Some Wyomingites will pay more than $600 a month for a standard bronze plan on the health care exchanges in 2018, the third-highest amount in the nation, according to a new study.
The study, conducted by HealthPocket, found that the average 40-year-old, nonsmoking Wyomingite will pay $608.65 per month for an average, unsubsidized plan. The national average is $426.81. Only Iowa — at nearly $610 — and Nebraska — $618.46 — have higher costs for customers purchasing that plan.
Kev Coleman, HealthPocket’s head of data and research, said there were a number of factors that could explain why Wyoming’s rates were so high. For one, the state has one provider — Blue Cross Blue Shield — for health plans on the exchanges, which, Coleman said, means there’s little economic pressure to lower costs.
“At the core of the issue is the rate and typology of health care usage among enrollees and the cost of delivering that care,” Coleman explained Friday. “The big issue when we’re taking a look at a risk pool, how often is it being used and what type of care is being used? Things like emergency rooms, hospitalizations, specialty drugs. Those are big cost-drivers. It’s much different than someone going into their primary care physician to talk about a cough or flu.”
Essentially, he said, older or more chronically ill Wyomingites are already more likely to use their health care for more expensive, specialty care. That drives costs up, particularly if healthier people aren’t buying plans.
“If you have a more frequent use of higher cost, it creates greater cost, which raises premium,” he continued. “The issue, then, is looking at costs of delivering health care.”
Nationally, the analysis found that every level of plan from bronze through platinum would see double-digit percentage increases. The average increase for silver plan premiums compared to last year, for instance, is 31 percent, across several age profiles.
The results come after a tumultuous period for the American health care system, during which President Donald Trump and Republican leaders tried repeatedly to roll back various parts of the Affordable Care Act. Though the legislative efforts largely failed, the president last month took steps to loosen some insurance regulations, and he said the government would stop payments to insurance companies, intended to offset the lower prices those companies must offer to low-income Americans.
Trump had threatened to withhold that money earlier in the summer.
As the debate continued in Washington, Blue Cross Blue Shield of Wyoming announced that it planned to increase its premiums for some ACA plans by 48 percent. A spokeswoman for the company said the largest factor in the increase was uncertainty from Washington, particularly related to the potential that insurers would stop receiving the cost-sharing reduction payments.
Coleman said the uncertainty “absolutely” played a role in premium increases and that most insurers had “baked in” the loss of the cost-sharing payments into their rate increases.
In his opinion, the solution to the seemingly eternally rising health costs is looking at new strategies to care for the small, but — for insurers — more expensive population of older, sicker Americans.
That won’t be easy, Coleman acknowledged.
“Much greater attention needs to be given to telemedicine and other means of delivering health care less expensively,” he said. “And we also need to look at how we might create different health care designs for the most expensive people within risk pools. The way you manage and monitor and deliver care for someone who has diabetes can be very distinct from a younger, healthy person in their late 20s or early 30s.”
That means effective strategies and interventions. Wellness efforts, while well-intentioned, are problematic because the most expensive medical problems — like cardiovascular or diabetic conditions — build over years, even decades, of behavior.
In any case, costs are up in Wyoming. A 40-year-old nonsmoker in Wyoming on a standard bronze plan can expect to pay more than $280 every month in premiums than a similar person in Montana. That number grows larger — and more frustrating — as you look at states like Arkansas, where the difference is closer to $300 a month.
“That’s a big chunk of income, just for the difference,” Coleman said.