Markian Hawryluk, Kaiser Health News
A wildfire displaced thousands of Coloradans just as the omicron surge began sweeping through the state, so health insurance was likely not on many people’s minds when the regular enrollment period for the state’s health insurance marketplace ended Jan. 15. But now, because of those twin emergencies, everyone in the state will get another chance to sign up.
State officials on Wednesday launched a special marketplace enrollment period, through March 16, open to all uninsured Coloradans regardless of whether they’ve been directly affected by the fire or the covid-19 surge.
The Marshall Fire started on Dec. 30, just two weeks before the deadline to sign up for a 2022 plan. The fire destroyed more than 1,000 houses and businesses, quickly becoming the state’s most destructive fire by number of structures lost.
“It’s such a disruption to people’s lives,” Colorado Insurance Commissioner Michael Conway said. “It’s not just the people who lost their homes — it’s across the board, affecting the entire community.”
Meanwhile, the emergence of the omicron variant of the coronavirus caused covid cases to spike to record levels in January, stressing hospitals and health systems.
“These folks are just trying to put their lives back together,” said Kevin Patterson, CEO of Connect for Health Colorado, the state’s health insurance marketplace, created under the Affordable Care Act. “So giving them some additional time seemed like a reasonable and thoughtful thing to consider.”
In addition to providing immediate relief to Coloradans in a crisis, the move underscores how much industry attitudes toward the Affordable Care Act have changed. Insurance companies were initially skeptical about the financial risks and worried that consumers would game the system. But the insurers have largely embraced the exchanges and are working to sign up as many people as possible. After experiencing few problems during the special enrollment period held last year because of covid, health plans have agreed to the removal of safeguards — such as a limited window of time to sign up for coverage — that regulators once required.
“Amid the recent COVID-19 surge and tragic wildfires, it is important that people in Colorado have the opportunity to obtain health care coverage,” Patrick Gordon, CEO of the Rocky Mountain Health Plans, said in an email.
Such periods have often been limited in scope and sometimes required people to provide proof they had been affected.
Colorado state officials are taking a different route. They opted to make signing up for coverage as easy as possible and are not requiring consumers to demonstrate they qualify.
“It didn’t seem like something that was necessary, especially when we look at our experience over the last year,” Conway said. “The vast majority of the year was effectively a special enrollment period, and there wasn’t that much disruption in the market.”
Insurance analyst Charles Gaba said there are three primary reasons for limiting health plan sign-ups to an open enrollment period.
The first is that deadlines spur people to sign up. Each year, enrollment numbers spike in the final days of the sign-up period.
Second, insurance companies need time to analyze their revenue and costs to set premiums for the following year. That process, Gaba said, typically begins in March.
Third, and most importantly, insurance companies initially lobbied for a limited open enrollment period to keep people from waiting until they are sick to buy insurance. That changed during the pandemic. Colorado and most other states that run their own exchanges held special enrollment periods in 2020 and 2021 because of covid. When the Trump administration declined to do the same for the federal exchange, health insurance trade groups urged it to reconsider. The incoming Biden administration agreed and extended the enrollment period through August 2021 — and more than 2.8 million additional Americans signed up for coverage.
Conway said no evidence exists that consumers waited until they were sick to buy coverage last year. With so many consumers eligible for no-cost or low-cost plans because of more generous subsidies, there is little reason for them not to sign up immediately.
“As health policy folks, sometimes we get into our heads and we see monsters under the bed that simply are not there because of the complexity of the system,” Conway said.
Health plans in Colorado were largely supportive of the move. John Roble, president of Cigna’s Mountain States market, said the company is allowing early prescription refills and is working with local hospitals to transfer patients to help alleviate crowding at overwhelmed facilities.
Past special enrollment periods largely attracted a healthier population than standard open enrollment periods. Those with chronic health conditions, who face the potential of high medical bills, usually enroll early in the standard open enrollment period.
“They are first out of the gate,” said Louise Norris, who operates a Colorado health insurance brokerage with her husband. “They’re ready to sign up Nov. 1.”
The procrastinators are those generally less concerned about their health and more apt to leave things to the last minute, she said. The added time will also help people who chose to go without insurance but then experience a significant medical problem after the standard open enrollment period closes, she said.
State officials said new health concerns stemming from the fires and the omicron surge may also make health coverage more important for some Coloradans.
Consumers benefit when more people, particularly more healthy people, enroll. “The more people that get covered, the more stable the overall risk pool is, the more stable the premiums are for consumers,” said Adam Fox, deputy director of the Colorado Consumer Health Initiative, a nonprofit consumer advocacy group. “All of those things help people stay covered.”
States that run their own exchanges often extend the deadline for signing up another week or two to give late-comers extra time. But it’s not clear whether any other states will follow Colorado’s example and provide a two-month or longer window in response to the omicron surge.
“Without the fires, I’m not sure that they would be thinking about it,” Conway said.