GLENWOOD SPRINGS — State insurance officials said on Wednesday that they will see if Garfield County can be severed from a special health-care reform classification known as the “Resort Area,” as a way of trimming the county’s anticipated health insurance premiums under the federal Patient Protection and Affordable Care Act (ACA).
One official conceded that the residents of Garfield County may be justified in feeling they have been unfairly lumped in with the wealthier residents of three neighboring resort counties.
Another said projected insurance premiums for Garfield County residents could drop by nearly a third if Garfield County were to be grouped with other, similar counties on the Western Slope, instead of with the resort counties.
Colorado Insurance Commissioner Marguerite Salazar said on Wednesday that she and others in the Division of Insurance have been operating with information supplied by the insurance industry, but checked by the division’s own experts, in setting up the 11 different “geographical rating areas” that largely define the implementation of the ACA in this state.
The system, as devised, places Garfield County in Rating Area 11, the same rate-setting area as Pitkin, Eagle and Summit counties, despite sharp socioeconomic differences between Garfield County and the other three.
As it stands, insurance premiums for Garfield and the other three counties are expected to be anywhere from 30 percent to nearly 50 percent higher than premiums for the residents of, say, Mesa County, despite similarities in the economic status and actual health-care claims histories between Garfield and Mesa counties.
In addition, Garfield County residents’ insurance premiums could be as much as 70 percent higher than premiums for those living in other parts of the state, despite the fact that Garfield County’s health-care cost histories are far lower than those of residents of other areas.
For example, according to the Colorado All Payer Claims Database (CAPCD) the average cost of total care by commercially insured patents in Garfield County was $2,954 in 2011, the year that the database was compiled.
But in Cheyenne County, which is in the lower-cost Rating Area 8 encompassing southeastern Colorado, the actual average cost of per-patient care in 2011 was $3,572, or $618 higher than the costs in Garfield County — a difference of 20 percent.
According to the Connect for Health Colorado website, designed as the state’s marketplace for insurance plans under the ACA, residents of Cheyenne County will pay much lower premiums for insurance plans than residents of Garfield County. For the lowest-cost plan on the site, the Bronze plan, a 27-year old individual’s monthly premium would range from $286 to $430 in Garfield County, and from $195 to $311 for the same plan in Cheyenne County.
Salazar said the calculations that have gone into setting up the ACA’s insurance marketplace were meant to set premiums based on actual health care costs averaged out over however many counties comprise a rate-setting area, and that the data used in those calculations came from the CAPCD (at www.cohealthdata.org on the Internet.) Socioeconomic factors were not used, she said.
“I agree, Garfield County doesn’t have the same costs,” Salazar said on Wednesday, referring to a comparison of this county with Pitkin County, where the average annual cost of health care is $4,000 per resident but premiums would be the same as for Garfield County.
In other Western Slope counties such as La Plata and Montezuma in the southwestern corner of the state, average health care costs are $3,043 and $2,833, respectively, or close to the costs listed for Garfield County.
The expected monthly premiums for residents of La Plata and Montezuma counties, which are in Rating Area 10 covering most of the Western Slope, would range from $228 to $385 for the Bronze plan, considerably lower than the premium rates for Garfield County.
But the idea of moving Garfield into Rating Area 10, which encompasses most of the other semi-rural counties on the Western Slope, would be a complicated and difficult thing to do, she said, in part because shifting Garfield County from one area to the other would affect the premiums paid by residents in those areas.
According to Tom Abel, a supervisor in the insurance division, if Garfield County were shifted to Rating Area 10, the premiums for all residents in Area 10 would immediately rise by roughly 1 percent, while the premiums in Area 11 would rise by approximately 6 percent. Premiums in Garfield County, he said, would decrease by about 29 percent.
“We have to look at it really closely,” said Salazar, referring to the idea of shifting Garfield County to Area 10, noting that the presence of Garfield County in Area 11 keeps the premiums lower for the other three counties, which would not be happy to learn of Garfield County’s defection.
“Raising [rates] for Summit and Pitkin,” she remarked, “they’re already yelling at us.”
And even given Garfield County’s unhappiness at being lumped in the resort category, Salazar said, the new insurance plans offered under the ACA “really do have benefits that they’ve never had before,” such as a prohibition against denying coverage because of pre-existing conditions, or raising premiums after a policy holder gets sick.