When patients walk into Dr. Michael Pramenko’s office in Grand Junction these days, they often walk in worried.

Already, residents of Colorado’s Western Slope pay more for health insurance than just about anybody else in the country while also having a smaller selection of insurers to choose from. The Republicans’ health care bill in Congress —which may yet be revived —could up their costs even more.

And now, the Western Slope is bracing for more possible bad news about its health coverage. This month, Wall Street analysts who met with insurance giant Anthem reported that the company is “leaning toward exiting a high percentage” of the Affordable Care Act exchanges in which it currently participates. If that happens, it could leave as many as two-thirds of the counties in Colorado with no or only one insurer available on the state’s health insurance exchange. Almost all of them are in rural mountain areas.

“It would be devastating to our exchanges if they dropped out,” Lt. Gov. Donna Lynne said.

And all these looming threats are weighing on patients, said Pramenko, a family medicine physician who is a past president of the Colorado Medical Society. Last week, for instance, he saw a 57-year-old patient who is already paying $1,000 a month for coverage.

“He doesn’t like the Affordable Care Act,” Pramenko said, “but now he’s wondering if he’s going to have any way to buy insurance next year.”

Lynne and others cautioned against premature panic.

A spokesman for Colorado’s Division of Insurance said the division has not heard from any insurers that plan to drop off the state’s exchange — known as Connect for Health Colorado — in 2018. Lynne said state officials are reaching out to insurers to find ways to keep them in the market.

In an email, a spokeswoman for Anthem said it is too early to comment on the insurer’s 2018 plans. Insurers must submit their 2018 plans to the state for review in May, though it is likely the deadline this year will be pushed back into June.

Nationwide, there has never before been a so-called “empty shelf” county with no insurers on the exchange.But 2018 will likely see the first. Humana’s announcement this year that it will abandon the exchanges means that several counties in Tennessee look to be without options for 2018.

An Anthem exit would have an even bigger impact nationwide. If it were to leave all 14 states where it currently offers plans on Affordable Care Act exchanges, about 250,000 in 300 counties would be without a single choice, according to the Robert Wood Johnson Foundation. In Colorado and elsewhere, Anthem and other insurers also sell individual plans off the exchange. But those plans may not meet the same standards as the exchange plans and people cannot use federal tax credits to help pay for them.

Barry White The Health Insurance Guy
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Barry White The Health Insurance Guy

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