Rural Oregonians Paying Much Higher Premiums under the Exchange

In particular, Malheur, Umatilla, Wheeler, Morrow and Jefferson counties are the hardest hit, while those living in Washington and Clackamas counties have the biggest advantage.

As people scramble to make the Dec. 15 deadline to sign up for healthcare.gov so they can have coverage starting Jan. 1, it’s become quite apparent that those living in rural counties are having to pay substantially more for their insurance.

Meanwhile, the Oregon Insurance Division has not received any new numbers since Nov. 30 about the number of people who signed up for the federal exchange – www.healthcare.gov –and anticipates more recent data will become available late next week, according to Lisa Morawski. Between Nov. 15-30, the numbers stood at 19,220 people, but no indication about which health plans these people had chosen.

Also, two plans – Moda Health and LIfeWise Health Plan – intend to continue offering individual coverage outside the exchange, according to Richard Skayhan, an insurance broker with Leonard Adams, who seeing a flow of people coming onto the exchange.

How affordable is the coverage?

Meanwhile, in order to assess affordability, The Lund Report examined the average premium of health plans as a percent of per capita income. Our analysis revealed that Malheur County has the least affordable coverage, with health insurance premiums costing, on average $319, or 23 percent of the per capita income of residents. Umatilla, Wheeler, Morrow and Jefferson counties come in a close second with premiums costing on average $319 representing 19 percent of the per capita income.

On the other end of the spectrum,  people living in Washington and Clackamas counties have the most affordable premiums as a percent of their per capita income, with rates averaging $283 for all adults, with these premiums representing 11 percent of the per capita income in both counties.

These percentages were calculated by multiplying the monthly average premium by 12 and dividing by the per capita income of each county. 

Across the state, the average premium for an individual ranges from $272 to $335 for those aged 21-60, with Moda Health once again offering the lowest average monthly  premium rate of $272, compared to the plan sponsored by Regence BlueCross BlueShield – known as BridgeSpan Health Company – having the highest costs, $335 on average.

When it comes to deductibles, the Oregon Health CO-OP came in at the lowest amount, $1,600 annually, followed by LifeWise Health Plan, $2,463, Health Republic Insurance Company, $2,865 – while ATRIO Health Plans had the highest deductible, $5,000 compared to BridgeSpan Health Company at $4,074.

  • In 2015 the medical deductibles have more than tripled over the past four years, and the average medical deductible for an individual has risen from $1,031 to $3,256, and the average medical deductible for a family grew from $2,315 to $6,512.
  • When looking at health plan costs as a percent of median family income, the average cost of the ‘Couple+ 1 Premiums’ were calculated. This was chosen because the average family size is ~3.1 in the U.S.

Grant and Wheeler Counties have the highest family premiums ($691) as a percent of the county’s median family income ($43K) at 19 percent. Clackamas and Washington Counties have the lowest premiums ($612) as a percent of median family income ($74.5k and $77K respectively) at 10 percent. Unsurprisingly, Clackamas and Washington Counties have the top two highest median family incomes in the state.  

  • The percent difference between the highest per capita income, $31k (in Clackamas), and the lowest per capita income, $16k (in Malheur), is 94 percent. In comparison, the percent difference between the eight counties with the highest average premium of $319, and the two counties with lowest average premium of $283, is a much more modest 12.7 percent difference. This data shows that while insurance premiums are indeed higher in lower income counties, the plan availability is not a limiting factor for individuals and families.
  • Clackamas, Multnomah, and Washington County offer the most number of plans with 86 in each county, and the more rural counties such as Malheur, Grant and Jackson have the fewest options. 

FURTHER INFORMATION

  • The data analyzed also shows the following:
  • Average premium metal levels
  • Average premium by insurer
  • Family premiums
  • Average deductibles
  • Per capita income by county
  • Average premiums by county

Note: Per capita, median family income and county population data were gathered from Wikipedia.http://en.wikipedia.org/wiki/List_of_Oregon_locations_by_per_capita_income

An “Availability Index” was developed to determine how many plans are available relative to the population so there can be a more concrete Number of Plans/County Population x 1000.

The statewide average availability is .57. The minimum number of plans offered in a given county is 54 so very small counties such as Gilliam, Sherman, and Wheeler have very high indexes of 28 or above.

The larger counties such as Clackamas, Multnomah, and Washington have indexes of .22, .11, and .16 respectively. This indicates that the availability of plans to smaller counties is not a factor in determining if the insurance is affordable or accessible.

Each county has health plan options from at least 7 of the 10 issuers.

Jen can be reached at [email protected]

Diane can be reached at [email protected].

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Comments

There is no silver lining with silver health plans sold through Obamacare.

The Lund Report should take a look at how many plans are depending on co-insurance for services. Without price transparency, this cost is an unknown known--in Rumsfeld parlance. The insurance companies know they can fix prices to be unaffordable when co-insurance puts the squeeze on patients. The same goes for drug prices that will be tiered this way. PhRMA is a big winner!

Ironically, insurance companies can claim all their expenditures to improve cost and quality of care constitute patient care with the "new and improved" medical loss ratio. This is particularly repugnant when insurance companies claim that divulging health care prices is "anti-competitive." Its why spending money on the All Payer All Claims database will do nothing to actually achieve its mission of decreasing costs and improving quality of care.

Limited networks and benefits are another way insurance companies get away with murder--literally. A patient can be admitted to the hospital from the ER and get services from doctors that are not on their health plan. These expenses won't accure to out-of-pocket maxium. And so it is true for benefits. But try to access that fine print when buying a health plan!

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