Relief is in sight – and it won’t involve a lawsuit – for the four counties in Colorado that have the highest Obamacare health insurance premiums in the country.
Local officials in the ski resort region in the mountains west of Denver had threatened to sue over the high rates. But on Friday Colorado Insurance Commissioner Marguerite Salazar said she wants to redraw those boundaries, making the resort counties part of a much larger 22-county pool.
The Affordable Care Act sets a lot of limits on what insurers can do – they can’t charge sick people more, for instance – but one thing that still counts is location, location, location. Premiums can be higher or lower based on how much doctors and hospitals cost in a specific area. And states get to draw those geographic boundaries. When Colorado lumped together Garfield, Pitkin, Eagle and Summit counties — an area that includes the towns of Aspen and Vail — the state created the most expensive insurance market in the U.S., almost by accident.
“It is about fairness,” Salazar said, explaining the new boundary. “When we put (the resort counties) together, we didn’t know what the difference and disparity was going to be. We found out pretty quick.”
That’s a switch from what Salazar was saying in December when she argued that it wouldn’t be fair for some of the state’s poorest counties to subsidize its richest by putting them in the same risk pool.
Local elected officials like Dan Gibbs from Summit County welcomed Salazar’s proposal, saying, “the status quo was killing our middle class.”
But if re-drawing the rating map has the effect Salazar predicts, resort county residents will still have some of the highest ACA premiums in the country.
The current premium for a 40-year-old non-smoker in the resort counties is $483 a month. Salazar says her best guess is that rates would drop 4 to 8 percent in those counties, bringing the premium down to $444 to $464 a month.
Rates would go up in the non-resort counties. Salazar says prices could rise 4 to 6 percent, which would drive the cost of a comparable plan up from $349 a month to about $366.
The new scrutiny of premiums and what drives the costs has some county officials meeting with local hospitals to at least study costs and look for strategies to bring them down.
Actual rates for next year are all speculation until June 6, when insurers have to submit proposed premiums for 2015.
So far there’s been no backlash from people in counties whose premiums are likely to rise. Commissioner Salazar is taking public comment until Wednesday, and plans to issue a decision Friday.
Beyond next year’s rates, another announcement Friday will surely influence health care prices in Colorado’s resort area. Kaiser Permanente, the state’s dominant health insurance company announced it will enter the western Colorado market in 2016. Kaiser hasn’t said which specific towns it will serve, or to which facilities it will send members for care, but increased competition could drive prices down. (Kaiser Health News is not affiliated with Kaiser Permanente.)
This story is part of a reporting partnership between NPR and Kaiser Health News.