Pathologists may be surprised to learn that the nation’s highest-cost markets for health insurance include Colorado ski resorts and rural regions
What do the 10 most expensive U.S. health insurance markets have in common? According to a story published by Kaiser Health News, the 10 highest-priced markets are characterized by lack of competition among doctors, hospitals and insurers.
That will probably not be a surprise to most clinical laboratory managers and pathologists, particularly if they work for a health system that has lots of market clout in their community. That’s because concentration of market share by just a few powerful hospitals or health systems is associated with higher prices for healthcare. However, there are exceptions.
Kaiser Researchers Studied Regional Markets for Health Insurance
To identify the nation’s regions with the highest cost for health insurance, researchers at Kaiser identified the highest cost of a Silver Plan in each region. In every state, health insurance exchanges established by the Affordable Care Act (ACA) offer Bronze, Silver, Gold, and Platinum plans.
According the report, published by Kaiser Health News, the type of coverage most often selected by consumers is the Silver Plan, which is a mid-range option.
The 10 highest-priced health insurance markets range from Colorado ski resort towns to Connecticut suburbs and rural regions of Georgia, Mississippi and Wisconsin, according to the Kaiser story.
Dark Daily Reported on the Least Expensive Health Insurance Markets
Kaiser Health News also reported the least expensive markets for health insurance. Dark Daily’s coverage of that side of the story revealed that insurance premiums were ranked lowest in areas like Minneapolis-St. Paul—cities with robust competition and deep experience with managed care. (See Dark Daily, “Kaiser’s Ranking of 10 Least Expensive Markets for Health Insurance Contain Surprises and Show Where Prices for Pathology and Clinical Laboratory Testing May be Cheapest,” March 3, 2014.)
But while the low price of $154 is a monthly premium paid by a 40-year-old in Minnesota, a whopping $483 per month may be paid by a resident of the same age in the Colorado mountain resort region. And $461 is the monthly premium paid by someone living in rural Baker County, Georgia. (Kaiser did note that these monthly premiums do not reflect any government subsidies for which an individual may qualify.)
“The causes of the stratospheric premiums vary from region to region, although a recurring theme is that in some areas the limited number of hospitals and specialists allows them to demand high prices from insurers,” Kaiser Health News reported.
10 Most Expensive Markets for Health Insurance in the United States
Kaiser Family Foundation researchers ranked the expensive health insurance markets by the lowest cost Silver Plan for a 40-year-old. The 10 most expensive markets, including specific counties, are:
- $483; Colorado Mountain Resort Region. Eagle, Garfield and Pitkin counties, location of Aspen and Vail ski resorts. (Summit County premiums are $462).
- $461; Southwest Georgia. Baker, Calhoun, Clay, Crisp, Dougherty, Lee, Mitchell, Randolph, Schley, Sumter, Terrell and Worth counties.
- $456; Rural Nevada. Esmeralda, Eureka, Humboldt, Lander, Lincoln, Elko, Mineral, Pershing, White Pine and Churchill counties.
- $445; Far western Wisconsin. Pierce, Polk and St. Croix counties, near the St. Paul, Minn. (Interestingly, Minneapolis-St. Paul was ranked the least expensive health care market by Kaiser.)
- $423; Southern Georgia. Ben Hill, Berrien, Brooks, Clinch, Colquitt, Cook, Decatur, Early, Echols, Grady, Irwin, Lanier, Lowndes, Miller, Seminole, Thomas, Tift and Turner counties.
- $405; Most of Wyoming. All counties except Natrona and Laramie.
- $399; Southeast Mississippi. George, Harrison, Jackson & Stone counties (In Hancock County, $447 is the lowest price plan.)
- $395; Vermont. All counties.
- $383; Fairfield, Connecticut. (The southwestern-most county that includes New York City commuter areas.)
- $381; Alaska. All counties.
Characteristics of Most Expensive Health Insurance Markets
Lack of competition in the markets is one of the main reasons for the higher pricing. Other reasons include poor health of the population and actuarial tables themselves. Kaiser researchers took a look at the Colorado All-Payer Claims Database and reported that, in Summit County, the average hospital inpatient cost was $786, 61% above the state average.
A New York Times analysis concluded that a goal of the ACA—to increase competition among insurance companies—is not being met in rural areas. The Times noted that insurers do not want to enter markets where medical costs are high or dominant players exist.
“There’s nothing in the structure of the Affordable Care Act which really deals with that problem [of little competition],” observed John Holahan. “I think that all else being equal, premiums will clearly be higher when there’s not that competition.” Holahan is a fellow at the Urban Institute and was quoted in The New York Times story.
Lessons and Insights for Clinical Laboratories and Pathology Groups
For pathologists, medical technologists and other laboratory leaders and professionals, health insurance marketplace issues are important to understand. Lessons can be learned from diverse areas like Colorado, Georgia and southwest Connecticut, where characteristics such as lack of competition, rural landscapes and poor health of populations have resulted in markets where, for now, health care seems to come at a higher price—even with the ACA in effect.
—By Donna Marie Pocius
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