GLENWOOD SPRINGS — Garfield County residents likely are in for sticker shock next month, when the federally mandated Affordable Care Act begins to go into effect.
The shock, however, is not due to the ACA itself, but to the manner in which it is being implemented in Colorado, and in particular the manner in which it will affect several counties on the Western Slope.
The ACA, the national health care reform policy sometimes referred to as Obamacare, begins going into effect for the masses on Oct. 1, and is meant to lower health care costs for consumers and provide coverage for uninsured Americans, among other intended effects. Oct. 1 is when states are to begin signing people up to the health insurance exchanges, a kind of insurance marketplace that many states are creating in response to the ACA’s mandate that all individuals be covered in advance of the Jan. 1, 2014, official rollout of the ACA.
Colorado’s exchange is called Connect for Health Colorado, and information about the exchange and about how residents can sign up for the ACA are available on the website of the Department of Regulatory Agencies (www.dora.state.co.us). Click on the Insurance Division link and then on the “New Health Insurance Plans/Rates for 2014” link to get to the Division of Insurance pages concerning the ACA.
Resort rating area
The plan for Colorado, which is not subject to immediate federal oversight, carves the state up into 11 “Rating Areas” that contain one or more counties.
According to a map on the state division of insurance website, Garfield County has been placed in Rating Area 11, lumped in with three wealthy neighboring counties — Pitkin, Eagle and Summit — with the result that insurance premiums here will be as much as twice as high as in other parts of the state that are arguably more similar to Garfield County than the resort areas in terms of income, cost of living and other attributes.
No information was immediately available to show how the health insurance premiums envisioned by Connect for Health Colorado compare to existing premium levels around the state.
One Glenwood Springs resident, former Valley View Hospital insurance negotiator Jim Markuson, wrote to Jo Donlin of the Colorado Insurance Commission to complain about the inclusion of Garfield County in Rating Area 11.
“We feel there is no justification for including Garfield County with Pitk+in, Eagle and Summit counties,” Markuson wrote to Donlin. “Not too many second homes in this county as compared to the other three. This is blue collar country and, in fact, is a bedroom community for Aspen/Basalt.”
Calling the Connect for Health plan “terribly unfair for middle class residents,” Markuson noted that the plan as outlined might be “fine for people below 400 percent of poverty,” which he said is a trigger level for caps on premiums.
But, he said, “There is no relief for middle income people needing individual insurance or insurance through a small employer. They will be the real victims of the Resort area geographic rating.”
He maintained that a system of rating areas suggested by the federal ACA managers would have been “a reasonable plan” compared to the one drawn up by the Colorado Division of Insurance.
Where Garfield County is being treated as a “resort” county, others on the Western Slope are not.
For example, Mesa County, which is more similar to much of Garfield County than the three resort counties, is in its own category, known as Rating Area 5, based on the Mesa County metropolitan statistical area.
And Rating Area 10, known on the insurance commission’s map as “West,” combines the northwestern corner of the state, including Rio Blanco, Moffatt, Routt, Jackson and Grand counties, with the southwestern part of the state, including Montezuma, La Plata, Archuleta, Hinsdale, San Juan, Dolores, San Miguel, Montrose, Delta, Gunnison, Lake and Ouray counties.
Rating Area 10, with its a total of a dozen counties, including some of the poorest in the state as well as some not-so-poor, is actually cut in half by Rating Area 11, the one including Garfield County.
The only similarly sized Rating Area in Colorado is Rating Area 8, which covers the entire southeastern portion of the state, from Conejos County northward to Mineral, Saguache and Chaffee counties at the area’s western edge, and from Baca County in the southwest corner of the state northward to Cheyenne County.
All together, Rating Area 8 encompasses 21 counties, also including some of the poorer areas of the state.
According to the insurance commission website, monthly premiums across the state are expected to span a range from $135.57 for “catastrophic” coverage of a 27-year-old non-smoker, to approximately $1,000 at the highest level of premium payments.
Within those extremes, coverage and premiums differ according to many variables, including whether an applicant qualifies for federal subsidies intended to keep insurance costs as low as possible, and the rating area where they reside. Insurance plans under this regime generally are divided into metallic levels — bronze, the lowest coverage level, followed by silver, gold and platinum.
A chart on the website shows that, in Garfield County, insurance premiums for policies at the bronze level, which are part of Connect for Health Colorado, will cost from a low of approximately $349 per month to a high of roughly $524 per month for a 40-year-old non-smoker.
In Rating Areas 1, 2 or 3, which cover Boulder, Denver and Colorado Springs, premiums for the same coverage are to range from $198.23 to $356.45 per month (Boulder), $203.41 to $311.50 (Denver) and $206.69 to $330.85 (Colorado Springs,).
One peculiarity of the map of rating areas is the fact that some ski areas, including Steamboat Springs, Winter Park, Crested Butte and Telluride, are not included in the Rating Area 11 —the “Resort” category. Instead, they are either in rates areas where premiums are consistently lower than in the Resort area.
A DORA spokesman, Communications Manager Vincent Plymell, said the decision to break the state up into 11 rate areas was made in late 2012, and that the rate levels are to be reviewed every year, with rate increases to be capped in 2015 and later.
When asked to comment about whether the 2014 rating year will establish a “baseline” for insurance premium levels, and that some observers are concerned that rates in the resort category of counties may rise by 30 percent or more before Jan. 1, Plymell said he would have to get back to the Post Independent with further information.