Why is health insurance so insanely high in Summit County? Experts ponder the question | SummitDaily.com

Why is health insurance so insanely high in Summit County? Experts ponder the question

Summit Chamber president Tony Pestello speaks during a town hall forum on health insurance costs at the Silverthorne Pavilion, Friday May 21.
Deepan Dutta // ddutta@summitdaily.com

The Summit Chamber held a town hall forum to discuss health insurance costs in the high country this past Friday at the Silverthorne Pavilion. Local and state officials got together with small business owners who are sick and tired of paying staggeringly high insurance premiums. In the end, the health care crisis wasn’t solved, but those attending left with a better understanding of how much work needs to be done to find one.

To state the obvious, health insurance is pricey in the high country. It is an issue that has been digging deep into bottom lines and affecting lives. Tamara Drangstveit, executive director of the Family & Intercultural Resource Center (FIRC), said she tries to help Summit residents find solutions for their own health insurance while also struggling to take care of her own employees.

“Anyone who lives in Summit County knows how serious the problem is here,” Drangstveit said. “The high cost of housing, high cost of child care, high cost of health care. All of us are struggling. We can’t find housing for employees, and spend $250,000 a year on health insurance. The fastest route to bankruptcy and financial ruin is having unexpected health care bill.”

Colorado insurance commissioner Mike Conway said that the people who hurt most from that system are people who try to find insurance on the individual market.

“The individual market is more expensive for a variety of reasons,” Conway said. “Members of the individual markets are higher risk. For example, folks who can’t get employed for health reasons wind up on individual market. Across the board, the individual market is sicker than other markets and that makes their health costs more expensive.”

When people can’t afford basic health insurance on the individual market, they could try to turn to Medicaid for subsidized insurance.

However, that’s a big hurdle in Summit County. Helen Royal, CEO of the Summit County Care Clinic, says that many people who would normally be eligible for Medicaid elsewhere aren’t here because of federal guidelines about median income, even if they can’t afford insurance on the individual market. The Kafka-esque system means that the Care Clinic has to pay for more uninsured clients, and therefore increase costs overall.

“Forty-five percent of our visits are people with no insurance,” Royal said. “It’s a huge challenge. They pay $10-$70 for services that would normally cost $350 or up, and we won’t turn anyone away who can’t pay. That’s why it’s helpful when we have insured people seek treatment.”

Some members of the business community blamed the Affordable Care Act, also known as Obamacare, for the spike in their own premiums. They pointed out that their premiums increased right after the health care law was passed, but Conway insisted that the problem with the insurance costs in the mountains was directly related to an existing problem in America before Obamacare: the cost of health care.

“In order to find the problem you need to look where it’s coming from, and costs are driving up premiums,” Conway said.

Conway explained that the costs have always been high, and continue to be, but because of fragmentation in the health care market as well as instability due to providers backing out of certain markets, those costs get disproportionately spread to areas like Summit County. He similarly shot down ideas such as creating local health insurance co-ops or buying insurance across state lines.

“Local insurance compacts are nice in theory, but providing care is far, far too expensive for a small group to pay for,” Conway explained. “And buying across state lines is great in theory too, but health care is not national, it’s local. Different areas have different needs and different costs, and they might not cover the hospital you go to or the procedure you need, which makes a low premium pointless.”

In the end, Conway said, the problem all of us need to focus on is getting a control of costs. But Conway admitted that nobody has figured out a way to do that.

“Having a true discussion about health care costs is a long-term, more difficult conversation to have,” Conway said. “It’s not something that will happen soon, or help people now.”

As a short-term solution, Conway put his support behind efforts to bring a “reinsurance” system to Colorado that would help insurers pay for high-cost health claims with a funding pool to draw from, thereby lowering their costs and client premiums.

Whatever the grand or temporary solution may be, the panelists in attendance agreed that locals need to work at a grassroots level to push their legislators to act. Drangstveit believes that Summit residents need to realize the power we have as a collective and then influence policy.

“When people say policymakers, they traditionally think elected officials,” Drangstveit said. “I don’t think health care can be solely resolved by legislation. We need buy-ins from citizens, businesses, and nonprofits. We all need to talk to each other — providers, hospitals, insurance companies, patients, business owners and government infrastructure. “

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