Public Health Issues, Trends In Health Care
Polis fights sky-high rates as ski town signups stall
Posted on 23 October 2013.
By Katie Kerwin McCrimmon
Health insurance rates are so high in Colorado’s mountain resort areas that U.S. Rep. Jared Polis plans to seek waivers from the federal government so people who skip buying insurance in 2014 won’t face financial penalties.
“We will be encouraging a waiver. It will be difficult for Summit County residents to become insured. For the vast majority, it’s too high a price to pay,” said Polis, D-Boulder.
Health coverage guides working to enroll Summit County residents in new health plans through Colorado’s health exchange have been deeply disappointed. They have not enrolled a single new client since Colorado’s health exchange launched on Oct. 1.
“People take one look at the rates and they walk out the door,” said Tamara Drangstveit, executive director of the Family and Intercultural Resource Center, the group that is leading efforts in Summit County to enroll people in new plans that start on Jan. 1 through Colorado’s health exchange.
“This is hard for me to say. We had really hoped that (the marketplace) would bring down rates. Sadly, that’s not what we’re seeing. People just can’t afford it. Their incomes are already squeezed too tight,” Drangstveit said.
Rates for plans on Colorado’s new health exchange, Connect for Health Colorado, are up to three times higher in resort communities from Breckenridge to Vail and Aspen than in other parts of the state. For instance, a 40-year-old buying a mid-level silver plan in Greeley could pay as little as $232 per month while that same person in the resort communities could pay as much as $667 per month.
In pushing his signature health reform legislation, President Barack Obama has been trying to promote the cost of health insurance as comparable to paying for cell phone service or cable TV. But the resort rates are significantly higher than $100 a month. Neither price for a silver plan factors in federal tax subsidies that customers could get, but often resort residents work so many jobs to afford housing that their incomes appear artificially high and could disqualify them from tax subsidies. (Click here to see rates in various regions of the state.)
Drangstveit said many year-round residents in Summit County pay about 50 percent of their income for housing. Few jobs come with health insurance and overall expenses like food and gas also cost more in resort areas, leaving people with little extra cash to buy health insurance.
Health coverage guides have worked with some clients for up to 90 minutes and walked them through the entire enrollment process only to have them suffer sticker shock and bail when it came time to pick a plan.
“They literally are walking out the door,” Drangstveit said.Asked how many have purchased plans so far, she said: “Nobody. Zero.”
Drangstveit said it has taken some time to work out glitches with the Connect for Health Colorado online system, but then it became apparent that computer problems weren’t the primary challenge in this mountain county about 70 miles west of Denver.
“It took us a while to get the system functional, but these are the kind of problems you expect with a rollout. The real problem is that it’s just too expensive,” she said.
Summit County is home to some of Colorado’s best-known ski areas: Breckenridge, Keystone, Copper Mountain and Arapahoe Basin. The county has some of the highest rates of uninsured people in the state, ranging from 25 to 30 percent. Rates are even worse among Latinos. A recent study found that Summit County ranked 17th worst among counties in the nation for the highest rates of uninsured Hispanics. According to U.S. Census data, just over 60 percent of Latinos in Summit County were uninsured.
Summit County’s three commissioners have been fielding complaints about health costs as well.
Commissioner Karn Stiegelmeier said the difficulty of getting health coverage undermines attempts to attract young families.
“We expect that everything is more expensive here, like gas. It costs more to get it here. It costs more to pay the worker at the gas station,” she said.
“But we’re working a lot on affordability of child care and housing. We want to have real families living here, not just people with higher incomes or retired people with good savings. We want to have a real community. Health care fits right into that. It’s one of those basic needs,” Stiegelmeier said.
After concerns about rates began to bubble to the surface, Rep. Polis wrote a letter seeking help from Colorado Insurance Commissioner Marguerite Salazar. He met with her last week.
Neither Polis nor Salazar thinks there is any way to bring rates down for resort residents in 2014. But Polis wants to see Summit County moved to a different region that includes Jefferson and Clear Creek Counties in 2015. (Click here to see a map showing the different geographic rating regions in the state.)
“That could result in up to 50 percent in savings,” Polis said.
Aside from getting people waivers to bar financial penalties next year, he doesn’t see any immediate solutions.
“I’m very concerned. (The rates) will prohibit many people from affording it (insurance) and signing up. Hopefully we can get Summit County moved (to a different rating region) for 2015,” Polis said.
Polis said Summit County is much more tied to Front Range communities for health care needs than resort communities farther west. He didn’t have an immediate suggestion for solutions for Vail and Aspen, which are not part of his Congressional district.
“What some counties need to do is figure out how they can reduce health care costs,” Polis said. “Health care is less affordable in those areas and counties need a comprehensive approach.
“This has little to do with pre- or post- ACA (Affordable Care Act),” Polis said. “Health care is very expensive and the ACA doesn’t remedy that.”
Because of new cost transparency under Obamacare, Polis said consumers are more aware of regional price differences that have long existed.
Salazar was not available to comment on the rates, but in a written statement she said geographic variations in rates are necessary since health costs vary so much across Colorado.
“Due to the legal requirements of the premium rate review process, the geographic areas for 2014 cannot be revisited,” Salazar said.
But she said members of the public will be able to express their views on new rates for 2015.
News that it could take well over a year to adjust prices is a dismal prospect for health providers working in Summit County.
Drangstveit, the enrollment specialist, worries that writing off an entire year will drive people away for good.
“Who knows if they’re going to come back? To me the best solution is one we can do most quickly. I would hate to discourage what could be hundreds of thousands of people signing up,” she said. “It’s not an easy process.”
Sarah Vaine is executive director of the Summit Community Care Clinic, the only safety-net clinic in the county. Last year, clinic providers saw about about 5,200 patients during more than 16,600 visits. A stunning 88 percent of patients were uninsured and paid only what they could afford. Safety net clinics in Park and Clear Creek counties have closed recently. Some people travel to the clinic from as far as Leadville and Eagle County.
Vaine sees a lot of patients who are not getting their health care needs met. For instance, a young man who has always been relatively healthy and never needed insurance suffered a stroke at age 37. He now has major concerns with hypertension. He gets all his care through the Summit Community Care Clinic and has no access to specialists that Vaine says he should be seeing.
“Uninsured people here have no options. They fall all the way through the cracks in that respect,” she said.
Because that patient has a relatively low income, he may qualify for Medicaid under the new expansion efforts in Colorado that allow childless adults who earn up to 138 percent of the poverty level to qualify for the public insurance program.
But even people who have insurance face higher costs. For instance, Vaine and her husband have what they consider to be a good, robust health plan. Still, when he needed an MRI recently, they decided to drive to Denver where it would cost $500 instead of $3,000 that it would have cost in their community.
Vaine expects many people to continue to forgo health coverage, which means Summit County will continue to lead the state and the nation in the dubious distinction of covering very few of its residents.
“In our community, where we are seeing hopes dashed is that when the rates were established, they were vastly different here than on the Front Range,” Vaine said.
Elsewhere in Colorado, she expects some healthy young people to “roll the dice and decide it’s not worth paying for the insurance.”
In resort communities, she fears potential customers won’t even bother shopping.
“To have to pay two to three times as much for insurance, it’s not even a choice. They’re not going to do it. It’s out of reach,” Vaine said.
For now, she’s crossing her fingers for a quick rate adjustment.
“My hope is that they make rates more fair, and second, that more people will buy in through the marketplace and we’ll be able to see costs reduced,” Vaine said. “I’m an optimist. I’m still encouraging people to do their research and maybe they’ll have some options.”