Health care law changes worry MCHA high-risk pool users [Pioneer Press, St. Paul, Minn.]

June 15--Advocates worry that AIDS patients will fall through the cracks and find themselves stuck with huge medical bills.

Parents fear that autistic children will lose access to a key early intervention therapy.

And some with more general medical issues wonder if their premiums might spike next year.

That's a sampling of the concerns state officials are hearing as they talk with residents about the future of a program called the Minnesota Comprehensive Health Association, the state's high-risk pool that currently provides health insurance for about 26,000.

For more than two decades, the safety net program has provided a way for thousands of Minnesotans to obtain coverage they couldn't find on the private insurance market, often because of costly health problems.

But these "pre-existing condition" exclusions will become illegal next year due to the federal health care overhaul legislation from 2010. So, state officials are talking to beneficiaries about when and how to wind down Minnesota's insurer-of-last-resort program, which is called MCHA for short.

Some beneficiaries sounded nervous at a meeting earlier this week in St. Paul'sRondo Community Library.

"The stakes are very high for us," said Wendy Pedersen, 39, of Minneapolis, whose son is one of about 130 children who receive autism services through MCHA that aren't covered by other health insurers. "We don't have another option."

"People are scared as hell," said Dave Rompa, a state employee who

works with HIV/AIDS patients currently covered by MCHA. "We have to do a better job getting consumers information."

"My fear is that the insurers are going to be mad ... and raise our premiums," said Roselee Buechler, 60, of Minneapolis.

State officials stressed they aren't trying to quickly push out current beneficiaries, especially since there are many unknowns about what coverage options will exist if people leave MCHA in 2014.

Those concerned about disruptions in their access to

services likely will be able to stay put in the short term, state officials said, although legislation passed this year called on the Commerce Department to plan for the eventual termination of MCHA.

Whereas some other states have decided to quickly close their high-risk pools for health insurance next year, "we did not want such an aggressive timeline," said Tim Vande Hey, deputy commissioner for insurance at the Minnesota Department of Commerce.

Even so, many individuals will find cheaper premiums, Vande Hey said, if they purchase coverage for 2014 through the private market or the state's new health insurance exchange rather than MCHA. That's because the program's premiums are always set at a slightly higher rate than the average premium in the private market.

The Commerce Department also expects that coverage available to MCHA enrollees through the exchange and private market will be similar to coverage available through the program, although specifics aren't available.

The state has a financial incentive to close MCHA sooner rather than later. Continuation of the program means that health insurance companies and their customers will be paying both a state and federal assessment -- rather than just a federal one -- to help cover the cost of patients with pre-existing conditions.

Even so, Vande Hey said: "MCHA is not going to be going away for 2014."

The Minnesota Legislature created the health insurance program in 1976 to help people who lack coverage options on the private market for a variety of reasons.

Some turn to MCHA when they lose job-based coverage through a layoff or employer's bankruptcy and can't find a policy on their own. Others do so after hitting lifetime or annual limits on their employer health insurance benefits, although the federal health law has phased out such limitations.

Some parents have coverage for themselves through an employer but not for a dependent child who winds up on MCHA. The program also has made coverage available to certain populations, including HIV/AIDS patients who qualify for assistance and families seeking coverage for a form of autism therapy known as early intensive behavioral intervention.

MCHA is not a state-funded program. It is a nonprofit group that answers to the Legislature and covers its costs through premiums paid by individuals plus an assessment on health insurance companies.

The promise of new insurance options next year has been met with a mix of reactions. During a teleconference hearing earlier this month, several people voiced outright skepticism that insurance companies actually will start covering people with health problems because of the federal law.

"I swear to God, they're going to have something on their applications that asks: Do you have a pre-existing condition?" insisted a man in Itasca County. "Insurance companies are there to make money."

"I've had two bouts of cancer," said a woman in Stearns County, "and nobody wanted me on their team."

"They'll have to accept me?" asked a man in Wright County. "Is that correct?"

"That is correct," replied Vande Hey, the Commerce Department official.

State regulators will be checking to make sure insurance companies comply with the law, Vande Hey said. State officials, for example, will review application materials to make sure insurers aren't asking questions about someone's health status. There also are consumer protections built into the new health insurance exchange, which is called MNsure.

"We no longer want insurance companies to compete on the basis of trying to enroll healthy individuals, and not enroll unhealthy people," Vande Hey said.

Insurers will be allowed to adjust an individual's premium cost based on age, geography and whether he or she smokes. But the federal law won't let insurers deny coverage, for example, based on a person's height and weight, said Tina Armstrong, a Commerce Department official.

"Height and weight has been one of the most common reasons for denial, but that won't be allowed going forward," Armstrong said during the conference call earlier this month.

The St. Paul meeting on Thursday and the June conference call were part of a series of events around the state to obtain public comments on the transition. So far, more than 350 people have done so.

The Commerce Department anticipates releasing a draft of its transition plan for MCHA by the end of June. Public comments will be taken in July.

"The final transition plan, which will include whether MCHA will be closed to new enrollees in 2014, will be issued on Aug. 31," said Anne O'Connor, a department spokeswoman, in a statement.

Christopher Snowbeck can be reached at 651-228-5479. Follow him at www.twitter.com/chrissnowbeck.

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