The Montrose region’s rate of uninsured people rose slightly between 2017 and 2019, according to fresh data  from this year’s Colorado Health Access Survey.

That percentage crept up from about 8 percent in 2017, to nearly 9 percent this year, according to the survey by the Colorado Health Institute.

“Even though that’s a nominal increase, we haven’t run the statistical significance on that,” said Joe Hanel, director of communications for the institute. The percentage shift may fall within the margin of error, he said.

“That said, it is still a little bit higher than the state average (of 6.5 percent). That’s consistent with what we’ve seen on the Western Slope for the past several surveys now. Once of the big reasons would be just the cost of insurance. It’s more expensive in rural Colorado, especial Western rural Colorado, than it is in Colorado Springs or Denver. There are fewer choices and the plan is going to be more expensive.”

Hanel was referring to small group and individual insurance markets.

Montrose County is part of the survey’s Region 10, which also included Delta, Gunnison, Hinsdale, Ouray and San Miguel counties.

Employer-sponsored health insurance still dominates the coverage type in Region 10, although it dropped from 32.4 percent in 2017 to 29.6 percent this year and lags the statewide rate of about 52 percent.

Individual market insurance —  the type purchased directly by individuals from carriers, or through Connect for Health Colorado (the state health insurance exchange) — was 12 percent in the local region, up from about 11 percent in 2017. The current percentage is more than twice that of the individual market rate statewide, where it’s about 7 percent.

Statewide, job-based insurance went up, while individual market insurance shrank slightly, Hanel said.

“That was the reverse in Montrose, in counter to the state trend,” he said.

It’s harder to come by data for job-based insurance, he also said. 

“There’s just a lot less job-based insurance and a lot more individual market insurance in Western Colorado and especially Montrose than in Colorado as a whole,” Hanel said.

“The economic structure has a lot to do with that. In rural areas, you have a lot of seasonal work, tourism and agricultural work, that typically doesn’t come with benefits. Lots of times, people are stitching together two or three gigs and if insured, they are getting it through the individual market.”

State’s boom not balanced

The state’s swelling population on the Front Range may be an indicator as to why employer-sponsored insurance rates are higher outside of Western Colorado, Hanel also said. People are moving to metro areas for jobs, which, thanks to the state’s booming economy, tend to include insurance benefits.

“Looking at this, it affirms one of our main storylines, which is the boom has been unbalanced. There are people doing a lot better, and the state on average is doing better, but average doesn’t mean everybody,” Hanel said, also pointing to other assessments the survey carried out, with respect to food insecurity.

Premium costs on the Western Slope are the subject of ongoing health policy debate; there are many factors, Hanel said, among them, the lower numbers of insurers and hospitals.

The Colorado Health Institute earlier this year analyzed competition for individual market insurance among hospitals.

“It turns out, no surprise, when you have fewer hospitals and/or fewer insurers, then the price of insurance is a lot higher,” Hanel said.

“In those situations, it’s hospitals that hold the upper hand to set their prices. Insurers have to provide coverage for people in the area.”

But, while the Western Slope’s insurance costs continue to outstrip those in more metro areas, change may be coming.

A bill passed last legislative session will cause insurance on the individual market to decrease between 28 and 30 percent, said Linda Gann, Connect for Health Colorado’s senior manager for its Western Slope Region.

The Western Slope has fewer people between whom to divvy up the costs associated with treating major medical events, Gann explained. That in turn increases premium rates for the individual market. 

House Bill 1168, the State Innovation Waiver Reinsurance Program (or “reinsurance bill”), created a fund for 2020 and 2021 to offset claims costs once they hit a certain level, and that should translate to less for individual market policy holders to absorb. 

The program provides reinsurance payments to insurers to help pay the bigger-ticket insurance claims — “reinsurance.” The state also secured the necessary federal waivers for reinsurance.

The premium decreases being realized through HB1168 are a “step in the right direction,” Gann said.

“It seems to be this last (legislative) session, there has been a lot of progress in helping the Western Slope in particular with the high costs of health care. Reinsurance is a big, big deal.”

Those who buy insurance directly from carriers or through the exchange should see their rates drop, she said.

“But the bigger thing that is going to be happening is the public option,” Gann said.

House Bill 1004 — cosponsored in the House by Rep. Marc Catlin, R-Montrose — directed the Colorado Department of Health Care Policy and Financing and Colorado Division of Insurance to develop and submit a proposal to the Legislature concerning the design, costs, benefits and implementation of a state option for health care coverage.

Those departments’ leaders have been meeting with stakeholders about what a public option could look like; Gann said she looks forward to the forthcoming results. 

It is important to continue bringing down costs on the Western Slope, she said.

The recent reinsurance bill was a good step forward for cost-lowering, Gann added, but the actual cost of care needs close examination.

“I expect to see in the next legislative session some activity around that topic. I think we’re taking a hard look at why is it so expensive over here. I’m hopeful. I think we’re looking at the right things and asking the right questions, but there’s more work to do,” Gann said.

She pointed to Summit County, where through the nonprofit Peak Health Alliance, large group, small group and individual market policyholders united and negotiated directly with providers, she said. They then put the resulting plan out for bid to carriers. Overall, the strategy led to a 41.5- percent decrease, Gann also said.

“That’s a really big number. To me, it’s an interesting model,” she said.

“Summit County is in the same rating region that we are in in Montrose. I think it will be interesting to see what happens. Clearly, Colorado has been a leader in trying to solve this very high cost of health care and health coverage.”

Peak Health Alliance recently expanded to six other counties, the Summit Daily news reported Oct. 1.

Statewide lament: ‘Too expensive’

The Western Slope tends to use slightly more health care services than other parts of the state, Hanel said, but the reason is not clear. The area’s population is a little older than average and in 2017, survey respondents on the Western Slope self-reported health outcomes a little lower than state average — just nothing that really explains the big difference in health care costs, Hanel also said.

“Another thing we can tell from the survey is the No. 1 reason people say they don’t have insurance is because it is too expensive,” he said. 

And that’s not unique to the Western Slope: “Ninety percent of people statewide said it is because it is too expensive.”

Although overall, the uninsured rate in the state has held steady since 2017, more residents switched coverage or went without any for part of the year. This “churn” creates some instability in the market.

“We’ve been seeing churn numbers increase year after year,” Hanel said. “There can be good churn — somebody who is uninsured and then gets insurance, or, if switching to find a better price or network, that can be good.

“From insurers’ point of view, it makes it a little bit harder to price their products. When they don’t have year-after-year history with the same people, it is more unpredictable and that can lead to some of these big price swings we’ve seen on the Obamacare market in the past five years.”

Churn — in the form of people going off the Medicaid rolls and becoming uninsured when faced with unaffordable premiums — is also affecting federally qualified health centers. (See related story.)

Still, the state can be proud of having expanded health insurance to nearly half a million residents over the past six years, Hanel said.

“But there are some warning signs statewide and in the Gunnison Valley Region (survey’s Region 10). Progress is definitely not inevitable and could be reversed. The work of getting access to care to everyone in Colorado is definitely not done."


Caught in the middle: 

Health centers’ uninsured patient rates grow

As the state’s economy grows, some people may begin making enough that they no longer qualify for Medicaid — but simultaneously, they cannot afford insurance. That is putting more of a burden on federally qualified health centers like River Valley Family Health Center and affecting health outcomes overall, the center’s CEO Jeremy Carroll said.

Over the past several months, River Valley, with clinics in Olathe, Montrose and Delta, has seen Medicaid patient numbers drop and uninsured patient numbers rise.

The number of Medicaid patients on River Valley’s clinical side has dropped 3 percent since January.

“Over 10 months, that is a steep decline. During the same time, we have seen our uninsured (rates) grow by 4.2 percent,” Carroll said.

Those numbers are better among patients accessing River Valley’s mental health services, which has served to level out the company’s overall rates of uninsured, but the drop on the clinical/medical side is concerning, he said.

“Everyone thinks we’ve got a better economy, so everyone should be better. The problem with maybe making a little more money is you price yourself out of Medicaid,” he said.

Health insurance through Colorado Connect for Health, the state’s insurance exchange through which people can purchase premiums in the marketplace remains out of reach for many people coming off Medicaid, Carroll said. So they roll from Medicaid to uninsured.

“That’s where clinics like River Valley step in,” he said.

River Valley and other such health centers offer sliding fees based on income, which sometimes can be as little as $15.

“The problem with it is, now that you’re uninsured, is getting into a specialty clinic, or going to get imaging done. If there is anything outside of preventative care, River Valley can’t really assist with those kinds of things,” Carroll said, referring to procedures that cannot be done in-house at the clinic.

Contracts with hospitals that provide for some discounted services are helpful, but these cannot take the place of Medicaid coverage, he also said.

The result: Medical issues are not managed well, leading to greater expense down the road, when the patient ends up in emergency care.

“That investment on the front end, of very solid preventative medical care, is essential to managing those diseases and diagnoses,” Carroll said.

“It makes it tough for River Valley, as we used to have a good payer in Medicaid and now they go to uninsured. It just makes it tough financially on community health centers.”

The concern is statewide, with some community health centers seeing as much as a 10-percent decrease in Medicaid and a spike in uninsured patients, he also said.

“We haven’t felt it as bad over here in Montrose County and Delta County, but there are some areas in the state that are being hit hard. It is exciting when we see a better economy, but it does create challenges for those who price out of Medicaid,” Carroll said.

“Community organizations have to be ready to step up and assist those patients to make sure they get the care they need and don’t fall through the cracks."

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