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.