When patients walk into Dr. Michael Pramenko’s office in Grand Junction these days, they often walk in worried.
Already, residents of Colorado’s Western Slope pay more for health insurance than just about anybody else in the country while also having a smaller selection of insurers to choose from. The Republicans’ health care bill in Congress — which may yet be revived — could up their costs even more.
And now, the Western Slope is bracing for more possible bad news about its health coverage. This month, Wall Street analysts who met with insurance giant Anthem reported that the company is “leaning toward exiting a high percentage” of the Affordable Care Act exchanges in which it currently participates. If that happens, it could leave as many as two-thirds of the counties in Colorado with no or only one insurer available on the state’s health insurance exchange. Almost all of them are in rural mountain areas.
“It would be devastating to our exchanges if they dropped out,” Lt. Gov. Donna Lynne said.
And all these looming threats are weighing on patients, said Pramenko, a family medicine physician who is a past president of the Colorado Medical Society. Last week, for instance, he saw a 57-year-old patient who is already paying $1,000 a month for coverage.
“He doesn’t like the Affordable Care Act,” Pramenko said, “but now he’s wondering if he’s going to have any way to buy insurance next year.”
Lynne and others cautioned against premature panic.
A spokesman for Colorado’s Division of Insurance said the division has not heard from any insurers that plan to drop off the state’s exchange — known as Connect for Health Colorado — in 2018. Lynne said state officials are reaching out to insurers to find ways to keep them in the market.
In an email, a spokeswoman for Anthem said it is too early to comment on the insurer’s 2018 plans. Insurers must submit their 2018 plans to the state for review in May, though it is likely the deadline this year will be pushed back into June.
Nationwide, there has never before been a so-called “empty shelf” county with no insurers on the exchange. But 2018 will likely see the first. Humana’s announcement this year that it will abandon the exchanges means that several counties in Tennessee look to be without options for 2018.
An Anthem exit would have an even bigger impact nationwide. If it were to leave all 14 states where it currently offers plans on Affordable Care Act exchanges, about 250,000 in 300 counties would be without a single choice, according to the Robert Wood Johnson Foundation. In Colorado and elsewhere, Anthem and other insurers also sell individual plans off the exchange. But those plans may not meet the same standards as the exchange plans and people cannot use federal tax credits to help pay for them.
“It’s too soon to tell,” Christine Bogott, a health insurance broker and the legislative chair for the Colorado State Association of Health Underwriters, said of Anthem. “I wouldn’t want anybody to worry until we know for sure.”
But Bogott agreed that, if Anthem were to drop out, it would scramble the individual health insurance market in Colorado.
“I can’t even imagine this,” she said.
What the anxiety reveals about the Affordable Care Act — even as politicians argue over its future — is how tenuous some of the law’s promises already are outside the Front Range.
Most Coloradans get their health insurance through their employers, while many others benefit from Medicare of Medicaid. About 8 percent of the state, though, buys individual plans on Connect for Health Colorado.
Those plans and the ease of shopping for them all in one place have been key in helping drive the state’s uninsured rate to historic lows — about 7 percent, according to the Colorado Health Institute. But the exchange’s benefit hasn’t spread evenly across the state.
In every county along the Front Range between Colorado Springs and Fort Collins, people have at least four choices of insurers offering coverage on Connect for Health Colorado. People on the Western Slope and other parts of rural Colorado used to have a similar number of choices.
But a series of pull-backs and withdrawals have left 14 counties in Colorado with only a single insurer on the exchange — Anthem. In another 29 counties, there is only Anthem and one other insurer offering plans on the exchange. The vulnerable counties include almost all of Colorado west of the Continental Divide, as well as Pueblo County and numerous counties on the Eastern Plains.
“We need to move in a direction with more options,” said Summit County commissioner Dan Gibbs.
The mountain counties also have the highest health insurance costs and the highest uninsured rates. Across Colorado ski country, the uninsured rate is roughly double the statewide average, while typical plans can cost more than $400 a month. A Colorado Health Institute survey found that 82 percent of the state’s uninsured said costs were a big reason they didn’t buy coverage.
But with fewer people — especially healthy people — buying insurance because of the price, the pool of those who are insured is relatively sicker, putting financial pressure on insurers. The more insurers who leave the region, the worse the problem gets. Prices go up. And more relatively healthy people whose premiums could help pay for care for people who are sicker bail on coverage.
“There is a bit of a death spiral that occurs if you don’t keep people in the insurance pool,” said Pramenko, the Grand Junction doctor.
Lynne, the lieutenant governor, said the state is working to address the problem, including with a bill under consideration at the state Capitol that would use state funds to help lower-income people in high-cost areas pay for insurance. Pramenko said insurers also need certainty from the federal government about what regulations will look like in 2018 and beyond, and he said the ongoing political squabbles in Washington do little to help.
“Are they just going to let the Affordable Care Act crumble?” Pramenko asked. “And, if they let it crumble, it’s affecting real people’s lives.”
