AUDIE CORNISH, HOST:
In California, the Affordable Care
Act is seen as successful, but it still has a competition problem. Nearly 30,000 people in California have only one insurer to pick from on its exchange. Pauline Bartolone, from Capital Public Radio, traveled to the mountains of Northern California to see what this is like for patients.
PAULINE BARTOLONE, BYLINE: Dennie Wright lives an Indian Valley, a tiny Alpine community at the northern tip of the Sierra Nevada Mountains, close to the Nevada state border.
DENNIE WRIGHT: We're back in the backcountry, you might say, but it is a beautiful place to live and that's why we choose to live here.
BARTOLONE: But it's not a place that insurance companies prefer to do business. In 2014 a major insurer, Blue Shield of California, stopped selling policies to individuals in many parts of Northern California. That left Anthem Blue Cross as the only insurer selling in all of that region on the exchange. Dennie Wright has one of those Anthem Blue Cross plans. He also has piles of medical bills and and insurance paperwork from over the past year. He had several heart related emergencies and was flown across the state border to a Nevada hospital.
D. WRIGHT: One of the things they don't want you to do is to get stressed out, and when you look at a bill like that think it might not be covered, there's nothing much more stressful than that.
BARTOLONE: The problem is Anthem Blue Cross covers emergencies out-of-state, but not routine care. Wright is still going back and forth with the insurer to get his Nevada care fully covered. And he's not sure what, or if, the company will pay if he continues to see the doctors in Nevada who are most convenient for him. Wright says the system makes no sense to him.
D. WRIGHT: I mean, you should have some choices, and especially if you're going to have one that's not going to cover you in the places you choose to go.
BARTOLONE: Thousands of Californians may feel like Dennie Wright. People in zip codes all across Northern California who need financial help to buy coverage are stuck with one insurer in Covered California. The exchange is discussing how to change that, but Executive Director Peter Lee says the insurance market in rural Northern California has been difficult for a long time.
PETER LEE: 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 how to improve access and choice and we'll continue doing that.
BARTOLONE: Covered California should help increase the number of insurers, says consumer advocate Anthony Wright from Health Access. He says policymakers should also lean on insurers and providers to participate in that market.
ANTHONY WRIGHT: 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.
BARTOLONE: Wright says more insurers in the marketplace make it more likely people can get the care they need.
A. WRIGHT: At one level we're trying to make a functioning market, but it still means that consumers are at the mercy of the market.
BARTOLONE: There are other health insurance options for Dennie Wright, but not through Covered California. Not everybody knows about those options or can afford them. For NPR News, I'm Pauline Bartolone in Sacramento
CORNISH: This story is part of a reporting partnership with NPR, Capital Public Radio and Kaiser Health News.