Nesse: Rural areas win with ColoradoCare (column)
August 22, 2016
There are many reasons to live in rural Colorado: plentiful elbow room, tight-knit communities and gorgeous panoramas, to name a few. But easy access to doctors isn't one of them.
People who live in places like Summit County already know this. The simple reality is that our state is big, our cities and towns are spread out and small populations can't support the full range of complete, modern health care on their own. We can't change those basic facts, but we can address the structural problems in our health-insurance system that make an already difficult situation much worse.
Amendment 69 (ColoradoCare) is our best chance at fixing what's broken.
Take insurance companies' provider networks. Those deals create problems that are particularly acute in rural areas. Even if you're insured, and even if your area is blessed with a surplus of doctors, it doesn't mean you can see them. Perhaps only one will be in the provider network you have access to. In big cities, the problem isn't as bad because of the number of providers nearby. But, in rural areas, the nearest in-network provider might be very far away.
If the insurance companies involved allow it, you might be able to see someone else. But you'll pay dearly for it, not least because you'll experience the timeless joy of claims fights and paperwork involving more than one insurer. If you can't quite afford insurance, or if you're on Medicaid, best of luck.
The situation isn't good for providers, either. Especially in rural areas, the administrative burden of dealing with a bunch of different insurance plans is heavy. If you're a doctor or a clinic in a small town, supporting one more insurance plan — and spending time and money on the negotiations and staff to make that possible — might only result in a handful of new patients who could never cover the expense.
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We can't really blame insurance companies for this. They're a product of the convoluted laws that define how our health-insurance system works.
We can't blame providers either: They're doing what they can, and many go above and beyond the call of duty to find ways of providing care to the underserved. Often, they simply eat the costs.
We can and should blame the way our health-insurance system is set up, though, and the good news is that we can vote to overhaul it in November. ColoradoCare does away with the mind-boggling bureaucratic complexity of insurance by covering everybody and simplifying how we pay for health care. As a result, doctors and clinics won't have to spend half their time figuring out how to care for their neighbors in spite of the system we have now.
As sensible as that sounds, it would be revolutionary for rural Colorado because it would ensure that everyone is a potential customer for the doctors in their area, and that nobody will be looked at as a liability. Since ColoradoCare works like Medicare, it spells the end of special deals, networks and other acrobatic maneuvers insurance companies perform to slice up the market just how they like it. Rural patients will enjoy better access, and rural providers can spend less time and money jumping through hoops.
We shouldn't pretend that the transition to a system like ColoradoCare will be easy. Nor should we pretend that it will completely solve the issues inherent to providing comprehensive care in rural areas. But a vote for ColoradoCare (Amendment 69) is a vote for a meaningful change in the right direction — finally! — rather than another patch on a system that doesn't work for rural communities.
Erik Nesse is a Colorado native, doctoral student at the University of Colorado and former health-policy researcher.
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