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How tourists are raising insurance rates for residents of Summit County, Colo.

November 7, 2013 at 12:00 AM EDT
Summit County, Colo. has an estimated 6,000 uninsured residents, and none of them have signed up for health insurance under the Affordable Care Act. Why? Because premiums there are sometimes twice as high as other parts of the state because of a discrepancy in Colorado law. Mary Jo Brooks reports on what's behind the imbalance.
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JUDY WOODRUFF: Now to our continuing coverage of the health care law and its impact.

Some of the essential concerns for rural parts of the country: Will premiums be low enough? And will there be enough competition among doctors, hospitals and insurers? The national picture is still being assessed, but residents in one Colorado county are already flagging worries there.

The NewsHour’s Mary Jo Brooks has the story.

MARY JO BROOKS: Summit County, Colo., is a premier travel destination, home to world-class skiing, mountain biking and trout fishing. Its also home to 28,000 residents who are mostly middle-class, with an average household income of $67,000 a year. Ten percent live below the poverty level.

For two months now, counselors here have been meeting with residents to explain the insurance options now offered under the Affordable Care Act. The goal? To sign up as many of the estimated 6,000 uninsured residents as possible. So far, they haven’t gotten a single one.

TAMARA DRANGSTVEIT, Family and Intercultural Resource Center: Every single one of them for whom we have gotten to the point of actually looking at the rates has taken one look and walked out the door. It’s just prohibitive to them.

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MARY JO BROOKS: Tamara Drangstveit is the director of the Family and Intercultural Resource Center, which has been contracted to help people navigate the health plans offered in the state-run exchange. Even she has been shocked by the high prices.

TAMARA DRANGSTVEIT: I really thought this was going to level the playing field, that finally families were going to get access to care and insurance and it was going to be affordable. And it’s not leveled the playing field. It really hasn’t.

MARY JO BROOKS: Colorado is one of the 25 states that are expanding Medicaid under the ACA, and that will help some of the currently uninsured get health coverage. But many residents don’t qualify, and even with tax subsidies, they are facing premiums that in Summit County are sometimes double what people are paying elsewhere in the state.

For example, a 40-year-old nonsmoking male in Denver could pay as little as $245 a month for a mid-level plan. That same person in Summit County would have to pay $446. It’s a geographic disparity that health officials say has always existed, but has become more evident because the ACA makes rates more transparent.

Colorado chose to establish 11 geographic zones for insurance companies to set rates. Rates were then determined by the price of medical services in those areas and how often services were utilized. Both costs and utilization rates are extremely high in Summit County.

But retired physician Dr. Don Parsons, who serves on the boards of the county’s only hospital and community clinic, says that’s because the state counts all medical visits, even by those of the thousands of visiting tourists who may use the services. He says that’s not fair.

DR. DON PARSONS, retired surgeon: There’s a regional population and a resort population, and they’re two very different groups. And somehow we have to acknowledge that the people who live here full-time cannot afford the same kinds of prices that the more affluent resort population can afford.

MARY JO BROOKS: U.S. Representative Jared Polis is concerned about that discrepancy. He’s a strong supporter of the Affordable Care Act, but thinks it needs to be fixed to work better in some areas.

REP. JARED POLIS, D-Colo.: The Affordable Care Act works for most of my district. Families in Loveland, Fort Collins, Boulder are saving money. It’s affordable for young people. You know, $280 to $320 a month, with subsidies for many of them, gets it down to a lower price point. But in the mountain communities, Summit and Eagle County, at the price point of $400 or $500 a month, it just doesn’t work.

MARY JO BROOKS: Polis has asked Colorado Insurance Commissioner Marguerite Salazar to address the problem. She, too, says she was dismayed when she saw the imbalance.

MARGUERITE SALAZAR, Colorado insurance commissioner: And when I saw that, it didn’t make sense to me at all. And so I understand the frustration that people have when they look at those and they say, wait a minute, it’s supposed to be more affordable.

Well, I just take that very seriously, and we’re going to do everything we can to make it more affordable.

MARY JO BROOKS: Salazar says it’s too late to adjust rates for 2014, but she will begin holding town hall meetings and hopes to incorporate changes for the 2015 plans. She warns, however, that fixing it in one area will have consequences for others.

MARGUERITE SALAZAR: You can’t just change one without making dramatic changes in another or it affecting the other side. Maybe we should just have one geographic rating. Maybe everybody kind of pays a little bit to get everyone on equal footing. But there is that idea that there or notion that then those — the poorer areas are subsidizing the more expensive areas. And I think we need to get to the costs to really start trying to make this issue seem more equitable.

MARY JO BROOKS: Polis has requested a waiver from the federal government, asking that Summit County residents have one more year before they are required to sign up for insurance. Some Republicans say that’s hypocritical and it’s one more sign that the ACA isn’t working.

But Polis is undeterred.

JARED POLIS: The problem is, the way Washington is caught up is, you have far too many on both sides of the aisle that are reluctant to change anything about it. There are some on the Democratic side who dig their heels in and see any change as a threat to health care reform. There’s many on the Republican side that almost gleefully want it to fail and refuse to make the commonsense changes that we need to make it work.

So, I think there’s a middle ground. Let’s make health care work.

MARY JO BROOKS: Unless Summit County granted that waiver, residents here, like all across the country, will have to have health insurance in place by the end of March.

GWEN IFILL: In an interview with NBC News today, President Obama said he’s sorry that some people have been dropped from their insurance plans, when he promised they could keep plans they liked.