Colorado grapples with increasing health care costs as feds continue ‘Obamacare’ squabble
July 18, 2017
Regardless of what may happen with health care in Washington, D.C., costs are almost certain to rise next year in Colorado and along the Western Slope.
The death knell for the conservative plan to repeal-and-replace the existing Affordable Care Act, otherwise known as "Obamacare" passed under the Obama administration, appears to be ringing. Two more Republican senators, Jerry Moran of Kansas and Mike Lee of Utah, announced Monday night they'd join Sens. Susan Collins of Maine and Rand Paul of Kentucky, in opposing the current bill as proposed, which prevented it from going up for debate on the Senate floor.
Republican efforts in the U.S. Senate, spearheaded by Majority Leader Mitch McConnell, also of Kentucky, have now shifted exclusively to attempts to repeal Obamacare with no substitute identified. If passed, the likelihood of it leaving millions of Americans without health care has spirits low that it will receive congressional endorsement either.
Such unpredictability at the federal level has sent ripples down to states as insurers attempt to set rates for the upcoming enrollment year and ensure they turn a profit — or even remain solvent. Due to variability in the market, more than one insurer available on Colorado's exchange recently asserted they missed projections or even lost money in the last year.
As a result, the slate of insurers carrying forward on the state's individual market requested an average hike of 27 percent for premiums on plans, the state Division of Insurance announced this past Friday. That follows the 20 percent average increase Coloradans experienced last year, with some rural, mountain communities seeing rates rise by more than twice that number.
What the DOI might approve for 2018 won't be known until the fall as the state Department of Regulatory Agencies division reviews the merits of each request. The numbers for how each will impact individual counties are not yet available, though small-group plans were petitioned to grow by an average of 7 percent statewide.
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Aside from general uncertainty, part of the reason insurers are asking for more, says Bethany Pray, a health care attorney with the Denver-based Colorado Center on Law and Policy, is they don't presently know if they can depend on federal reimbursements for cost-sharing reductions they're required to provide under the ACA. To date, those have been paid out to preserve mandated discounts on deductibles to eligible consumers, but without a commitment from the Trump administration to maintain those payments the insurers have been sent scrambling to recoup possible large-scale losses.
"It leaves carriers wondering how they're going to cover those costs," said Pray. "They need to be made whole by getting those dollars from the federal government, and so far they're paying it but they're not sure if they'll be paying it next year. If they don't get that money from the feds they're going to be out a lot of cash, so they want to make sure their books are going to balance."
Beyond the rationale, consumers are most concerned about the bottom line. Of the 900 or so people in Summit County who bought an individual plan on the state exchange through assistance provided by the Family & Intercultural Resource Center, 62 percent went with Kaiser Permanente, with Anthem gaining 23 percent of the customer base. Locally, Cigna and Bright Health Plans, a newer offering through Centura Health, more or less split the rest of the enrollee business.
Kaiser's initial rate request stands at roughly a 14 percent expansion statewide, Anthem at almost 27 percent and Cigna at close to 10 percent. Details on the potential Bright Health hike were not yet known.
Rural communities like those on the Western Slope usually face larger increases, though, so that could just be the beginning. That thought sends county leadership into a tizzy.
"I don't know anyone in Summit County who's seen a 27 percent income increase annually — not anyone," said County Commissioner Dan Gibbs. "The increases are not sustainable at all. Many people, particularly the middle class, are already living right on the edge of surviving in our community and have to decide whether to pay their rent, their health care for an individual or their family or day care."
To help offset new challenges facing area residents, Gibbs and others are trying to find ways to address the high costs that continue to threaten pricing out individuals and their families. Conversations are ongoing with state senators and representatives to try and find relief, but the county is also working on its own answers.
One idea is to collaborate with St. Anthony Summit Medical Center and local foundations to provide additional premium assistance for those at more than the currently allowable federal poverty level to receive a subsidy. How the county and its partners would cover those costs should that move forward is still under consideration, but Gibbs believes Summit can't wait on the state or federal governments to play politics before moving forward with action to bring some form of aid to its citizens.
"We're a creative community that when our community faces challenges, I think we're capable of not waiting for the state or federal government to help us — we can come up with our own local solutions," said Gibbs. "This is not a Republican or Democratic issue, this is a common sense issue that impacts everyone in Summit County, and I'm optimistic that we can come up with some local solutions that can be meaningful."
State lawmakers are otherwise in the process of pouring over a list of recommendations from the Colorado Commission on Affordable Health Care that it developed over three years. The charge of that group was finding ways to reduce some of the underlying expenses in the current health care system.
It's anyone's guess where that will lead with prospective legislation, especially as new proposals seemingly come out by the day at the Capitol in Washington, D.C. For now, Coloradans are forced to look internally for results while the U.S. Congress makes further attempts to terminate the present health care system.
"We're now looking at the possibility of repeal without replace, and that just wouldn't work for Colorado," said Pray. "The loss of federal funding and the uncertainty in the market would just be disastrous."