ACA

The John Minor Wisdom U.S. Courthouse, home of the Fifth Circuit Court of Appeals, New Orleans, where a lawsuit challenging the constiutionality of the Affordable Care Act is being considered. (Public domain photo)

When the Watch surveyed the health-insurance landscape last spring, there were more questions than answers.

For example, would at least one carrier remain on the state’s health insurance exchange, selling Obamacare policies to Western Slope residents in time for re-enrollment this fall?

If so, would prices of policies be more expensive?

And what about Obamacare itself: might it be repealed altogether?

The answers, in order, are yes, no, and it’s still unclear.

The good news first: Colorado’s individual health insurance market is not only still up and running in the San Juans, but prices for policies have dropped for 2019-20. The majority of Coloradans get their insurance through their employers. But for those who must purchase it on their own, policy prices have fallen. The reason is the state’s new reinsurance waiver, which provides a pool of money that helps insurers cover especially big health care claims. The effect of reinsurance is lowered premium prices, especially on the Western Slope, where coverage is the most expensive in the state (the reinsurance bill was sponsored by a group of Western Slope legislators).

Full-price premiums “are down 30 percent in the individual market” as a result of reinsurance, said Linda Gann, senior outreach manager for Connect for Health Colorado’s West Slope Region.

There is more welcome news about health insurance prices, and choices: a new community health insurance initiative in Summit County that will take effect next year could serve as a model for places “like Telluride, Durango and the Roaring Fork Valley,” where health care costs are similarly high, and which are studying the new initiative closely, Gann said.

Called the Peak Alliance, the initiative was created by a collection of “large groups, small groups and individuals who created their own health co-op and negotiated prices for care” with providers and hospitals in Summit County. As result of these group’s negotiations, “premiums have dropped 41.5 percent. That’s incredible,” Gann said.

Over the last few months, there’s also been progress when it comes to the so-called State Option for affordable health insurance coverage (read about it at tinyurl.com/we9u5yr). If such a plan passes, it would be available to Colorado residents who must purchase insurance on their own regardless of what happens to Obamacare.

The Colorado Division of Insurance and the Department of Health Care Policy & Financing issued a draft report on developing a State Option on Oct. 7.

“Since that time, insurance commissioner Michael Conway and Kim Bimestefer (director of the Department of Health Care Policy & Financing), have held stakeholder meetings about the draft report,” assistant insurance commissioner Vince Plymell said in an email to the Watch.

Public comments closed on Oct. 25.

“The final report will be delivered to the Legislature, per HB19-1004, this Friday,” Plymell wrote.

Like the Peak Alliance, HB19 derived support from the Western Slope:  “The bill was cosponsored by Marc Catlin, a Montrose Republican,” Gann pointed out. “Colorado has always been at the forefront of health insurance, and all this is happening so quickly. The way I understand it, State Option plans will be available in 2022.”

That still leaves next year, and the following, to get through without abruptly losing your health care coverage (at least, that’s the fear). The Trump administration is currently supporting a lawsuit, Texas v. Azar, brought by 18 state attorneys general that seeks to strike down the entire Affordable Care Act (ACA) on the basis that is unconstitutional (the ACA is being defended by a group of Democratic states, including Colorado).

The lawsuit is under consideration by the Fifth Circuit Court of Appeals in New Orleans, which could issue a ruling any day.

“Regardless of the ruling, we’re not panicked in Colorado,” said Bob Mook, the communications director at the Colorado Center of Law and Policy. “The public will just isn’t there” to strike down Obamacare entirely. “People like knowing that their pre-existing conditions will be covered.” At this point, Mook said, “You’re looking at myriad worst-case scenarios in order for this to be dismantled entirely.”

“It’s been such a roller-coaster with this administration,” Gann said. “Wherever this goes, consumers can be confident that the plans they purchase for next year will remain in place. For now, we’re very happy that full-priced premiums are down.”

DEVIL IN THE DETAILS

Even so, “There are complications every year” when it comes to purchasing individual insurance, Gann allowed, “and this year is no different.”

Specifically, the price reductions won’t apply to most Western Slope residents, because most people receive tax credits to help cover the costs of their policies. “Our current customers who receive tax credits aren’t seeing these price reductions,” Gann said frankly.

But for those who may have made too much money to qualify for such reductions in the past — individuals who make more than $49,001 annually — “We’re suggesting they come back and take another look,” Gann said.

“Everybody’s all excited about these rate drops,” said Telluride insurance broker Brett Borup, who helps about 350 clients purchase plans annually on the state’s exchange. There is still just one insurer — Anthem — offering plans on the exchange this year for San Miguel County, Ouray County and Montrose County residents to purchase (Rocky Mountain Health Plans, which used to offer plans locally, has reintroduced them in Delta County). Borup urges those who need help with picking a plan to check in with him sooner rather than later. Brokers don’t charge individuals a fee for their assistance: “We get a commission from the carriers,” Borup explained. Consumers should understand, “You’re paying no more for an expert to help you navigate this.”

This year is unusual, according to Borup.

“Though the price of the average plan went down 30 percent, Bronze plans fell 25 percent, and Silver plans” — which offer more extensive coverage — dropped 35 percent in price. Thus, you may get more coverage for your money by trading up.

“Your buying power for Bronze plans went down because of the way the subsidies work,” Borup explained. “The most important thing to remember is that the tax-credit, which helps pay for your premium, is reconciled on your federal taxes. You estimate what you think your income will be next year,” but if you guess too low (and end up making more money), what you will pay for insurnace goes up, as well. “I’ve had people looking at paying back $12,000, $14,000” because they didn’t estimate their income correctly, Borup said. Despite a reduction in 30 premiums, he has still had people pass up coverage this year, saying they couldn’t afford it.

Marissa Marshalka, health equity coordinator at Tri-County Health (which serves San Miguel, Ouray, Montrose and Delta counties) has witnessed the same thing.

“If you’re making over $103,000 as a family of four in Telluride, which is not that much, you’re not getting any subsidies,” she pointed out. “I met with a family the other day that wasn’t ready to make the commitment to purchase health insurance yet, and I don’t know if they will. They were looking at $2,000 a month in premiums and a really high out-of-pocket maximum of potentially $13,000 for the family.”

Marshalka worries about such people and such decisions to forego coverage.

“When it comes down to it, if someone gets in a car accident or breaks their arm at the resort, they could be on the line for tens or even hundreds of thousands of dollars,” she said. “That’s how people go into medical debt. I’m even more worried about the people we’re not seeing who are just opting out. I work with a lot of Spanish-speaking people; the Town of Telluride is 25 percent Latino. A lot of people won’t even come in and talk to us. These are the people, ironically, who might be able to qualify for tax-credits and subsidies, but people are so fearful that their attitude has become, ‘I’d rather not accept anything. I want my name out of the system.’ This administration is trying to change the law not through Congress, but through the nitty-gritty — by creating a sense of fear, so people don’t even want to go to the doctor’s office. It makes the whole conversation about health insurance more challenging.”

That said, Marshalka said she has not heard a lot of concern about Obamacare being repealed; people’s understanding is that there is likely to be a public health care option in Colorado. Katie Keith, a Georgetown University professor who teaches the ACA and tracks it closely, said whichever way the federal appeal court rules, Texas vs. Azar is almost certainly headed for the Supreme Court.

“The Fifth Circuit’s ruling is likely to result in some confusion since it will probably come during this year’s open enrollment season,” Keith said. “But, even if the Fifth Circuit agrees in any way with the lower court, the decision is likely to be stayed while the case is on appeal to the Supreme Court. That means that nothing will change any time soon. People should still enroll, pay their premiums, and expect their plans to remain in place. The Supreme Court is likely to have the last word on this case, but we won’t know the timing of an appeal to the Supreme Court (and thus what it means for coverage for 2021) until we have the Fifth Circuit Court’s decision.”

BUYING HEALTH INSURANCE

Open enrollment for insurance under the Affordable Care Act — so-called Obamacare plans — is taking place right now. The last day to select a plan with an effective start date of Jan. 1 is Dec. 15. Open enrollment ends on Jan. 15. Connect for Health Colorado, the state’s health insurance marketplace, offers a “quick-cost and plan-finder tool” at planfinder.connectforhealthco.com to help you estimate any tax credit you might be eligible for. This Saturday, Tri-County Health will hold an enrollment fair in the Courthouse Annex at 335 W. Colorado Ave. from 10 a.m. to 4 p.m., “we’ll have another in Telluride on Dec. 4, and we’ll have one in Ridgway on Dec. 7,” health equity coordinator Marisa Marshalka said. “We’ve been very busy with individual appointments, and we’re trying to get people to come to the fairs — we can help people as soon as they walk right through the door. It’s ideal, because this way you can come in when it works best for you, not for us. Bring your best estimate of what you expect to earn next year, and we can help you pick out a plan that’s right for you and your family.”

In addition to Obamacare plans, short-term health insurance plans are available in Colorado. Beware: These plans do not cover pre-existing health conditions. The State of Colorado strengthened their protections earlier this year (learn more at colorado.gov/pacific/dora/news/updated-regulation-govern-short-term-health-plans-colorado). “It was consumer issues that drove the new regulation,” said Vincent Plymell, the state’s assistant insurance commissioner. Regulators haven’t received much feedback, pro or con, about short-term plans, “But open enrollment isn’t a time when people contact us much about the problems with their insurance,” Plymell allowed. “It is later, when something gets denied or they experience other difficulties, when they let us know. Colorado insurance consumers don’t have to wait until they have a problem, though. They can always contact the Division of Insurance with questions or concerns by phone at 303-894-7490 or 800-930-3745, or email at DORA_Insurance@state.co.us.”