Minnesota's insurance plan of last resort nears end of line

  • Article by: JACKIE CROSBY , Star Tribune
  • Updated: August 30, 2013 - 7:16 AM

Rollout means the state must move people out of its high-risk pool.


FAMILY TIME: At their home in Blaine, Amy and Daron Cox were part of MCHA. They have two boys with autism; the older one is considered recovered.


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Donna Devine is tired of being branded as “uninsurable” more than a decade after being treated for cancer.

“It didn’t seem fair,” said Devine, 48, of Edina. “I haven’t had any recurrence. But it doesn’t matter to the insurance companies. They don’t look at you as a person — they look at you as a risk pool.”

Until now, Devine’s only option has been to buy insurance through a state-run program that helps those with pre-existing conditions or who have been denied traditional coverage. The program, called the Minnesota Comprehensive Health Association (MCHA), serves about 26,000 residents, but it will be phased out in 2014 when insurers will be required to take all comers under the Affordable Care Act.

“The good news is that the people we’ve cared for for years will now be able to go to the market and buy regular coverage, just like you and me,” said Kirby Erickson, executive director of the high-risk insurance program.

State officials have spent months working on a plan that would quickly move enrollees out of the MCHA program and into the private market.

The challenge will be to do so without interrupting care or flooding the market with people with high medical needs that could cause premiums to spike.

People have turned to the state’s high-risk program if they have used up their COBRA benefits or need to buy coverage for spouses and dependents.

The program also is available to self-employed workers, legal immigrants or those who are older than 65 but don’t qualify for Medicare. Many have ongoing illnesses, pre-existing conditions or have had organ transplants — all of which make it hard to get insurance under today’s rules.

“These are huge issues for a very targeted population,” said Lynn Blewett, a professor of health policy at the University of Minnesota who studies national trends in health insurance. “MCHA has been an important part of Minnesota’s safety net in that we have a very stable high-risk pool that’s well established and has worked well over time.”

Erickson expects “vast numbers” of MCHA enrollees will eagerly choose to shop with brokers or use the new competitive online insurance exchange, known as MNsure, where some will qualify for premium discounts.

But those who are in the middle of chemotherapy, long-term treatment programs, or are disabled will get special attention from a team that might include nurses, pharmacists or mental health specialists.

“We are very concerned about small subsets of our population,” Erickson said. “We recognize they will be anxious and reluctant to take risks. It’s human nature. If I’m being treated for cancer, the last thing I want to do is change my health plan.”

‘In-between people’

Minnesota’s high-risk insurance program is the largest and one of the oldest in the nation, launched in 1976 to create a safety net for those denied coverage. Today, 35 states operate similar programs that cover about 220,000 Americans.

Several states, including Texas and Wisconsin with the next-largest enrollments, will stop their programs immediately at the end of the year and move people to the exchange or private market.

Minnesota officials had hoped to take several years to unwind its program, but a lack of federal funding to ease the transition has put it on a faster track. The state Department of Commerce, which oversees the MCHA program, is expected to release details of the changeover next week, but a draft of the plan calls for closing the gate to newcomers at the end of this year and allowing a transition period through the end of 2014.

Yet a small slice of Minnesotans enrolled through the state’s high-risk pool could find themselves in a bind as MCHA gets dismantled. Even though the federal law won’t let insurers deny coverage, there’s no guarantee that certain therapies and drugs now included in the MCHA program will be covered by insurance plans on the open market on the MNsure online exchange.

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