Health Care In The States

It’s Hot Springs Vs. Ski Slopes In Colorado Insurance Battle

By Eric Whitney

February 13th, 2014, 2:40 PM

The county with the highest health insurance premiums in the country is drafting a lawsuit against Colorado, saying the state’s approval of the rates violates anti-discrimination protections in the Affordable Care Act.

Garfield County Attorney Frank Hutfless says county commissioners told him “to prepare a lawsuit to be filed against the state, and particularly the department of insurance, the insurance commissioner and perhaps the governor.”

At issue is the decision by Colorado Insurance Commissioner Marguerite Salazar to include Garfield county in the state’s “resort” insurance rating area, which a Kaiser Health News report found to have the highest premiums in the U.S. The lowest-price silver plan in the rating area for a 40-year-old male is $483 a month, versus $245 a month in Denver.

Salazar says the four-county area has significantly higher costs for health care services, which justify the higher rates. Salazar was appointed by Democratic Gov. John Hickenlooper to her post in August 2013.

Garfield county’s elected officials dispute that their costs are as high as the other counties in their group. They say they have little in common with neighboring counties that include the ritzy Aspen and Vail ski resorts.

The only ski area in Garfield County is a small family-oriented resort that doesn’t try to compete for the global “destination skier” market like the sprawling mega-resorts in Pitkin, Eagle and Summit counties. Many of those resorts’ workers live in Garfield County, which is generally more affordable. Its Glenwood Hot Springs have lured tourists since the 19th century, but in nowhere near the numbers of skiers that visit the big resorts.

Many residents are also proud that Garfield County is home to more than 10,000 active oil and gas wells, more than any Colorado county but one. Its resource-extraction tradition means it has more in common with neighboring Mesa County, which is in a different, and much less expensive, insurance rating area.

And Colorado’s All Payer Claims Database suggests that Garfield’s health care costs are more similar to Mesa than the three ski-resort counties it’s grouped with for insurance rating purposes.

Between 2009 and 2013, the database says the total cost of care per health plan member in Garfield County was between $83 more expensive and $402 less expensive than Mesa County. In contrast, Garfield County was at least $1,125 less expensive than Pitkin County, home to Aspen, over the same period.

Still, compared to urban Denver County Garfield County is expensive. Its total cost of care was consistently at least $1,100 more expensive than Denver’s from 2009-2012.

While the database is by no means comprehensive and its cost-of-care numbers are only approximations,  it’s the best publicly available information on costs. Both the state Division of Insurance and the county threatening to sue it cite the database as the basis for why Colorado’s rating areas are or are not fair.

Garfield County Attorney Hutfless says it’s too soon to say what specific remedies he’ll ask for in the lawsuit, but, “all of which (will be) directed to achieving some sort of equity for citizens in this county.”

He says that although Garfield County’s elected leaders are prepared to go to court, they’re also open resolving their issues by other means. He expects to make a draft of the lawsuit available to the state in late March, prior to filing it in federal court.

Insurance Commissioner Salazar last week announced a new study by her office into higher health care prices and insurance premiums in Colorado’s resort counties. She says she’ll have results, and potential strategies for relief, in May before insurance companies have to file proposed rates for 2016.

7 Responses to “It’s Hot Springs Vs. Ski Slopes In Colorado Insurance Battle”

  1. larry says:

    Solution? Eliminate the corrupt health insurance companies and go to a universal single-payer government run healthcare system for all Americans. Although far from perfect, Obamacare took the first step. Now it’s time for Congress to take the next step. Medicare-For-All.

  2. Paul says:

    Larry, insurance companies do not set the cost of care, they set premiums which are the cost of insurance. Single payer would not change the costs unless you are also talking about price controls which would really be a disaster.

  3. Rick says:

    Larry…before you assume the government can efficiently, effectively and equitably provide healthcare to all, name me 3 current programs that you would point to as government succes stories? Let’s start with, the post office, food stamp program, IRS or defense? The very people you suggest provide our healthcare have complicated it beyond belief. Absent the private market, Medicaid or Medicare would not survive.

  4. Ray says:

    Insurance is a product to help pay for healthcare charges.

    Healthcare Charges. Repeat that 5 times. Drill it in.

    Health insurance pays for healthcare charges. The more those charges are, the more they must collect in premium to pay for those charges. If hospitals and doctors in a region charge more, the insurer must also charge more, in order to pay those charges. Don’t forget, the government has mandated what they must cover, at what cost to the insured, they don’t exactly have wiggle room.

    This is the equivalent of suing banks because the mortgage payments on expensive houses is expensive. More to the point, it’s like a county full of expensive houses suing their banks because banks in counties full of cheaper houses have average lower mortgages. It’s not their fault the house is expensive, they just offer a law-abiding product to help pay that cost. They meet all regulation. They have been reviewed and approved. The cost is something largely out of their control.

    Sue the doctors. Sue the hospitals. Sue the people CHARGING the money, not the people abiding by all law and regulation offering a product to help you pay their obscene charges.

  5. larry says:

    By definition, insurance companies come between the doctor and the patient. By definition, private insurers are the “middleman” in the doctor/patient relationship and they charge (by law) a 20 percent commission for the privilege of playing that role. If having insurance companies coming between the doctor/patient relationship is so important, then why is it every other industrialized nation on earth is perfectly capable of operating their healthcare system without these corrupt insurance company shysters? To be sure, insurance companies add to the cost of healthcare. Only a complete moron or a Republican thinks otherwise. Private insurance companies add at least 20 percent to the cost of America’s healthcare system. Meanwhile, every other industrialized nation on earth covers 100 percent of the citizens at half the cost of American style healthcare. And, to make things worse, 36 of those industrialized nations rank higher in overall healthcare metrics. Lamebrain Republicans want you to believe that America has the best healthcare in the world. That may be true, but only if you can afford it! Apparently over 50 million Americans can’t afford it. How’s that for “world class” healthcare, you idiot!

  6. paula says:

    Larry is correct. If we must have an entity to process and pay claims, I’d rather have a “non-profit” entity that has some serious Congressional oversight. All studies have concluded that no entity does medical claims processing and payment better than Medicare and Medicaid. Why? Because they work for the tax payer, not for shareholders. It’s time to get Wall Street out of the healthcare industry. Wall Street has proven that they can’t be trusted. Wall Street has no business in serious medical decisions about life and death. People who deal with Wall Street are basically dealing with a casino. You want Wall Street, go to Las Vegas.

  7. Herman says:

    Paula: that’s a lot of faith you’re placing in our government. What’s motivated you to be so trusting? A recent OPM ruling has essentially removed for Congress the same requirements and restrictions implemented by the ACA that the rest of us have to abide by (in some instances… not entirely). It doesn’t inspire me to think that in a single-payer system, we’d be turning over control of the healthcare industry to a government that isn’t governed in the same way as you or I. At least employees of the private healthcare industry have to play ball like the rest of us, and I think we could probably all agree that insurance executives are no more or less corrupt than congressmen. Given the choice, I’d much rather put my faith in executives whose freedoms and choices are the same as mine.