State Investigating Why Health Care So Expensive in Pitkin, Nearby Counties

Feb 3, 2014

Commissioner Marguerite Salazar, Colorado Division of Insurance.
Credit http://justforthehealthofit9hf.blogspot.com/


Following complaints from customers and local officials about the high premiums for health care in resort mountain communities, state officials now say they will look into why health care prices are so high in Pitkin, Eagle and Garfield counties. The Colorado Division of Insurance announced Monday, February 3rd it’s launching a study to get to the bottom of that big question… despite the announcement, they don’t plan to lower premiums soon.

Editor’s note: Below is a transcript of reporter Elise Thatcher’s story.

Reporter: State lawmakers recently set up a meeting in El Jebel for locals to talk with Colorado’s top insurance official. Senator Gail Schwartz helped organize the get-together.

Gail Schwartz: "I think that they were surprised at what they heard. I don't think they began to appreciate how serious the nature of these cost impacts were to our citizens and our workforce. People were spending thirty percent of their income on insurance coverage. And not even having access to catastrophic plans."

Reporter: Schwartz approves of the new study.

Schwartz: "Well, I'm relieved, let's go back and revisit what the cost of care is, and why we may have such high rates overall, and then we can be part of a system that really can spread out what it does cost to serve citizens throughout the state."

Reporter: Vince Plymell with the Colorado Division of Insurance says his agency has been examining the issue for months.

Vince Plymell: “This is absolutely a concern for us.”

Reporter: Plymell describes the Division plans to review health care costs statewide, to figure out why they're different from one place to the next.

Plymell: "That isn't something we regulate. We don't regulate doctor's costs, hospital costs, but it's something we want to dig into and get under the hood on."

Reporter, talking with Plymell: "And why isn't this information already available?"

Plymell: "Well, I think in some respects the data of just the cost themselves is, there's various sources, like the All Claims Payer Database, it's available. But the why behind it is some of the tough things to get at. That's figuring out why are hospitals charging this or specialists or things like that. Which isn't as readily available. It is tough to tease out all the different things that are pertinent to this situation. And it's challenging to get it, the information to get the information from carrier to carrier, from hospital, hospital, to hospital, from provider to provider. And also just trying to put it all together into something meaningful.”

Reporter, talking with Plymell: “Garfield County asked the Governor to intervene in some fashion regarding the higher premium prices in the resort pricing area, which includes Pitkin County and Garfield County. Is that connected to this study in any way?”

Plymell: "Yes, I would say so. This in fact it was the Governor and his office that asked Commissioner Salazar to undertake this study, to look at health care costs and the variation. My guess is that it stems from the request for him to be involved, to do something to look into this himself."

Reporter, talking with Plymell: “Has the state submitted any proposed changes to the federal government? There was a deadline about that recently.”

Plymell: “We did not submit any changes.  One of the problems is as you move things around in this kind of puzzle, is it’s like a balloon. You move things here and prices squeeze out over there. But more importantly we didn’t really have any new data, and we knew it couldn’t be justified to the Department of Health and Human services. So, one of the trade offs is, the commission is really keen on moving forward with this study to try and figure out something more than just, moving a county here, a county there, or addressing it in the short term, she wants to dig into what the real driver of  health premiums, and that’s healthcare costs, and find out is there something more that can be done, is there something more to address that real key part of the issue.”

Reporter: That's Vince Plymell, spokesman for the Colorado Division of Insurance in Denver. Eagle, Pitkin, and Garfield County officials weighed in with their thoughts on the new health care study. Eagle County likes the idea. And so does Pitkin County Manager Jon Peacock.

Peacock: "I think we're very supportive of the state looking at that. You know the problem is that people need insurance now."

Reporter: That's a problem because the state has decided not to lower premiums until 2016… That’s causing Garfield County Commissioners some heartburn. Frank Hutfless is County Attorney.

Frank Hutfless: "The commissioners thought, that that was just ridiculous. We have provided them with reams of new data, new statistics, and in fact that new data shows that Garfield County has an average health care overall cost of less than greater Denver metro area, and less than statewide average."

Reporter: Hutfless says Garfield County is again deciding whether to file a lawsuit against the state over this issue. For now, State Representative Millie Hamner and State Senator Gail Schwartz are working together to find an intermediate fix. That could mean making tax subsidies more widely available. It could make a huge difference for professionals like Carbondale resident Amy Barr. She’s the Executive Director of United Way for Garfield and Pitkin Counties. And she tells us that even though she’s a breast cancer survivor, she’s forgoing insurance completely... because rates are so high.