High Country cost of health care, Part 1: Affordable Care Act plans in the high country aren’t so affordable
HIGH COST OF HEALTH CARE
Total cost of care comparison (dollars paid per person, per year)
- Eagle County: $3,036
- Garfield County: $2,954
- Pitkin County: $4,010
- Summit County: $3,182
- Grand County: $2,344
- State: $2,727
Outpatient facility costs
- Eagle County: $1,036
- Garfield County: $988
- Pitkin County: $1,512
- Summit County: $986
- Grand County: $737
- State: $655
- Eagle County: $944
- Garfield County: $839
- Pitkin County: $1,332
- Summit County: $990
- Grand County: $649
- State: $865
Source: Colorado All Payer Claims database
Editor’s note: This is the first in a three-part series. The second installment examines the reasons for high medical care costs and insurance premiums in the mountain resort region.
Kirsten Struve Texler is wondering how she’s going to be able to afford health insurance anymore. The single mother of a 10-year-old son owns her business and carries an independent insurance plan that expires this week.
She went to Connect for Health Colorado, the marketplace where consumers can shop for Affordable Care Act coverage, assuming she could find a good deal on a new plan. Those seeking Affordable Care Act insurance have to first get approved or denied for government assistance programs like Medicaid, Medicare and Child Health Plan Plus before they can shop in the insurance plan marketplace. But because of a severe pre-existing condition, she said she couldn’t get approved or denied for assistance. Instead, she was sent to yet another government agency where she’ll have to file more paperwork and wait.
Struve Texler is one of many mountain residents who have learned that the plans offered under the Affordable Care Act in the mountain resort region aren’t so affordable. Those who can’t qualify for government assistance programs like Medicare, Medicaid or Child Health Plan Plus, and who do not have health insurance through their employers, must sign up for Affordable Care Act coverage for 2014 or face tax penalties. Struve Texler is playing a bureaucratic waiting game with major consequences. She’ll wait for her documents to clear and will have to go without insurance during that time. She hopes she doesn’t need to see a doctor or visit an emergency room during the waiting period, which she said she was told could be a couple of months.
In 2014, the minimum tax penalty for not carrying health insurance coverage will be $95 per uninsured adult and $47.50 per child, or up to $285 for a family, with fines going up from there depending on income level. Some families would rather pay the penalty than be forced to spend anywhere from $300 to $600 per month, per person, on premiums. Struve Texler has no choice but to pay for expensive premiums because she knows the alternative would be major out-of-pocket medical bills, but other folks are choosing to roll the dice.
That’s what Jorge, who lives in Summit County, expects to do. He didn’t want his last name published because he’s not proud of his situation.
Jorge is a maintenance man for a Summit County condominium complex and earns $13 per hour. He is married with children and his wife does not work. His employer told him to look for individual insurance this year, so he got in touch with Gaston Feuereisen, a health coverage guide with the Family & Intercultural Resource Center, a Dillon-based nonprofit that helps families in need.
It would have been Jorge’s first time buying health insurance for himself and his family.
“I have been debating if we will be able to afford these plans, but at this time, we do not think that we will be able to pay for the coverage,” Jorge said in Spanish, with Feuereisen translating.
Jorge cited other bills, calling them his “actual responsibilities,” as his reason for not being able to afford the insurance.
FIRC executive director Tamara Drangstveit said residents in the mountain resort region can spend 50 percent of their income on rent. In Denver, it’s typically 30 percent or less.
“When you’re spending 50 percent on rent, it doesn’t leave any other money really for much, other than probably food and transportation, maybe child care,” she said. “These are people working two or three jobs already.”
FIRC has been meeting with families in Summit County looking to sign up for Affordable Care Act coverage, but nearly everyone has gotten sticker shock.
“All of the individuals we’ve helped so far have opted not to take the plans,” Drangstveit said. “We’re in the highest insurance bracket in the state.”
Drangstveit is referring to Region 11, the region drawn by the state of Colorado Division of Insurance that includes Eagle, Summit, Pitkin and Garfield counties.
The Colorado Division of Insurance reviewed and approved 541 new health insurance plans from 18 carriers earlier this year that meet federal Affordable Care Act requirements. The division reported that a review of rates and justification for those rates took place before approval.
The high cost of health care in the region means insurance premiums are often double what they are on the Front Range.
On the Connect for Health Colorado marketplace, for example, a 35-year-old nonsmoker can find a basic plan for $179 per month, with a $5,000 deductible. That same plan in Summit County is $336 per month. In Eagle, Garfield and Pitkin counties, it’s $388 per month.
U.S. Rep. Jared Polis said last week he would seek waivers from the federal government for the region, part of which includes Polis’s second congressional district. He wrote a letter to Colorado insurance commissioner Marguerite Salazar Oct. 9 expressing his frustration about higher insurance rates in Summit County and urging the division to revisit the approved rates. He suggested that Summit County be moved to the same rating area as Clear Creek and Jefferson counties, but the division cannot designate new regions until the 2015 coverage year.
“High insurance rates will make it more likely that Coloradans living in Summit County will choose to forgo coverage entirely, leading to an increase in health care costs for the state but more importantly threatening the health and welfare of these same residents and their families,” Polis wrote.
Jorge is one of those Coloradans. He’s already paying off a previous medical bill little by little from when his son had a stomach problem. Jorge also has sleeping problems and a hernia that will eventually require surgery. He’ll have to figure out what to do about it when the time comes.
Jorge said most people he has talked to will also not be able to afford the cost of the insurance plans offered in Summit County.
“I think the prices are too expensive for us here to pay,” he said.
Many residents uninsured
The Center for American Progress Action Fund, a Washington think tank, released a study in July about American counties that need the Affordable Care Act the most. Counties in the mountain resort region are on the list.
The study cites low-income families — those who make less than $25,000 per year — as the most likely to be uninsured.
“This group makes up about 31 percent of all the uninsured in the United States, and about 25 percent of this group does not have health insurance. Households making between $25,000 and $49,999 do not fare much better. This group makes up about 32 percent of all the uninsured, and about 21 percent of this group does not have health insurance coverage.”
Eagle and Garfield counties made the list of the top 50 U.S. counties with the highest rates of non-elderly uninsured individuals making between 138 percent and 400 percent of the federal poverty level, which is currently $11,490 for an individual, and $23,550 for a family of four. Garfield and Summit counties also are among the top 50 counties in the country with the highest rates of uninsured Hispanics.
The resort region designation is locked in for 2014 insurance coverage, however the review process for 2015 geographic regions is already underway. The Colorado Division of Insurance issued a statement last week saying it would seek stakeholder input about proposed geographic rating areas.
One county that will surely speak up is Garfield. Commissioners there indicated in early October they would challenge the rating that clumps them together with Eagle, Pitkin and Summit counties. They can’t do anything about 2014 rates, though.
And while the resort rating has ignited debates about whether Eagle, Garfield, Pitkin and Summit counties should be classified together as one region, costs for health care in the region would indicate otherwise. According to the Colorado Hospital Price Report, the four main hospitals in those four counties have some of the highest costs for health care in the state.
Lauren Glendenning is the editorial projects manager for Colorado Mountain News Media. She can be reached at (970) 777-3125 or email@example.com.
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