Rural residents confront higher health care costs, exacerbated by Affordable Care Act
"Either they're mad as all get-out, or I can hear them crying on the phone. It just breaks your heart," said Hardin, whose customers are seeing monthly premiums that cost at least $500 a month more than if they'd lived in Atlanta. "I think there was the idea that it might reduce costs, and now they're seeing that it's not."
Some are even considering moving to avoid the premium increases.
In Gardnerville, Nev., about 50 miles south of Reno, freelance writer Tim Plaehn is considering moving to Uruguay, where he and his wife lived for a time and still have friends.
Plaehn pays about $400 a month in premiums but expects his tab to rise above $1,000 when his current plan expires. He makes too much to qualify for insurance subsidies but isn't sure he can afford the jump.
"I'm hoping something will change in the law to make it more affordable, because otherwise, something's going to break," he said.
Some premiums in Las Vegas are about $600 a month cheaper, but he said he doesn't want to live there.
Colorado Insurance Commissioner Marguerite Salazar has traveled to several rural regions to explain the rates to angry customers.
At the meetings, state insurance officials pass out the actuarial data behind the premiums, including details from Colorado's All Payer Claims Database, which lists hospitalization rates and other factors used to determine the cost of health care in a region.
Salazar then walks residents through the differences and says that state officials cannot lower rural rates without driving insurers out of the market.
"They've got to have rates that will allow them to pay the doctors," Salazar said at a November meeting in Greeley, a northeastern Colorado town where rates are higher than Denver.
Salazar recently announced a task force to review the rating zones, but added in a public statement that any changes would have to be based on new data.
Her spokesman, Vincent Plymell, said there is nothing state regulators can do. There are no easy short-term fixes to reduce costs in rural areas, where everything from MRIs to baby deliveries costs more, he said.
"Costs are higher like they are for housing or food or everything else. Health care costs aren't something we have the ability to control," Plymell said. "It's easy to kind of point the finger and say it's the big, bad insurance companies, but it's a lot more complicated than that."
U.S. Rep. Jared Polis, a Colorado Democrat whose district includes part of the state's expensive mountain region, appealed last year to U.S. Health and Human Services Secretary Kathleen Sebelius for a waiver for such areas.
Sebelius replied that the matter is a state issue. There would be no federal assistance for variances in state-approved health insurance rating areas.
"I'm somewhat frustrated that there are waivers being extended to small- and mid-size businesses, yet individuals are being faced with costs that they can't afford," Polis said.
For now, health advocates in rural Colorado say they have few answers for patients who want to buy insurance, but simply can't afford it because of where they live.
"People really see the value of insurance up here, and they're mystified about why our premiums are so much higher," said Tamara Drangstveit, executive director of the Family and Intercultural Resource Center in Frisco, Colo., about 25 miles east of Vail in the heart of the state's ski country.
"They want insurance," Drangstveit said. "They don't want to break the law and get a fine, but they live in a certain area and they have no choice."
Kristen Wyatt can be reached at http://www.twitter.com/APkristenwyatt
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