Rural Nevada is nation’s third most-expensive health care market


Affording insurance isn’t getting any easier for rural Nevadans.

The Las Vegas Review-Journal first reported on higher premiums in the hinterlands in November. We found that while specific rates vary by age and household situation, rural residents who bought coverage through the Silver State Health Insurance Exchange pay more on average than Las Vegans who purchase through the marketplace. A 40-year-old nonsmoker in Clark County could find an exchange-based plan for as little as $264.58 a month; that same consumer living in Battle Mountain or Hawthorne would pay $343.96, though a federal tax credit could help defray the higher cost, depending on income.

Now, a study shows that premiums outside Nevada’s cities rank among the nation’s highest. The lowest-price silver plan — the basic benchmark plan that qualifies consumers for cost-sharing reductions in deductibles and out-of-pocket expenses — costs $456 a month in rural Nevada, according to the Kaiser Family Foundation, a California-based nonprofit organization that studies the U.S. health system. That made the region the third-most expensive insurance market in America, bested only by southwest Georgia ($461) and Colorado’s Rocky Mountain resort region ($483).

In line with our November report, Kaiser blamed the higher premiums at least partly on smaller networks of doctors and hospitals, which mean insurance discounts are smaller. Some rural areas may also have lower rates of employer-sponsored insurance, and sicker populations as a result.

In Kaiser’s report, rural Nevada is defined as 10 of the state’s 17 counties: Esmeralda, Eureka, Humboldt, Lander, Lincoln, Elko, Mineral, Pershing, White Pine and Churchill.

It’s important to remember that a lot of rural Nevadans may not have to pay the full monthly premium. Because their rates are higher, they’re likelier to qualify for the tax credit to offset some of the expense.

Still, rural enrollment is “absolutely no better and probably worse” than it is in Southern Nevada, said Larry Harrison, a Las Vegas-based independent insurance broker who sells statewide through National Healthcare Access, and is also a spokesman for the National Association of Health Underwriters.

“They just don’t have the resources in terms of agents, (enrollment) assisters and navigators,” Harrison said.

Andres Ramirez, president of Ramirez Group, Nevada’s biggest insurance-navigator firm, agreed that higher premiums affect rural enrollment.

“If you don’t qualify for the (tax credit) and you need insurance either on or off of the exchange, it’s extremely expensive,” Ramirez said.

Lagging rural sign-ups won’t necessarily keep the state from reaching its enrollment goals because in some counties the number of uninsured people is in the single- or double-digits, Ramirez said.

“Even if the entire population in rural Nevada did not enroll, they make up less than 1 percent of the uninsured,” he said.

But that doesn’t mean high costs don’t matter. Ramirez said he’s optimistic that expenses over time will decline as telemedicine puts rural residents in touch with doctors in far-flung cities for routine care and early diagnosis. In the meantime, though, there’s little the state can do about the pain of pricey premiums in the hinterlands.

■ Mary (no last name given) wants to know how anyone can say the Affordable Care Act is “broken.” She writes: Americans are spending less on health care, which is what the law was designed to do. The exchanges are having problems but it is important to look at the big picture, and the big picture looks like it is working.

It’s true that the pace of inflation in health care has fallen, Mary, but that’s not the same thing as spending less.

The latest numbers from the Centers for Medicare and Medicaid Services show a slowdown in the rate of growth of health spending, but what we spend per capita is still going up.

The agency said Americans spent $8,915 per capita on health care in 2012, up 3 percent from $8,658 in 2011. That’s definitely a slower growth rate than we saw from 2006 to 2007, when per capita spending jumped 5.3 percent, to $7,649.

The nation as a whole spent $2.79 billion on health care in 2012, up 3.7 percent from $2.29 billion in 2011. Spending spikes have eased noticeably: The inflation rate routinely came in 8 percent to 10 percent in the early 2000s, according to the centers.

The thing is, spending increases began to ebb in 2008, when the gain dipped to 4.7 percent. In 2009, spending rose just 3.8 percent. The Affordable Care Act didn’t pass until 2010, so it’s hard to give it all of the credit for reining in spending growth.

Instead, a 2013 Kaiser Family Foundation report points to another big factor: The economy. Kaiser found that 77 percent of the decline in spending “can be explained by changes in the broader economy.” In other words, when unemployment rises and incomes drop, people are less likely to go to the doctor because they can’t afford the copays. Elective procedures, which aren’t a medical necessity, fall off as well.

The rest of the decline has come from “structural” changes in the health system, which means new ways of paying for and receiving care, the Kaiser analysis said. But again, insurers and employers were making those changes before the Affordable Care Act passed. More managed-care arrangements, such as health maintenance organizations that limit doctor networks, as well as higher deductibles and other types of “patient cost-sharing,” have become the norm in employer-sponsored insurance, and that’s curbed consumption of medical services, Kaiser said.

The system may save even more money with improvements in technology for tracking and managing health services.

But the foundation also said it’s impossible to predict whether the slower growth will continue. Factors eyed by experts include economic improvement and the growing ranks of the insured, both of which could boost health care inflation. What could keep it in check? Smaller increases in federal payments to Medicare providers and a new tax on high-cost, benefit-rich “Cadillac” plans.

■ Cancer center signs contract: Comprehensive Cancer Centers of Nevada reached out to let us know that the practice has finally signed a contract with the Nevada Health CO-OP, a nonprofit, Culinary Health Fund-sponsored insurer created in 2012 to sell coverage on the state exchange.

We first reported Jan. 28 about confusion among the center’s patients. The practice was listed as a provider in networks of plans sold through the state exchange, but it hadn’t actually signed any contracts with exchange-based insurers. Comprehensive Cancer Centers continued to treat existing patients with new plans, but new patients had to wait until a network deal was in place.

Now, people who buy CO-OP plans are good to go, a spokeswoman for the practice said Wednesday.

 

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