal audits and created red tape that are resulting in enrollment declines for those eligible for these important safety net programs.

It’s important to know that most Coloradans covered by Medicaid are already working. Those who are not working have good reasons for being out of work, such as disabilities, caregiving responsibilities, or age. In any case, good health is essential for maintaining employment. To restrict access to health care for those already struggling is counter productive.

Moreover, monitoring and enforcing the new work requirements is costly, time intensive, and heavy on paperwork. So far, they have not led to savings, but have instead needlessly burdened law-abiding Coloradans.

The Trump administration also is actively dissuading legal immigrants from accessing public assistance programs like Medicaid. Under a new “public charge” rule, if an immigrant is determined to have a high likelihood of needing assistance, it’s much harder to gain longer-term approvals (like a green card) for staying in the country.

These changes through the Department of Homeland Security have already had a chilling effect in Colorado, discouraging legal immigrants who need assistance from seeking Medicaid insurance subsidies, as well as the earned-income tax credit, food stamps, and other welfare programs. Young people protected by the Deferred Action for Childhood Arrivals program are also impacted.

I am committed to protecting our Medicaid and CHP+ programs from federal interference and any action that makes them less effective for the most vulnerable among us.

Collaborate with medical experts to increase quality, efficiency, and reach

Conversations around health care reform are often focused on insurance companies. I will seek guidance from and partnerships with health care providers to seek innovative reforms and improvements. Clearly, health care providers on the front lines have valuable knowledge to offer and the greatest incentives to bring consumers the best possible care.

For example, the state should support the primary care model, which has proven essential to a lower cost, high performing health care system. Patients deserve increased flexibility in care delivery, and the state can support expansion of technology options such as telehealth that have emerged during the pandemic. Additionally, the state can support innovation in electronic health records, while helping to ensure privacy and data security.

Increase health care options for rural Coloradans

Colorado must improve health care access in rural and underserved areas of the state. In addition to addressing cost issues, we need to incentivize more practitioners of all types and care groups to locate in these areas.

In the short term, we need to incentivize new medical graduates to practice in places with the greatest need. I would consider programs that subsidize relocation costs, housing allowances, and tuition assistance.

The bottom line is we must ensure excellent and equitable health care across Colorado. This is a key way to reduce the economic inequality that is undermining our society on so many levels. We must find better funding mechanisms for incentivizing excellent health care throughout the state in order to do this.


The fundamental structure of the U.S. health care system — employer-sponsored insurance — has become detrimental and obsolete on many levels. We need to institute improvements:

Lift constraints on businesses and innovation

Big businesses have an overwhelming recruitment advantage in the current system. They can spread insurance risks across a large workforce, and thus offer greater coverage and lower premiums. The prohibitive cost of offering health insurance to a small workforce has become a foundational disadvantage to small businesses in this country, suppressing innovation.

Unlock jobs to improve options for workers

Employer-sponsored health insurance prevents workers from changing jobs or starting their own enterprises because they are worried about losing their insurance. Many Americans remain in jobs for this reason, even when making a change could improve their lives. They may have or be caring for a family member with a chronic condition. They know that purchasing health insurance on their own is extremely expensive. They know that the current Federal administration is working to end protections for pre-existing conditions.

Address wage stagnation

As health insurance premiums have increased sharply in the last two decades or so, wages have been mostly flat. Small businesses in Colorado struggle to cover the costs of health care insurance for their employees, and are declining to do so at an increasing rate. This deficiency is putting a cost burden on all segments of society, and as usual, workers bear the brunt of the problem.

Properly classify workers

Because of the high costs of providing health insurance, some businesses have skirted the law by deeming people as part-time or contract laborers with no benefits, limited job protections, and compromised workplace safety. This can result in workers needing government assistance and becomes a form of corporate welfare. Smaller business owners end up footing this cost.

Create meaningful change

In disentangling health insurance from employment status, I believe a single-payer system would enliven worker choices, innovation, and entrepreneurship by shifting the health care responsibility from businesses to society at large. A pragmatic step in that right direction is to shift away from employer- sponsored health insurance to an open exchange model.

In this scenario, businesses will not provide private health insurance to their workforce. Rather, they will submit a fee based on the number of FTEs, as an average of overall health care costs for employees. Those funds will go into the state exchange. Employees can then shop freely on the exchange. To help pay for insurance, everyone, regardless of employment, will qualify for standard tax deductions. People in need will qualify for further premium help.

This will relieve businesses of the massive administrative burden and costs of dispensing health insurance for their workforces. It will give employees the flexibility they need to make the right decisions for themselves and their families. It will encourage more risk taking and enliven start ups. This approach makes the most of the exchange system established with the ACA, and expands it logically. I’m committed to pursuing innovative ideas like this one to give Colorado businesses and workers far better options for managing and accessing quality health care.

Judy Amabile is a candidate for Colorado House District 13 in the 2020 election.

Natalie Belmear holds a Master of Social Work from Indiana Wesleyan University and is a policy advisor to Elect Judy Amabile.

Special thanks to Phoebe Norton for her work developing Mental Health Districts.

Cover photo by Ryan Hoffman via

Paid for by Elect Judy Amabile

© 2020 Judy Amabile

[1] “Addressing Stigma | CAMH.” addressing-stigma. Accessed 7 Sep. 2020.

[2] “See Me.” Accessed 7 Sep. 2020.

[3] “9 Ways to Fight Mental Health Stigma | NAMI: National ….” 11 Oct. 2017, Accessed 7 Sep. 2020.

[4] “Insurance Coverage Mental Health Wellness Exam | Colorado ….” Accessed 7 Sep. 2020.

[5] “Understand Criminal Justice Involvement — Treatment ….” Accessed 8 Sep. 2020.

[6] “Colorado Colorado — Treatment Advocacy Center.” Accessed 8 Sep. 2020.

[7] “Overview — University of Memphis CIT Center.” Accessed 8 Sep. 2020.

[8] “Mental Health Response Team (MHRT) — City of Irving.” Accessed 8 Sep. 2020.

[9] “Mental Health Colorado promotes a “Miami Model” for ….” Accessed 8 Sep. 2020.

[10] “Crisis Intervention Program | Arapahoe County, CO — Official ….” Accessed 7 Sep. 2020.

[11] “Colorado Colorado — Treatment Advocacy Center.” Accessed 9 Sep. 2020.

[12] “Decriminalization of Mental Illness — Conference of State Court ….” Accessed 9 Sep. 2020.

[13] “Decriminalization of Mental Illness — Conference of State Court ….” Accessed 9 Sep. 2020.

[14] “AOT — Treatment Advocacy Center.” Accessed 9 Sep. 2020.

[15] “What is a Community Mental Health Center? — ABA Degree ….” Accessed 9 Sep. 2020.

[16] “NAMI Boulder County Input to the Colorado Task Force on ….” Accessed 9 Sep. 2020.

[17] “Mental Health Courts Program | Overview | Bureau of Justice ….” 19 Feb. 2012, Accessed 11 Sep. 2020.

[18] “NAMI Boulder County Input to the Colorado Task Force on ….” Accessed 11 Sep. 2020.

[19] “Housing and Shelter | SAMHSA.” 15 Apr. 2020, /homelessness-programs-resources/hpr-resources/housing-shelter. Accessed 11 Sep. 2020.

[20] “Counselors’ Role in Decreasing Suicide in Mental Health ….” Accessed 14 Sep. 2020.

[21] “Back to School: Mental Health Screenings ….” 28 Aug. 2019, Accessed 14 Sep. 2020.

[22] “Schools experiment with universal mental health screenings ….” 24 Jan. 2014, -with-universal-mental-health-screenings. Accessed 14 Sep. 2020.

[23] “The Importance of Mental Health Awareness in Schools.” Accessed 14 Sep. 2020.

[24] “Colorado Middle Class Families: Characteristics & Cost Pressures,” Accessed 14 Sep. 2020.

[25] “Protect Colorado’s Medicaid, CHP+ enrollees amid federal pressure.”, Accessed 14 Sep. 2020.



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Judy Amabile

Judy Amabile

Candidate for Colorado State House District 13