Health insurance enrollment climbs in Northwest Colorado, and in state | CraigDailyPress.com
Michael Neary

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Health insurance enrollment climbs in Northwest Colorado, and in state

Northwest Colorado still trails rest of state in rates of enrollment

Curtis Ellgen, 24, graduated from Brigham Young University—Idaho in December, and then he returned to work on the family ranch in Moffat County. He lives there with his wife, Amber, and their 2-month-old daughter, Payton.

Craig — On a cold and sun-scorched morning, Curtis Ellgen was up early, as usual, feeding cows and tending to the ranch where he lives with his wife, Amber, and their 2-month-old daughter, Payton. Ellgen graduated from Brigham Young University – Idaho in December with a bachelor of science degree in mechanical engineering. But he felt called to return to the ranch in Moffat County where he grew up. — On a cold and sun-scorched morning, Curtis Ellgen was up early, as usual, feeding cows and tending to the ranch where he lives with his wife, Amber, and their 2-month-old daughter, Payton. Ellgen graduated from Brigham Young University – Idaho in December with a bachelor of science degree in mechanical engineering. But he felt called to return to the ranch in Moffat County where he grew up.

— On a cold and sun-scorched morning, Curtis Ellgen was up early, as usual, feeding cows and tending to the ranch where he lives with his wife, Amber, and their 2-month-old daughter, Payton. Ellgen graduated from Brigham Young University – Idaho in December with a bachelor of science degree in mechanical engineering. But he felt called to return to the ranch in Moffat County where he grew up.

"I like being outside a lot," said Ellgen. "I don't want to be stuck in an office."

Now, with the help of his uncle, Ellgen is working on the family ranch, about 10 miles southwest of Craig.

"He's showing me the ropes," Ellgen said.

Ellgen noted that, as someone who's self-employed, he needed to find insurance on his own rather than through an employer. So he went online and learned about Greg Neal, a certified broker in Craig for Connect for Health Colorado. He ended up purchasing health insurance for himself and his family, a process he said would have been tough to navigate on his own.

"It does help to have a broker help you through it," he said. "It's not first-time user-friendly."

Ellgen, who is 24, is eligible under the Affordable Care Act to use his parents' insurance policy, but he opted for his own plan.

"Now that I'm on my own, and out of school, I just wanted to get my own plan figured out," he said. "Being married, I figured it was better to get our own plan together."

More people insured in Northwest Colorado

More people are carrying health insurance in Northwest Colorado, even though the rate of those uninsured remains comparatively high in this part of the state.

In Garfield, Routt, Moffat and Rio Blanco counties, 18.2 percent of the population lacked health insurance in 2014 — compared with 22.8 percent who went without health insurance in 2012. Those numbers come from the Colorado Health Institute's analysis of the American Community Survey, and they continue a trend that's been building over the past several years.

In Colorado, the rate of uninsured was 10.6 percent in 2014, compared to 14.4 percent in 2012.

The increase in people with insurance flows largely from higher numbers of residents enrolled in Medicaid, but Connect for Health Colorado officials also report higher numbers of people who, like Ellgen, enrolled in private insurance through the Affordable Care Act marketplace this year.

In Moffat County, 237 people enrolled between Nov. 15, 2014 and Feb. 15, 2015, compared with 196 during a similar period last year. That's an increase of 21 percent. Neighboring counties saw even larger enrollment increases: Routt County's enrollments rose by 25 percent, and Rio Blanco's enrollments nearly doubled, rising by 81 percent.

In addition to Neal, medical staff members throughout the area have been helping people sign up for insurance through the Affordable Care Act. The Northwest Colorado Visiting Nurse Association, for instance, has five staff members who serve as health coverage guides, said Janie Dunckley, director of business development. Dunckley said the Northwest Colorado VNA receives a grant from Connect for Health Colorado that helps fund the work.

Effect on health care

Charity Neal, director of public health for the Northwest Colorado Visiting Nurse Association, said the increasing rates of insured residents are showing some effects — especially when it comes to seeking out primary care.

"I think people are starting to seek primary care more often," said Charity Neal, the wife of Greg Neal.

Charity Neal also noted that the presence of federally qualified health centers allows people to receive primary care regardless of their ability to pay. In Craig, the VNA's Community Health Center is federally qualified.

But insurance can make a difference — even with the presence of such a health center, Charity Neal said.

"People are more open to receiving services when they have that feeling of qualification," she said. "It's helped to remove some of that stigma."

Charity Neal emphasized, too, that a federally qualified health center such as the VNA's only provides primary care.

"The expansion of Medicaid and the increase in insured individuals … have allowed people better access to specialty care," she said, but she added a caution.

"In the Medicaid world we're still running into challenges with providers that will accept Medicaid in the specialty realm," she said. "People are having to go further and further for specialty care on Medicaid."

Jennifer Riley, chief of marketing and business development at The Memorial Hospital, in Craig, noted an increasing number of Medicaid patients seeking services.

"We've seen movement from private-pay individuals (those with no insurance) to Medicaid patients," Riley said in an email. "Although our reimbursement from Medicaid is not as high as it is from other payers, it's some reimbursement."

Charity Neal described, too, the way that good health ranges beyond immediate doctor's visits.

"Just being able to go to the doctor may not be addressing what's keeping me from my best health," she said. "It may be that there's not adequate sidewalks for me to work on. It may be that I have food insecurity; I'm not sure where my next meal is coming from. Those are things that just going to the doctor don't fix."

She said that the VNA and other organizations are working with primary care providers to encourage patients to seek out broader health strategies.

"When (primary care providers) are seeing people for wellness visits, they're referring them to walking groups and talking with them about depression — about all these things that weren't classically done in the primary care office," Charity Neal said.

Wrestling with costs

Greg Neal said the larger fine for not having insurance this year has created an incentive for people to sign up.

For a single adult, the fine for 2016 is $695 or 2.5 percent of the income, according to healthcare.gov. Families pay an additional $347.50 per child, with a maximum penalty of $2,085.

The penalty is prorated by the month and kicks in once a person misses more than three months of coverage.

"People were planning to avoid that," Greg Neal said.

And avoiding costs is a prime reason that many people have refrained from buying insurance in the first place.

Joe Hanel, a communications expert with Colorado Health Institute, an organization that tracks rates of insurance coverage in the state, said the primary reason people tend to forgo health insurance — cost — is more pressing in western Colorado.

"Insurance is more expensive in western Colorado, and there's less competition," Hanel said, noting that there are fewer and smaller insurance companies in this part of the state.

Hanel said that people in western Colorado are also more likely to buy insurance on their own rather than through an employer since the area harbors fewer large employers offering health insurance.

Greg Neal said the subsidies offered through the Affordable Care Act have been effective for people, so long as they were able to discover that they existed.

"Once the word of mouth got out about the subsidies in the last few years, it helped accelerate enrollments," he said.

Greg Neal said the majority of people he worked with found the insurance to be affordable with the subsidy, but he also noted that deciding on the best plan — and the best way to take advantage of the possible subsidies offered — generally required outside help.

That need, he explained, is what motivated him to become a certified Connect for Health Colorado broker when the first round of enrollments began under the Affordable Care Act in 2013.

"I knew people would need help navigating that system," he said, "because it's not an easy system."

The deadline for most people to buy insurance through Connect for Health Colorado has passed, but Greg Neal — along with others in the community — continues to work with people eligible to sign up because they experienced major life changes such as moving into the state or changing jobs.

Medicaid Enrollment

Moffat County

1,944 (October 2012)

3,763 (October 2015)

Routt County

1,483 (October 2012)

3,867 (October 2015)

Rio Blanco County

788 (October 2012)

1,194 (October 2015)

Colorado (state)

650,605 (October 2012)

1,272,951 (October 2015)

Those statistics, conveyed by the Colorado Health Institute, come from the Colorado Department of Health Care Policy and Financing. Colorado was among the states that expanded Medicaid under the Affordable Care Act, tapping federal funding to do so.