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Colorado health insurance rates are set to fall dramatically next year — for some. Here’s what that means for you.

From premium decreases to local purchasing alliances to carrier departures, there’s a lot going on with Colorado health coverage right now

  • Credibility:

Gov. Jared Polis on Thursday stood proudly in the Capitol’s west foyer next to an easel shrouded in a black sheet and announced something no Colorado governor has since the implementation of the Affordable Care Act.

“It’s the first time in the history of the health exchange that rates are going down!” he declared.

And, with that, a staffer pulled the sheet off for the reveal: A 20.2%  average statewide decline in health insurance premium prices next year for a significant slice of the market.

The drop is one of the most tangible accomplishments of Polis’ administration so far, and it’s due largely to the state’s new reinsurance program, in which the state takes money collected from hospitals and other sources and gives it to insurers to help them pay their more-expensive claims.    

There’s also some bad news. People in 22 counties will have only one company to choose from when they go shopping for plans on the state’s insurance exchange next year — up from 14 counties this year and a blow to Polis’ efforts to increase health care options across the state.

And there’s plenty of other things going on as we barrel toward the open enrollment window for next year’s plans, which opens on Nov. 1.

Here’s what Thursday’s announcement may mean for you.

The website for Connect for Health Colorado, the state’s health insurance exchange, shown in October 2018. (Eric Lubbers, The Colorado Sun)

Do you buy insurance on your own?

Are you self-employed or do you not get insurance coverage through your job? Then you are shopping for insurance in the so-called individual market, which covers about 7% of the state’s population. And that makes Thursday’s announcement likely good news for you — maybe even really good news.

The 20.2 percent decrease in premiums for 2020 plans applies only to the individual market. If you are a young person buying coverage just for yourself, it probably translates to a few hundred extra dollars a year for you. If you are a family of four, it could translate to thousands — and maybe even more than $10,000 — in savings, depending on where you live. (The biggest savings will be on the Western Slope.)

These are premium prices, though — in other words, what you pay just to have insurance. Deductibles, those things you have to pay before insurance really kicks in and that, themselves, have become a barrier to care, aren’t decreasing.

Do you live on the Western Slope or Eastern Plains?

You could potentially have fewer choices if you’re shopping in the individual market.

If you live in (deep breath) Logan, Phillips, Segdwick, Washington, Yuma, Dolores, Eagle, Garfield, Grand, Gunnison, Hinsdale, Jackson, Lake, Moffat, Montezuma, Montrose, Ouray, Pitkin, Rio Blanco, Routt, San Juan or San Miguel counties, you will have only one company to choose from when shopping on Connect for Health Colorado, the state’s insurance exchange. That’s 22 counties in total, up from the 14 counties with only one carrier in the current year.

That increase is a bit misleading — in most of those counties that are losing an insurer for next year, the departing insurer offered plans in the counties this year but didn’t have anyone signed up. But in Eagle County, for instance, people currently covered with Kaiser Permanente will need to go shopping for a new carrier.

The problem of too many counties with too few insurers has people looking for a different model to provide coverage. (More on that below.)

Colorado Gov. Jared Polis speaks on Feb. 1, 2019, at a town hall meeting in Frisco about the high cost of health care in Colorado’s mountain communities. (John Ingold, The Colorado Sun)

Do you get coverage through your employer?

Are you like roughly half of all Coloradans and receive coverage that is provided by the company you work for? Then you’re not going to see any direct impact from these rate decreases. (It’s partly a function of lawmakers’ disproportionate focus on the individual market.)

But Polis said these rate decreases may help you, in a roundabout way. If cheaper premiums cause more people to sign up for insurance, then fewer people will receive medical care while being uninsured, he said. And if doctors, nurses and hospitals are treating fewer uninsured people, he said, they have less reason to push the costs of the care onto people with insurance.

“Thoughtful policy changes and hard work can reduce costs,” he said. Polis did not make any projections about how much people with employer coverage might save because of this dynamic.

Do you not have insurance?

Are you among the estimated 6.5% of Coloradans without insurance? State officials are hoping the lower premiums for next year will entice you to purchase coverage.

The state has estimated that, with these kind of premium reductions, there will be about a 3% increase in the number of people purchasing plans in the individual market next year. What that translates to in terms of a decrease in the uninsured rate is unclear, though.

But Polis made this vow Thursday: “There will be a decrease in the number of uninsured in our state.”

The next Colorado Health Access Survey, the gold standard for measuring the uninsured rate, doesn’t come out until 2021. 

St. Anthony Summit Medical Center (Courtesy of Centura Health)

Do you live in a mountain resort community (or close to one)?

Do you count yourself as a resident of Summit, Eagle, Grand, Archuleta, Dolores, La Plata, San Juan, Montezuma or Pitkin county? Then you may have a brand new way of negotiating health prices and buying insurance coming your way — one that the state hopes will drive down insurance prices even further.

Following the success of the Peak Health Alliance — which is poised to reduce health insurance prices for people in Summit County by more than 40% next year — more than a half-dozen other counties across the state have started looking at creating their own version of what the state calls a “community purchasing model.”

In this model, communities band together to directly negotiate prices with local doctors and hospitals. Then, with those (possibly lower) prices in hand, they ask insurance companies to bid for their business. The idea is that the community groups can deliver savings both to people buying coverage themselves but also to local employers.

Already, county government employees in Grand County will be included in the Peak Health Alliance for next year. Next year, officials in the southwestern counties of Archuleta, Dolores, La Plata, San Juan and Montezuma hope to build up an affiliate or affiliates of Peak that will have local leadership, Peak CEO Tamara Pogue-Drangstveit said.

“Peak is very much about empowering communities and purchasers in those communities to sit at the table and make decisions for themselves,” she said.

Meanwhile, leaders in Eagle County have launched the Mountain Healthcare Coalition, and folks in Pitkin County have the Valley Health Alliance.

And there could even be a statewide version. The Colorado Business Group on Health is in the process of amending its bylaws to allow it to become a purchasing alliance, said Robert Smith, the group’s executive director. Smith said a statewide alliance would be able to maximize employers’ leverage in the health care market and prevent community-by-community fragmentation.

It all means that you can expect more changes ahead.

“We,” said state Sen. Bob Rankin, a Republican from Carbondale, “have a lot more work to do.”

Rising Sun