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Why Colorado’s health insurance sign-up numbers look strong, even as the rest of the country struggles

Running its own insurance exchange protects the state from some of the national turmoil

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The conventional wisdom about how health insurance enrollment across the country would go this year went something like this: B-R-U-T-A-L.

Major Trump administration changes took effect that were likely to diminish people’s interest in buying plans through an insurance exchange. High prices continued to bedevil consumers. And national numbers so far bear these fears out: About 350,000 fewer people have signed up for insurance through the federal HealthCare.gov portal this year compared to the same period last year.

That’s what makes Colorado’s sign-up totals so surprising. They’re up. Not by a lot, but not by a little, either.

So why has Colorado thus far escaped the national slump? There’s at least one big reason worth understanding.

Just looking for open enrollment deadlines and other how-to info? Skip to the “What’s next” section.

The basics

First thing, we’re only talking about a small subset of the health insurance market here — people who don’t get insurance through an employer or through Medicare or Medicaid. This is the “individual” health insurance market, the people who buy plans on their own. It makes up about 8 percent of the total market in Colorado.

People in the individual market buy plans either through a health insurance broker or an online exchange. Most of the country uses the HealthCare.gov exchange, run by the federal government. Colorado is one of 12 states that runs its own exchange, free and clear of federal involvement. It’s called Connect for Health Colorado.

This all was created as a result of the Affordable Care Act, which also contained a mighty big hammer to drive health insurance sign-ups: It imposed a penalty on people without insurance. Last year, the penalty was $695 or 2.5 percent of your income, whichever was greater.

What Trump changed

The Trump Administration has been steadily whittling away at the Affordable Care Act — the law also known as Obamacare. It slashed funding for HealthCare.gov marketing and for organizations that help people sign up for coverage. It encouraged the use of short-term plans and other types of coverage not sold on the exchanges.

And, along with Republicans in Congress, it did away with the penalty for not having insurance. Starting in 2019, the fine is $0.

That last one could have been potentially significant for Colorado, where sky-high costs in some parts of the state provide ample incentive to skip coverage. But the penalty does appear to have been somewhat successful in nudging people to sign up, according to a recent Colorado Health Institute report. The report found that fewer Coloradans skipped having insurance as the penalty increased.

Why Colorado is different

Through November, consumers made 46,332 medical plan selections on Connect for Health Colorado — one plan selection, of course, can cover multiple people, such as a family. That’s nearly 6 percent more than the 43,881 plan selections made during November last year.

It’s too early to say whether it’s just an earlier crowd this year or if this represents real growth. But 15 percent of those signing up so far are new — not returning — customers.

Structurally, the main difference between Colorado and much of the rest of the country is that Colorado’s control over its own insurance exchange means it can largely opt out of the federal turmoil.

Connect for Health Colorado controls its own marketing and outreach budget, which it has been using for radio and social media ads and to support sign-up assistance centers. It made technical improvements to the website in the hopes of streamlining the sign-up process. It also found some extra money to help local organizations better serve their areas.

Kevin Patterson, Connect for Health’s CEO, gave an example of a health district in Larimer County. Because of its autonomy, Connect for Health was able to chip in some money to help the district reach out to consumers who live in the county but outside the health district’s boundaries — people who might otherwise not have gotten that kind of attention.

“I think it’s fair to say we’re able to target and market in a way that connects with our citizenry,” Patterson said.

What’s next

Open enrollment runs through Jan. 15. But to have insurance that starts on Jan. 1, 2019, you must sign up by Dec. 15.

If you don’t sign up during open enrollment, you’ll have to wait until open enrollment starts again next fall. The only exceptions are if you have a major life event — such as you lose your job or you have a baby. Then you get a special enrollment window to buy coverage.

Colorado insurance officials this year used a regulatory technique that resulted in the lowest price increases for health insurance on the individual market in years. If you are eligible to receive a tax credit to help pay for premiums (go to connectforhealthco.com to figure out if you are), Patterson said it’s likely you will be able to find plans for $50 a month or less. But, since those plans could come with high deductibles, it’s best to shop around.

If you’re not eligible for a tax credit, using an insurance broker may help you make the best choice. Connect for Health can help you find one.

Need in-person help? You can call Connect for Health at 1-855-752-6749. (Connect for Health styles that as 1-855-PLANS-4-YOU.) You can also use a live chat feature on the website. Connect for Health can also connect you with an enrollment center or a person certified to provide enrollment assistance.

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