Dan Gibbs has a story he’s trying to help local residents tell.
Since 2014, the former state senator and representative — and since 2010, one of Summit County’s three elected commissioners — has been brushing up on his knowledge of the local, state and federal health-care statutes.
As the region in which he calls home and helps guide continues to face escalating insurance premiums and overall health costs — some surveys suggest the county has the most expensive health care in the entire nation — he’s aiding efforts to find answers on how to draw down this inflated pricing.
Most recently, he has acted as one of the leading voices on a bill presently in the state legislature that would have Colorado’s Division of Insurance begin a study examining what drives the cost of health care based upon geographic region. The idea is to identify what makes costs in the mountains and along the Western Slope so much higher than Denver and other more densely-populated areas throughout the state.
“It’s a very simple bill that has major ramifications potentially for us,” says Gibbs. “It’s not just a mountain issue; it’s a real challenge. We need to work together to solve these problems.”
“I know I’m not going to make everyone happy, but my heart is in the community.”Dan GibbsSummit County commissioner
The proposed law, HB 16-1336, comfortably passed the state House last Friday by a vote of 54-11 and now moves on to the state Senate. State representatives Millie Hamner (D-Dillon) and Bob Rankin (R-Carbondale) acted as the bipartisan bill sponsors in the House, and Sens. Kerry Donovan (D–Vail) and Ellen Roberts (R–Durango) will now carry the bill in the state’s other legislative body. They’ve been grateful to Gibbs — previously a staffer of more than six years for former U.S. Sen. Mark Udall (D-Colorado) — for the assistance and direction, of late acting as a point person and making multiple trips each week down to the Capitol to offer his insights.
“He’s played a really critical role, and we really appreciate what he’s done,” said Rep. Hamner. “We’ve been hearing from our constituents but weren’t really sure what the right path would be. Dan really helped us in terms of organizing input and been a conduit of information between legislature and all of these counties.”
With the goal of eventually discovering the means toward affordable, quality health care for the region foremost on his mind, Gibbs persists in this work and pursues a mantra that prominently hangs next to his desk, reading: “Ask yourself why you have not accomplished more.” He has been attending various health-commission and trade-group meetings, still trying to build additional support enthusiasm for the bill.
“I try to be a strong presence down in Denver to let people know that what we have now is not acceptable,” he said, “that it’s a breaking point for our communities. People are being priced out. People are deciding whether or not they can pay their rent, their health care, childcare based on just what insurance companies can do without doing a thorough analysis. This is not acceptable for our constituents.”
agent of change
Over coffee last week, he emptied out the contents of two hefty accordion folders full of his research on how the state came up with its health-care plan after Pres. Obama signed the Affordable Care Act (ACA) into law in March 2010. Colorado submitted its plans to the feds on how it would create its health exchange, but the mountain community fell into what he called a “flawed system” from the get-go.
“This will make your jaw drop,” he explained. “The state cut-and-pasted a letter from the insurance companies without really following through on what they’re supposed to do. We’re in this flawed system from the start in this geographical-rating area based on what the insurance industry told the state they’d do for them, and the state rubberstamped it. It’s just crazy. That shouldn’t have happened that way.”
The letter, signed by Gov. Hickenlooper, initially broke Colorado up into 11 geographical areas in the state and placed Summit into what was known as the resort region. With it came the highest premiums in Colorado — and in the country. Through a strength-in-numbers approach, Gibbs and fellow county commissioners in the area were successful in getting this region eliminated, instead grouping the entire Western Slope (less Grand Junction) into a different geographical insurance area to try to reduce costs.
The plan worked, even if prices remained above and beyond what other Coloradans paid. But once the Division of Insurance forced the Colorado HealthOP — one of several insurers available to residents on the state’s health-care exchange and, typically, the least expensive option — to close its doors at the end of 2015, premiums for individuals in Summit County shot up as much as 40 percent.
In turn, several people in the mountains had the idea to establish one geographical area rate for insurance companies across the state. The study that would be initiated through the passage of HB 16-1336, once potentially moved through the Senate and signed into law by Gov. Hickenlooper, is viewed as the first step. The data from this investigation would, the thought is, explain what the actual cost-drivers are in the health-care industry and provide designs for how to decrease some of this financial strain at the local level.
Though the bill has bipartisan support and any number of co-sponsors, it does also have its critics.
They say that if a single-region rate were eventually instituted through follow-up legislation, health-care costs would merely be redistributed, and those in larger populations (and lower risk areas) would be subsidizing the costs of rural communities such as Summit County. Gibbs doesn’t see it that way, even if for now HB 16-1336 will only create a study exploring the concept.
“The state needs to have a larger, statewide discussion now that the Affordable Care Act is law,” he said. “We need to treat health-care insurance more like (a utility), where just because we live in a particular map area, that our insurance isn’t going to be quadruple what you have in Denver or in Pueblo. I personally don’t think that’s right. We should all share the burden of the health-care cost for everyone in Colorado.
“I recognize that things are more expensive in the mountains,” he continued, “but it’s not 200-percent more. You go to a grocery store here versus one in Denver, we know it’s more expensive. But show me the justification of why (health care) is that much more expensive.”
nuts and bolts
The biggest curiosity among many who feel the pain of these mountain health-insurance premiums is why they cost so much and how that cost is broken down. Some will tell you the pricing comes from limited local hospital and clinic options. If there’s only one game in town, goes the thinking, the single entities sets the rates.
Most agree that utilization rates, meaning the number of times patients go through certain types of tests or imagining, for instance, play at least some role. The more times a test or X-ray or MRI is conducted in a specific region, the cheaper the overall cost of care. And the larger a population, the more times a service will occur.
Today, more than 60 percent of people from Summit County currently use health-care services down in Denver. That may be at least in part because one of the area’s cheaper insurers, Kaiser Permanente, since the HealthOP folded, does not have a relationship with the Centura Health-run St. Anthony Summit Medical Center in Frisco and sends patients down to the metro area for care. Still, that doesn’t do anything to benefit the region’s utilization rates.
“We are monitoring the bill as it is a study and are always interested in helping understand the differences between health insurances and health costs,” Centura released in a written statement. “We seek any way to improve accessibility to optimal health care.”
HB 16-1336 would scrutinize such aspects of the health-care industry and also specifically analyze other aspects of overall costs, like prescription drug costs, provider rates and the regional pricing of various surgical procedures. It’s the bill sponsors’ primary argument for passing the piece of legislation.
“We have a lot of people who live up here and don’t think they’re being heard,” said Hamner. “It’s why it was so important to carry this legislation. Ultimately, I’m hoping to have some solid reasons for why insurance rates are so much higher in this geographical region, what’s driving that cost up and what some potential solutions might be.”
It’s also why Gibbs carries on in his research of health care and in beating the drum for discovering the true costs in the region through this proposed legislation.
“I’ve been working in politics for a long time,” he said. “So I have a good idea of what’s possible and what’s not. Any time you introduce bills dealing with health care, even if it’s an analysis, it’s not easy. There’s no predetermined outcomes of this (bill). Let’s see what the outcome looks like after we have this analysis.
“I know I’m not going to make everyone happy, but my heart is in the community,” he added. “That status quo is great for a lot of people, but it’s not great for consumers. It’s a breaking point for folks who are deciding whether they can stay in our community or not, and this gives my constituents a chance to tell a story that what we have right now, the status quo, is not working for us.”