When Blue Mountain Clinic Executive Director Anita Kuennen sought health insurance for her staff, she dropped her family’s coverage thinking that the clinic’s group rate would prove less costly than her family’s. She was wrong.
“What I didn’t understand was that it actually increased the rate,” Kuennen says. “It didn’t offset the prices for our group rate to have more people.”
Kuennen’s dilemma underscores a report released May 28 by Health Care for America Now! that pins skyrocketing premiums on the consolidation of Montana’s health care industry. The report specifically calls out Blue Cross/Blue Shield Montana (BCBS), Missoula’s largest health care provider. The report alleges BCBS controls 75 percent of the state’s market, but the company and the state auditor’s office argue that number is closer to 43 percent.
“In theory, the bigger the pool, the more we spread the risk,” explains Steve Seninger, director of the Health Care Policy Research Program at the University of Montana. “That should lead to more stable premiums. But at the same time, there’s a lot of monopoly power in the market.”
The key, Seninger says, is to compare the rising cost of health care to rising premiums. “When you look at the national data and the data for Montana, premiums have been going up faster than the overall health care cost index,” he says. “It’s a way [for health insurance companies] to stay ahead of the game.”
Frank Cote, senior director of government relations at BCBS Montana, disputes that his company’s position in the market leads to higher premiums.
“If you have a good, responsible company,” he says, referring to BCBS, “and people are happy with the service they’re receiving, then it’s okay.”
In Kuennen’s situation, Cote kicks the blame to state lawmakers. He says state regulations dictate the variance in premiums for small groups like the Blue Mountain Clinic.
That’s little consolation for Kuennen. She dropped her family from the Blue Mountain Clinic’s insurance plan because it was too expensive and is currently shopping for another private plan.