The free market has reached Teton County’s health insurance system.
Mountain Health Co-op, a nonprofit insurer that moved into Wyoming this year, has come to an agreement with St. John’s Health to bring the hospital into its network. Until now, Teton County was the only place in Wyoming the co-op wasn’t planning on covering because it lacked a contract with St. John’s.
“If you haven’t had coverage before, or want to switch to the co-op, call us. We understand that getting covered can be confusing and we are here to help every step of the way,” CEO Richard Miltenberger said in a press release.
Health insurance cooperatives are private, nonprofit insurers, which differ from for-profit companies. As nonprofits, they reinvest the money they make into the company, either by offering lower rates or more services.
Mountain Health, for instance, has used profits in recent years to add coverage for insulin, as well as some vision and dental benefits.
“This is so refreshing because the goal is not to take money out of the system,” Miltenberger told the News&Guide.
The Affordable Care Act incentivized such cooperatives by offering some subsidies and grants to them.
“The nonprofit organizations were a last-minute addition to the 2010 health law to satisfy Democratic lawmakers who had failed to secure a public option health plan — one set up and run by the government — on the marketplaces,” Kaiser Health News reported in a story earlier this year.
Many were not able to stay in business during the tumultuous years following the passage of the landmark health care legislation. Larger, more established health insurance companies outcompeted them on the marketplaces because they had name recognition and stronger financial backing.
Mountain Health Co-op is one of three that remain in the market. After gaining a foothold in Idaho and Montana, the co-op expanded into Wyoming.
“We’d like to create an opportunity for people to have an option, which they don’t right now,” Miltenberger said.
Blue Cross Blue Shield of Wyoming has been the sole marketplace insurer for Wyoming for quite some time, and the co-op offers the first competition Teton County residents have seen in a while for individual plans. In a capitalistic economy like the United States’, Miltenberger said, competition is ultimately good for the consumer.
He compared it to a town having a Safeway grocery store, then seeing another grocery store open. People would likely check out the new store to compare prices and quality before making the decision to stick with Safeway or jump ship.
“That doesn’t mean that you know you don’t like Safeway if you want to have another grocery store in your town,” he said.
For American consumers, however, health care isn’t like going to the grocery store. Competition doesn’t operate the same way, in part because it is so expensive and entry into any market is often too costly for new companies.
According to Seema Verma, administrator of the Centers for Medicare and Medicaid Services, a lack of competition harms consumers.
“There are many drivers of high prices, but provider consolidation is an important one — when there are fewer competitors, patients have fewer choices and prices go up,” she wrote on the agency’s website. “Worst of all, when a single monopoly controls a market, there is no restraint on costs, and no pressure to improve quality.”
Against the odds of health insurance co-ops folding, Mountain Health Co-op is creating such competition in Jackson. It announced earlier this year that it was moving into Wyoming, buying a preferred provider network of contracts with hospitals in the state to make most of them in its network.
St. John’s was the only hospital in Wyoming that was not part of that provider organization, and Miltenberger said at the time that he hoped to get a contract in place this year. As of Monday’s announcement, it appears he got his wish.
Consumers thinking about Mountain Health have just a few weeks left to sign up. Open enrollment for plans on the Affordable Care Act marketplaces began Nov. 1, and it lasts until Dec. 15.
During that period, anyone can sign up for health insurance plans. Outside that six-week window, you must have a qualifying event, like losing your employer-sponsored health care plan or moving to a different county.
St. John’s Chief Financial Officer John Kren characterized the decision to bring the hospital into the Mountain Health network as a win for local patients.
“This is just another example of how St. John’s Health demonstrates our commitment to better serving all of the patients in our community and surrounding communities by continuing to find innovative ways to provide access to highest quality care possible,” he wrote in an email. “Being in network with so many top tier and excellent partner networks is just another way of moving the dial on this vision.”
This story has been updated. The original indicated that Blue Cross Blue Shield of Wyoming is a for-profit company. It is a nonprofit. — Eds.