MNsure is “Minnesota’s one-stop health insurance market place.” Five percent of Minnesotans who are self-employed and other individuals not getting health insurance through their employer can get their health insurance through brokers, insurers, or MNsure. About 270,000 people statewide get their coverage through the individual market.
Governor Mark Dayton, who has been an avid supporter of the Affordable Care Act (ACA), widely tagged as Obamacare, stated on October 12, “The reality is, the Affordable Care Act is no longer affordable for increasing numbers of people.” MNsure premiums are expected to increase substantially for 2017, 50% or more. Dayton is considering calling a special session after the general election to address the escalating cost of health care. It should also be noted that he said last month that due to the ACA, “We have the lowest rate of uninsurance in our state’s history.”
Increases are expected for those individuals who go out and buy their own insurance and also those who buy through MNsure, where many qualify for discounts. MNsure applications can be made through a broker or online.
Fillmore County residents that need to apply for individual health care are encouraged to make their application with the help of social service employees that understand this complicated system to assure that questions are answered fully and accurately. It is important that any changes in income and other factors be reported accurately with each year’s application. To get a better understanding of the process, I met with Fillmore County social services manager Neva Beier, and eligibility workers Deb Leutnik, Terri Root, and Valerie Arnold.
Leutnik explained their are four levels in which MNsure applicants may be placed. The level is determined from answers given to the questions in the MNsure program, like income and household size. The levels include Medical Assistance for low income people, MNCare which is premium based state health care for the working poor, Insurance Assistance and Tax Credits for people with a step higher income, or an Unassisted Qualified Health Plan for those cut off from any assistance because they are over income eligibility limits. Once a MNsure application is submitted, the applicant will receive an eligibility notice from the state letting the applicant know exactly what the individual or family members qualify for.
Leutnik said these are scary times, referring to the politics surrounding MNsure and the ACA. Root said MNsure is its own entity and the only platform to use for health insurance applications. She added that an insurance broker may also recognize that an applicant could qualify for assistance programs. Leutnik said those with employer provided health care will not qualify for MNCare.
MNsure applications for 2017, in the event that there are no changes in the answers to MNsure program questions from last year, will be able to be submitted automatically for the first time this year, simplifying the process. Leutnik commented that the system is better than it was when it was initiated in the fall of 2013. Root said the system serves its function very, very well. Seventeen hundred families have been helped with their applications by county social services.
At the federal level, income data that is reported inaccurately will result in an alert. County employees do not see the data, but receive an alert that the data doesn’t match. This alert system can prevent abuse of the system. There is also a Minnesota Department of Employment and Economic Development (DEED) hub that looks at income data and will send out an alert if the data doesn’t match.
Leutnik maintained MNsure is working for our clients, allowing clients to get the care they need. She suggested the losses that insurance companies are claiming are in part do to people going to health care providers to get treatment for issues that hadn’t been treated before. I took this to mean that issues that have been ongoing are now being treated, including issues that also may have become more serious because they were not treated early on. People are encouraged to go in for well check-ups/preventative care.
Prior to the ACA, social services worked with Medical Assistance clients; now they also work with MNCare clients. Beier said the goal of the state is to streamline the process. She suggested the process is overly complicated and it can take up to 20 minutes for a worker to change an address. Some people are confused and frustrated by the process. Another eligibility worker, Arnold, was recently hired to help with the large number of clients during the sign up period. Beier ended her comments stating many families within the county would be impacted without the benefits provided through ACA.
ACA, enacted in 2009, has allowed 20 million Americans to get health insurance that had none previously. Individuals with pre-existing conditions can not be denied insurance.
There is general agreement that ACA has problems. Dayton has made that clear. The problem is the affordability of health care especially for those who aren’t income eligible for supplements. In 2015, 70% of MNsure applicants qualified for some kind of assistance. Minnesota tax breaks are not available for individuals with a net income over $47,000 or a family of four with a net income over $97,000. For many, the rising premiums, along with the much higher deductibles, have made the purchase of individual health insurance unaffordable.
It was announced by Blue Cross Blue Shield in June that they will not sell policies in the individual market in 2017. The company blames the need for rate increases on “higher than expected medical costs and increased usage of covered medical expenses.” Department of Commerce commissioner Mike Rothman has suggested the rate hikes are not sustainable. In order to retain the participation of insurance companies in the program, large rate hikes were approved for the remaining participating insurance companies, increases upward of 50% in 2017.
There seems to be some agreement that MNsure at the state level and ACA at the federal level need to be fixed. Many still advocate repealing ACA and starting over. Minnesota Republicans want to lower premiums and deductibles, offer more choices, and make the system more efficient. These goals are laudable, but will be difficult to achieve while keeping health care widely accessible.
One thing contributing substantially to higher medical costs is the sometimes out of proportion cost of drugs. Dr. Jeffrey Sachs recently appeared on a morning news show that I happened to be watching. He explained that Medicare can’t negotiate with pharmaceutical companies over the price of drugs that are purchased. In 2003 when Medicare was extended for drug coverage, pharmaceutical companies lobbied to have a clause included in the legislation which did not allow the federal government to negotiate drug prices. He suggested the clause was allowed to remain in the legislation because politicians have and are accepting large donations for their reelection campaigns from these companies. Sachs illustrated his point with a drug used to treat hepatitis C, which can be produced for about $1 per pill and is sold for $1,000 per pill. The drug, Sovaldi, is sold by Gilead Sciences, a biopharmaceutical company. A three-month regimen to treat hepatitis C costs $84,000. An investigation was initiated in 2014 by the Senate Committee of Finance into the pricing of this drug.
Keeping health care accessible while offering affordable rates will require not only efficiency, but also will require an eyes wide open look into what drives medical costs.
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