Affordable Care Act: Helping or hurting Northwest Colorado?
November 21, 2014
With all the political charge behind the Affordable Care Act, it can be hard to sort out the facts. And with it now entering only its second year of implementation, it can be harder still to tell how it's benefiting Americans.
State of the uninsured
In 2013, the year before the ACA was first implemented, Northwest Colorado had the highest rates of uninsured people in the state, according to the Colorado Health Institute's Colorado Health Access Survey.
"The northwest corner of the state has the highest percentage of residents without coverage at 24.8 percent, meaning that one of four people is without health insurance," the Colorado Health Institute said in a report summarizing data from the 2013 Colorado Health Access Survey.
Colorado demarcated areas for data comparison called health statistics regions. The data above describes HSR 11, which includes Moffat, Routt, Rio Blanco and Jackson counties.
With a population of 46,198 in 2013, according to CHI, this equates to more than 11,450 people without health insurance. What's more, 57 percent of these people have been uninsured for three or more years, according to CHAS.
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"People who are chronically uninsured often receive less preventative care, receive fewer early detection services and experience more complications from chronic conditions," according to a CHAS report.
In 2013, 82 percent of Coloradans surveyed cited high cost as their reason for not having health insurance, by far the most common reason reported. Lost coverage due to a change in life circumstances, such as a job loss, was the second most common reason.
"The percentage of uninsured Coloradans who say they don't have health insurance because they don't need it more than doubled between 2009 and 2013, increasing from 11.1 percent to 24.9 percent, the most dramatic change among the reasons cited."
Northwest Colorado has some of the highest numbers of uninsured residents who said they don't need health insurance, falling into the more than 30 percent category on a map prepared by CHI.
Gisela Garrison, Community Health Center director for the Northwest Colorado Visiting Nurse Association, cited lack of knowledge and reluctance as two of the biggest reasons she sees for the high numbers of uninsured residents in the region.
"The Western way of being self-sufficient, of not wanting to have anybody look into your business, how much money you make, how many kids you have," is why Garrison thinks many people do not take advantage of public programs like Medicaid and Child Health Plan Plus, as well as the new health insurance marketplace.
She has observed that many people prefer to rely on their church community to take care of them when they’re sick rather than the state.
Data revealed through the CHAS confirms that beliefs regarding health care are different in rural areas than urban areas.
"Living in rural, more isolated areas appears to influence feelings about the system," according to a CHAS report.
The truth behind the numbers
There has been some confusion based on various statistics released this year as to whether premiums are going up or down for residents of Northwest Colorado.
Part of the source of the confusion is that Colorado's Department of Insurance redrew the boundaries that determine how premiums are priced.
"For 2015, DOI realigned the geographic areas in the state, consolidating the higher health cost regions into larger rating areas. Geographic rating areas are used by insurance carriers to price premiums," according to a press release from the Colorado Department of Regulatory Agencies. "For 2015, individual plans in the West rating area, which includes the mountain areas, but not Mesa County, will see average premium decrease of 7.44 percent."
Across Colorado, plan premiums will increase an average of 1.18 percent over 2014 rates, according to DORA.
Erin Gleason, community health insurance coordinator for the VNA, explained that the region with the highest health insurance premiums in the nation for 2014 — Garfield, Pitkin, Eagle and Summit counties, which includes the ski resort towns of Aspen and Vail — now has been lumped with the West rating area, which includes Northwest Colorado.
"Now that we're joining with them, our rates are going up," Gleason said.
For a 40-year-old non-smoker in Craig, the lowest cost bronze and silver plans on Connect for Health Colorado, the statewide health insurance marketplace, remained almost exactly the same price for 2014 and 2015 — approximately $309 and $350 per month, respectively.
However if you compare the standard silver-level plan with the biggest individual insurer in the area, Rocky Mountain Health Plans, there was a nearly 40 percent jump in the premium from $349.03 in 2014 to $485.22 in 2015, according to Gleason.
"This is due to the rating area changes," Gleason explained. "However, there are cheaper options for consumers if they are willing to exclude providers in Eagle, Garfield, Pitkin and Summit counties."
She emphasizes that under the new health insurance system, people need to re-evaluate their plans every year during the open enrollment period, which began Nov. 15 and will end Feb. 15.
"We need to be doing this every single year and re-evaluate because it is a competitive marketplace," Gleason said. "Keep in mind they come out with new plans every year, so this might not be the best plan this year as opposed to last year."
More questions than answers
Overall, the number of insured is increasing, with about 10 million people nationwide signing up for insurance for 2014 who were previously uninsured, according to a New York Times article published Oct. 29. The uninsured rate decreased to 11.3 percent nationwide in 2014 from 16.4 percent the year before.
In Moffat County, The New York Times reported that uninsured rates saw more than a 10-point decrease, from 18 percent uninsured in 2013 to 8 percent in 2014.
The Affordable Care Act will need more years under its belt before anyone can make any clear calls about its effectiveness, and regardless, getting people insured is not the end of the story.
Access to health care in rural areas, especially specialty care and especially for the increasing number of Medicaid patients, will continue to pose challenges to those working to get people the health care they need.
"It's a much more complex issue than just having insurance," Garrison said. "Having insurance does not automatically mean you have access to whatever you need. It's not an even equation."
Contact Lauren Blair at 970-875-1794 or lblair@CraigDailyPress.com.