The Garfield County commissioners want the state government to help some area residents pay the high health insurance premiums that they face under the Affordable Care Act (ACA), the federal health care overhaul law that took effect on Oct. 1.
The commissioners sent a letter to Colorado Gov. John Hickenlooper on Monday protesting the fact that state insurance officials lumped Garfield County together with several neighboring resort counties in a geographic rating area used to set insurance premiums under the health care law.
Garfield County was paired with Pitkin, Eagle and Summit counties in the so-called Resort Rating Area, meaning that Garfield County residents will pay the same health insurance premiums as residents of those other three counties despite the fact that they spend less on health care annually, according to a state database of insurance claims.
Garfield County’s membership in the resort rating area keeps prices lower here than they otherwise would be, and moving Garfield County into another rating area — such as the inexpensive western Colorado area that includes Mesa County — would cause premiums both here and there to rise.
“You could almost say that this county was the non-consenting sacrificial lamb in the state’s scheme to keep prices lower for the resort counties,” said Garfield County Attorney Frank Hutfless, who drafted the letter to Hickenlooper.
The letter alleges that the state devised its health insurance rating areas based on “misinformed and flawed decision-making.”
Specifically, the letter claims that state officials repackaged a memo from a trade group, the Colorado Association of Health Plans, and submitted that to the federal government as their rating area scheme.
“The Division of Insurance used a lobbying organization’s letter verbatim in requesting those rating areas,” said Hutfless. “We are not convinced that enough objective reasoning went into their creation.”
The letter requests that Hickenlooper meet with Garfield County commissioners to discuss whether the state could provide county residents facing high health insurance premiums with some form of price relief.
As justification for the meeting, the letter states that the county has so far received no response from the state to its inquiries about modifying the rating area scheme, other than a statement from Colorado Insurance Commissioner Marguerite Salazar that the rating areas can’t be modified until 2015.
“While we know that many individuals are concerned about the 2014 premiums, we are unable to make any changes at this late date,” Salazar said during an online meeting with Garfield County residents over their health care premiums in early December. “The 2014 premiums are supporting plans being sold right now.”
The Division of Insurance submitted a list of recommended changes to the state’s rating area structure to the federal government on Jan. 1, but that list has not been made public. A division spokesperson had no comment when asked whether the recommended changes include Garfield County’s removal from the Resort Rating Area.
Meanwhile, some Garfield County residents are still reeling from sticker shock over what they would pay for insurance purchased on the state health care exchange set up to comply with the ACA.
Commissioner Tom Jankovsky said he had heard from several individuals who would pay roughly $400 more per month than they had been paying for their previous health care coverage.
“There is nothing affordable about the Affordable Care Act in Garfield County,” said Jankovsky. “This is a large economic hit to our citizens … [resolving it] is my No. 1 priority for 2014.”
Under the ACA, anyone with an adjusted gross income under 400 percent of the federal poverty level ($45,960 in 2013 dollars) can qualify for some level of subsidy help with their health insurance premiums from the federal government.
According to an analysis by the Colorado Center for Law and Policy, roughly 61.5 percent of Garfield County residents could qualify for a subsidy or for Medicaid, the free or low cost government insurance program made available to more Americans under the ACA.
Yet 29.7 percent of Garfield County residents don’t qualify for either of those options, according to the analysis, meaning that they could face higher costs when shopping for health insurance on the state exchange than they would in the private insurance market.
As the Denver Post health care writer Michael Booth has noted, many people in Colorado’s resort communities earn more on average than people on the Front Range, which disqualifies them for subsidies under the ACA. Yet resort dwellers also have a higher cost of living than city residents, a fact that the federal subsidy scale doesn’t account for. That leaves many resort area residents ineligible for subsidies, even though they could use them based on their cost of living.
Hutfless said that while the county would wait to hear back from the governor about a meeting on the insurance premium issue, officials also are weighing whether to demand an investigation of the state’s rating area scheme by the state legislature, or to submit an open records request to the Division of Insurance demanding that the agency release documents relating to the design of the state’s insurance rating areas.
Such documents, Hutfless said, could help clarify the criteria that the state used to put Garfield County into the resort rating area.
“I believe we extend the olive branch … before taking any other action,” said commissioner John Martin, referring to the county’s request for a meeting. “However, I still think that some of those other options need to be remaining on the table.”