Why babies born on Oct. 20 hit the jackpot and the financial woes of some government A-listers.
Oct. 19--Plenty of choice.
That's what the Affordable Care Act intended to provide health-care plan buyers, in hopes that competition would reduce cost.
And it's worked out that way in most areas: Consumers in the Twin Cities have 66 plans to choose from on the MNsure health care exchange; in St. Cloud they had 32, and even Bemidji has 30 plans.
Rochester? Consumers only get one single plan to choose from.
And not a very comprehensive one either. It's a silver level Blue Cross and Blue Shield of Minnesota plan with a $3,000 deductible, costing $384.25 a month for a 40-year-old non-smoker. That's more than the same plan cost anywhere else in the state.
"It's very, very disappointing," said Robert Coates, a 61-year-old retired school psychologist who wants to replace a private health insurance plan that's being phased out. "I was really looking forward to getting some better coverage for less monthly, and it looks like it's going to cost me almost twice as much, not to mention the lack of choices."
Since the site opened Oct. 1, local consumers have been stunned at the lack of choice, even as the Jan. 1 deadline for getting health insurance under the ACA is approaching rapidly.
The ACA, which will mandate that all Americans get health insurance, requires that all states provide insurance exchanges such as MNsure to provide an "apples-to-apples" comparisons of health plans from multiple insurers and an easy way to enroll. Low-income people who sign up receive assistance when enrolling to cut the cost.
Coates paid $224 a month through the Iowa Farm Bureau plan he had, but for the MNsure plan, with subsidies, he might pay $400 a month. If he lived in Dakota County, he would pay less than $100 a month for the plan, he said.
Elsewhere in southeastern Minnesota outside of Rochester, consumers have also have a fairly limited menu of 13 plans, including no platinum plans.
Why? Mayo Clinic's relatively high fees -- for high-end care -- and its dominance in the market may be a factor, many say.
"They (Mayo) may say here's our price list, take it or leave it, and insurance companies are saying it's hard to meet people's expectations for affordable insurance when we have to pay these kind of prices to providers," Minnesota health care analyst Allan Baumgartensaid. "I'm just speculating, but I think it's reasonable speculation."
In an emailed statement, Mayo Clinic spokesman Bryan Anderson said the clinic is "disappointed with the plan offering in southeast Minnesota, and will do all we can to make certain insurers understand what we are doing to provide efficient, high quality care to our patients."
Multiple factors have driven a different strategy for plans in the Twin Cities, including competition for market share, narrow networks, and demographic factors, as rural areas tend to have older populations with higher health care costs, Anderson said.
"Mayo Clinic remains committed to driving greater efficiency in our delivery of care, and we are making progress," the statement said. "Our staff are involved in hundreds of projects to improve quality and reduce expenses, to reduce the cost of care to our patients. We do believe that our outcomes provide value to patients that are not necessarily reflected in current reimbursement models."
MNsure has heard complaints about the issue, and it's working with the Departments of Health and Commerce, and are legislators, to seek solutions, said Jenni Bowring-McDonough, media relations coordinator for MNsure. She declined to speculate on why insurers declined to offer coverage in Rochester.
"The board does not have the authority to require that insurers offer plans in a specific geographic area for plan year 2014," Bowring McDonough said.
There may be more plan options soon for Rochester residents.
Medica, which offers a plan in Olmsted County outside of Rochester, is hoping to expand that network to Rochester, perhaps in a few weeks, said Dannette Coleman, vice president and general manager of individual and family business for Medica, The Mayo Clinic Health System and Olmsted Medical Center are providers in Medica's network, but not Mayo Clinic Rochester, and access rules prevented it from offering the plan in Rochester, she said.
Medica is working with the Department of Health and the Department of Commerce to see if it's possible to expand its offerings to Rochester, Coleman said.
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