The good news for individual and small-group health insurance customers in 2021 is only 10 of Colorado’s 64 counties will have just one Affordable Care Act plan that legally can’t deny consumers for preexisting conditions and comes with – for now – federal tax subsidies.
The bad news for mountain-resort dwellers, who have been hit with some of the highest monthly premiums in recent years, is that Eagle and Routt counties are two of the unlucky 10. Together, Eagle (the state’s 15th most populous county at 55,127) and Routt (23rd most populous at 25,638) account for more people (80,765) than the other eight rural counties combined (64,848).
Those other eight counties with just one ACA marketplace insurance carrier are Logan (22,409 residents; 25th largest); Moffat (13,283; 35th); Yuma (10,019, 38th); Rio Blanco (6,324; 46th); Washington (4,908, 53rd); Phillips (4,265; 54th); Sedgwick (2,248; 57th) and Jackson (1,392; 61st).
“Eagle and Routt stand out like huge sore spots on that list,” state Rep. Dylan Roberts said. “Combine that with the fact that there are so many more people who buy on the individual market here compared to the rest of the state, it is beyond disappointing. And our uninsured rate in these counties is about twice as high as the rest of the state, so add that to the frustration.”
Roberts, whose house legislative district is composed of the two counties, grew up in Steamboat Springs in Routt County and now lives in Avon in Eagle County. He laments that, according to the Colorado Health Institute’s Colorado Health Access Survey, Health Statistics Region (HSR) 11, which includes Routt County, has a 10.1% uninsured rate and a 12.8% individual market.
HSR 12, which includes Eagle County, has a 14.3% uninsured rate and an 11.1% individual market. The state averages, according to the survey, are 6.5% uninsured and 7% individual market. That means, for example, that more than 6,000 people don’t get insurance through their employer and buy it on the individual market in Eagle County, and nearly 8,000 are uninsured. In Routt, more than 2,500 people are uninsured and 3,200 are on the individual market.
And those numbers are likely going way up in 2020 with unemployment that surged to more than 20% as the local economies shut down due to the ongoing COVID-19 pandemic. Most people get their health insurance through their employer.
“The number of people getting health insurance on the individual market can be hard to pin down, but we generally say about 7% to 8% in Colorado,” said Vincent Plymell, assistant commissioner of the Colorado Division of Insurance. “However, that is not based on recent data, and that number could be growing as people have lost employer-based insurance during the pandemic.”
Ironically, one of Roberts’ top legislative goals this past session – a state public option – was derailed by the budgetary costs of the pandemic. Roberts says the bill (HB20-1349) he introduced with Vail state Sen. Kerry Donovan would have reduced premiums 9 to 18% a year and given all 64 Colorado counties a new option on the health care exchange.
Roberts said that since the state’s public option would have been built into the existing private insurance infrastructure, the start-up costs would have been minimal, but with the state budget facing a $3.3 billion shortfall due to COVID-19, those funds simply were not available.
With so many people losing health coverage along with their jobs, Roberts vows to try again during the session slated to begin in January in order to have a public option up and running for 2022, adding Routt and Eagle counties deserve more than just one ACA-compliant plan that can’t deny for coverage due to preexisting conditions such as COVID-19.
“That is simply not fair, and when you combine that with the fact that our tourism-based mountain communities were hit hardest by the virus and face record unemployment because of this global pandemic and recession, it is a public health emergency,” Roberts said.
In Eagle County, another attempt at increasing insurance choice – a nonprofit cooperative spearheaded by the Vail Valley Partnership chamber of commerce and Vail Health hospital called the Mountain Healthcare Coalition – was also derailed by the pandemic.
“[A plan by] 2021 was our goal and it was going to be a push,” Vail Valley Partnership President and CEO Chris Romer said. “And we were pushing – had a meeting with the state scheduled for mid-March that was cancelled due to COVID and then obviously everything blew up. We are starting to refocus efforts on this … but we’re clearly aiming at 2022 at this point.”
Modeled after Summit County’s Peak Health Alliance co-op, Romer said the Mountain Healthcare Coalition is “designed to lower rates and maintain or increase benefits by offering a competitive product to the market. Health insurance costs remain a key cost-of-living driver and barrier to business growth and both business and individual retention in Eagle County.”
However, in late 2019 Romer expressed concern that the state public option would increase costs for rural hospitals. Roberts is confident the 2021 version of the bill “will not harm our smaller hospitals but also get consumers the choice and affordability they deserve.”
One thing the legislature was able to get done in 2020 was pass a reinsurance bill (SB20-215) that extended funding for that program for at least five years without raising taxes. Reinsurance reduced Anthem silver plans for a family of four in Eagle County from more than $2,100 a month in 2019 to around $1,650 in 2020.
The Colorado Division of Insurance recently released preliminary premiums for individual and small group health plans for 2021, with public comment open through Aug. 26, and statewide individual plans would go up just 2.2%, with small group plans increasing 5.7%. Those increases would have been much higher without reinsurance, which uses hospital fees and federal funds to pay a portion of high-cost claims, allowing insurance companies to lower premiums.
In the DOI’s Area 9 West, which includes Eagle and Routt counties, Anthem individual plans would increase just .2%, but decrease in total by 28.3% due to reinsurance. Small Group premiums for Anthem would increase only 0.6% in Region 9, while overall Small Group premiums would increase 7% in the area and 5.7% throughout the state.
“If we look at the exchange products, so you’ve got the individual market … that reinsurance helped stand up and it’s $40 million and some odd dollars a year assessed to Colorado hospitals and we’re very, very supportive of that, but small group there’s nothing there,” said Nico Brown, who heads up business development for Vail Health and Howard Head Sports Medicine, which have been working closely with Anthem to obtain discounts.
Brown points to the more than 3,400 businesses in Eagle County — 80% of which have 10 employees or fewer and 90% of which have 20 employees or fewer. The remaining 10% are larger, self-funded employers.
“You’ve got this whole group of mom and pop businesses that we need to help support, and that’s where a lot of the work on the small-group market has come in, and if you look at the MEN [Anthem’s Mountain Enhanced Network] product, it’s very competitive,” Brown added.
Of course, health insurance and the entire health care system will be impacted dramatically by the COVID-19 pandemic and possible seismic changes at the federal level with a pending U.S. Supreme Court decision that could eliminate the ACA and strip its subsidies and coverage away from approximately 20 million Americans.
The Trump administration supports a lawsuit challenging the law and has been promising a better replacement without delivering one for the past four years. On Friday, President Donald Trump alluded to a possible executive order requiring protections for people with preexisting conditions, which is already the most popular tenet of the ACA – or Obamacare.
“Our focus on getting upstream on prevention as well as early detection of different ailments, pathologies you might have, that’s the way forward, and whatever comes down in terms of the federal politics we’re just going to have to be nimble, be agile, adjust and figure out, OK, if the game changes, then we’re going to learn how to play that game better,” Vail Health’s Brown said.