“That was new to us, you know, Covered California. Anthem Blue Cross was the insurance carrier," Wright said. He signed up, and three months later suffered a heart attack.
It was a rough year for Wright overall. First it was the heart attack, then he was assaulted at work, and there were more heart-related emergencies. More than once, he was flown across the state line to Reno for care.
Like other people in this remote area, Wright learned that Anthem Blue Cross only covers out-of-state care for emergencies. For routine care, people need to select a doctor in California. But Wright says travel to doctors in California, even though it is in his own state, is not as safe or convenient as going to Reno. Now, Wright and his wife, Kathy, have piles of medical bills and insurance denial letters.
Wright continues to see the Nevada doctors who put a defibrillator in his chest. State workers' compensation and Anthem Blue Cross will pay for some of the bills, but the Wrights don’t know if everything will be covered.
“One of the things they don’t want you to do is get stressed out," says Dennie Wright. "When you look at a bill like that, thinking it might not be covered, there’s nothing much more stressful than that.”
Rural Northern California Insurance Problems Pre-Date the Affordable Care Act
There are other options for Wright, but not through Covered California. Wright made too much money to qualify for a subsidy, so he could have picked a plan outside the Covered California exchange. But his insurance agent didn’t know that was an option. For people who depend on the subsidy to afford health insurance, Anthem was the only choice through Covered California.
Covered California executive director Peter Lee offered a different impression of choices in the marketplace last July.
“In every corner of the state, consumers will have at least two plans to choose from, and in most areas, where most of the Californians live, they can choose between five or six plans,” said Lee during an event to announce the marketplace's 2015 plans and premium rates.
But information released for a Covered California board meeting this month shows that 22 counties in Northern California have areas where there is only one choice of insurer.
Lee says now the exchange is working to increase the range of choices in places where there are none. But he says the situation pre-dated the exchange.
"The challenges of northern, rural counties have been there for a long time and are still a challenge that we’re trying to address head-on," says Lee.
Lee said the exchange is encouraging existing plans to expand to areas where there are enough doctors. And it’s looking to bring in new carriers in 2016.
"We aren’t the solution to all the problems that have always been there in terms of challenges in rural communities, and that’s something we’re certainly looking at how to improve access and choice," says Lee.
Health consumer advocates agree that Covered California can have a powerful role in shaping insurance options. Still, Anthony Wright, executive director of Health Access says increasing choice in rural areas is not simple.
"Some of this is a combination of putting pressure on the insurers, and some of this is trying to do work to actually increase the number of providers on the ground in these areas, whether through more training, incentives to be in some of these more rural areas," says Wright.
Wright says more insurers in the marketplace makes it more likely that people can get the care they need.
“This is one of the reasons why we advocated for a public option, a public plan. Just like yes, you have UPS and FedEx, but you also have the United States Postal Service that goes everywhere and provides some guaranteed service to everybody," he says.
"At one level, we’re trying to make a functioning market, but it still means that consumers are at the mercy of the market.”
This year, people who want more choice than what Covered California offers, must venture into the broader health insurance market if they can afford it.
