health insurance

The Tri-County Health team, in an image taken at the Building Better Health Conference, a kickoff meeting for open enrollment last October. From left to right: Lily Kiely (Telluride), Alexis Klein (Telluride), Carol Schutter (Ouray) and Erich Lange. Members not pictured include Skitter Jones (West End), Marlen Olivas Romero (Telluride) and Angela Bullard (Delta). (Courtesy photo)

Most people get their health insurance through their employer(s). The fate of their coverage is not in doubt.

If you have purchased insurance through the Affordable Care Act (ACA), however — aka ‘Obamacare’ — you can be forgiven for questioning whether your insurance is about to be repealed.

Indeed, you may have been wondering about that for the past two years.

So far, the Trump administration has failed to “repeal and replace” Obamacare, but that hasn’t stopped the president from bringing up the idea repeatedly. And a month ago, the Justice Department took what many say has amounted to the administration’s most significant attempt to dismantle the ACA: It announced its intention to support a decision by U.S. District Judge Reed O’Connor, of Texas, who last December ruled the ACA completely unconstitutional.

O’Connor’s ruling is under appeal. But if his decision stands, 20 million people across the U.S. stand to lose their health insurance, including 170,000 Coloradans. (An additional 400,000 Coloradans would lose their Medicaid coverage.)

Montrose retiree David Swedlow, 64, is one of those people.

“I had this outrageously expensive health-insurance policy. The cost kept going up and up,” Swedlow recalled. “It got to the point where there was just no way I could afford it anymore. I was paying close to $1,300 a month.”

A friend told Swedlow about Connect for Colorado, the state’s health insurance marketplace, and put him in touch with Alicia Plantz, a health coverage guide who assisted him in applying for a much-less-costly policy. He’s now had an Obamacare policy for several years — ever since the plans have been in existence. “I had terrific help picking out my plan and I’ve been pleased with it,” Swedlow said. “Because of my low income, I was able to qualify for an affordable policy. It helps you rest at night, knowing you’re covered for any major anything.”

Swedlow is not alone. Health insurance rates on the Western Slope are some of the highest in the state, but for those who qualify — and most do — Obamacare offers financial relief in the form of tax credits, which makes the coverage much more affordable. The good news is the coverage has gotten less expensive. According to Connect for Health’s most recent statistics, premiums are down an average of 14 percent compared to last year, “and many rural and frontier counties saw an even greater decrease.”

What’s more, enrollment in the San Juans is on the rise. San Miguel County has the highest percentage of Obamacare policyholders in the state (12 percent of the population is enrolled), and the typical monthly premium is $74. In Ouray County, which has the third-highest percentage of enrollees (10 percent own an Obamacare plan), the average premium there is $67.

Over the past few years, the ACA has become increasingly popular not only on the Western Slope, but across the U.S. According to a new study from the Kaiser Family Foundation, 50 percent of the public now supports the law and 39 percent are opposed (the positive percentages are even higher when it comes to protecting preexisting conditions and allowing children to stay on their parents’ policies until age 26).

“We’ve solidified our marketplace, and ratcheted up the numbers of people enrolled,” said Erich Lange, community programs manager of Tri-County Health Network, “and it kind of shows. We’ve been hitting the streets, educating the community through word of mouth, and by speaking with representatives from community organizations and medical centers. We do this year after year, because people have to re-enroll.”

An April 16 report from the Commonwealth Fund found Colorado has one of the top three health insurance marketplaces in the country, with 2019 enrollments up 5.3 percent on average compared to 2018 (only Massachusetts and New York are higher).

“The thing that’s exciting about the marketplace is, we can help a lot of people,” said Linda Gann, Connect for Colorado’s senior manager for the Western Slope.

People like a 60-year-old Montrose woman who wished to remain anonymous “because it is so deeply personal for us, how much having Obamacare has meant.”

She did want to share how much help the coverage has been, though. “My husband had colon cancer, and I had breast cancer” over the past few years, she recalled, “and we’ve had an overwhelming number of medical bills. They would have been life changing without this insurance. I know a gentleman from Ridgway who tore his shoulder, but because he didn’t sign up for Obamacare, he put off having surgery. I’m glad I didn’t have to put off a mammogram, which was how my breast cancer was diagnosed. I had one bill from the radiology oncologist for $56,000. These are numbers that are inconceivable to pay off” without good coverage.

STILL EXPENSIVE FOR SOME

The ACA may be able to help a lot of people, but as Gann pointed out, “We can’t help everybody yet.”

As it is, about 25 percent of enrollees do not qualify for tax credits (those who earn $49,001 or more annually). That’s why Gann is enthusiastic about House Bill 19-1004, which recently passed both the House and the Senate in Colorado “and the governor has expressed delight in signing it into law.”

The bill would require the Colorado Division of Insurance and Healthcare Policy Financing to study a so-called “public option” for insurance. “It’s just a study, but it will happen right away, and the findings could be available later this year,” Gann said. “A public option can mean a lot of things. It could mean buying into the State of Colorado’s employee health plan, or maybe into our state’s Medicaid plan, or perhaps some combination of the two. The reason I think it’s so important is that this is a bipartisan bill. Our own Marc Catlin, a Republican from House Distrcit 58, was a sponsor. He’s on record that we have to do something to make insurance affordable for everybody. It’s not something his caucus has supported in the past. This is the next step in the progression to help everybody, especially people in rural areas.”

A new initiative in Summit County — another rural community where health costs are especially high— seeks to pool the purchasing power of the county’s largest employers in order to negotiate better rates with providers. The collaborative is set to launch in 2020, according to a Summit Daily newspaper article that said the new alliance “could drive down health care costs — for real this time.” If the collaboration is successful, small employers and individuals will be invited to purchase health insurance through it, as well.

The new initiatives hold much promise, but the question remains: What about the Texas lawsuit? If it is upheld, might those with ACA policies lose them immediately?

Gann thinks not: “We’re well past repeal-and-replace,” she said. “We’re moving forward to see what we can add to that. Connect for Colorado’s board rarely makes statements, but we’re in public support of Bill 1004.”

In the meantime, she added, “the ACA remains the law of the land, and Colorado is one of the most effective implementers” of the law in this country.

Indeed, on Jan. 31, Colorado joined other states in defending the Affordable Care Act in the Texas lawsuit, which is now before the U.S. Court of the Appeals for the Fifth Circuit.

“The U.S. Department of Justice is refusing to defend an important federal law and is working to undermine access to health care,” Attorney General Phil Weiser explained of the state’s decision to defend the ACA. “Given that Congress refused to repeal the ACA, it is wrong of the Justice Department to ask a court to invalidate the law. The lower court decision (in Texas last December) doing just that is incorrect. I will fight to overturn it, working hard to protect Coloradans’ access to health care.”

On Friday, at a campaign rally in Indianapolis, President Trump praised his administration’s success in eliminating the ACA’s individual mandate. He added, “Now we’re going for the rest.”

Katie Keith, who teaches courses on the Affordable Care Act at Georgetown University Law Center and follows health insurance law closely, said she worries such statements may not only frighten people who own ACA policies, but confuse others who may decide, “If the law’s about to be overturned, maybe I shouldn’t bother to pay my premiums.”

“The irony is the marketplaces are more stable than they’ve ever been. And yet this is all more confusing than ever,” she said. “You really can’t blame folks for not understanding what is happening.”

The bottom line, according to Keith: “People should pay their premiums and expect that their claims will be paid and that their insurance will stay in place probably until the Supreme Court says otherwise, and a decision like that is certainly not coming this year.”

In other words — no matter what politicians may say — not only will you not lose your insurance this year, you’ll have an opportunity to re-enroll yet again this winter for coverage in 2020.

“It’s important to understand that it will be many months, if not another year, before we know the final fate of the ACA, and in the meantime, things are more stable than before so there’s no need to worry about it,” Keith said. “Setting aside what the president has said, the agencies that implement the ACA have been clear, and have said multiple times, that they’re going to enforce the law as long as it’s the law of the land, which is the most normal position for them to take.”

As for how much premiums will rise next year, that won’t be known until later this summer.

What’s also not known is how many carriers will be offering insurance. Although several carriers — including Rocky Mountain Health Plans, Humana and Cigna — used to offer ACA plans in the San Juans, today only Anthem Blue Cross Blue Shield remains.

“They’ve been the sole insurer for the past couple of years,” Erich Lange said. Here, too, there is a bit of good news. “They’re not required to stay in the marketplace, but there’s no indication that they’ll be pulling out, and we’d be the first ones to know” if they were, Lange went on. “There’ll be some minor changes with their policies, plans and deductibles, but for the most part,” the plans on offer for 2020 “will be similar to what you could purchase last year.”

Lange suggests calling an insurance navigator who can help you make sense of the marketplace. Anthem may be the only insurer offering on the state’s health exchange, he pointed out, but it offers about 14 different plans.

“Our assistance is entirely free and we’re able to deploy our team to help you,” Lange said. “If someone needs to meet after 5 p.m., or on a Saturday, we can do that and make it as easy as possible.”

To locate a health insurance navigator or for any other type of assistance involving an ACA plan, visit connectforhealthco.com/person-help/.