Among those affected could be children with autism and others whose illnesses require intensive treatments or expensive medications, such as for AIDS, multiple sclerosis and some mental health issues.
Amy and Daron Cox fear they may be caught in limbo. Both sons have received autism diagnoses and are covered through MCHA’s high-risk pool.
“We’re the in-between people who get dropped by Obamacare and the exchange,” Amy Cox said.
She credits an intensive two-year behavioral therapy program covered by MCHA with giving her older son the skills he needs to start first grade this fall with few signs of the autism. The younger son is now enrolled in the program and has received occupational and speech therapy.
Through MCHA, the family pays about $230 a month in premiums plus a $3,000 deductible for each child to get access to the treatments. That’s on top of a traditional plan they buy to cover Daron, a self-employed IT consultant, Amy and their daughter.
Outside of MCHA, few Minnesota health plans cover this type of autism therapy out of concern over its effectiveness and cost, which can run $100,000 a year. Legislators passed a law earlier this year requiring businesses with 50 or more employees to cover the autism treatment, but that doesn’t help the Cox family.
For now, the couple plans to keep their younger son enrolled in the autism program and hang onto MCHA as long as they can.
“We’re hoping and praying that nothing changes for a while so we can get through it,” Amy Cox said.
Who gets the check?
Although the state operates the high-risk pool, it isn’t funded with taxpayer dollars.
Enrollees pay hefty deductibles plus a premium, which is capped at 25 percent above the average cost of a similar health plan. Premiums cover less than half of the actual medical costs, however. The difference is made up with an assessment on insurance companies, which they pass on in premiums to individuals and businesses.
The year ahead will be critical for the state and insurers to convince young, healthy people that buying health insurance is a worthwhile investment.
While the federal government will kick in some money to help insurers absorb the increased medical costs to cover the sickest citizens, the funds will only be available for three years, and the amount decreases each year.
“We’ve assumed all along that some portion of people in MCHA would come to the individual market, but we’ve had to guess what that number would be,” said Geoff Bartsh of Medica, the health plan that covers those in the state’s high-risk pool. “The goal is to encourage as many people as possible to voluntarily choose to purchase in the individual market this first year. Many may find out it’s a really good deal if they do.”
MCHA’s Erickson, a semiretired health care executive, aims to have as many people as possible working with brokers or buying on the MNsure exchange by the end of 2014.
“It’ll all come together at some point, but it’s unpredictable,” said Erickson. “We have 26,000 people who will make 26,000 different decisions. I can’t tell you where they’ll go. No one can.”
Devine, who works in medical billing, is grateful the state could throw her a lifeline after she was found to have late-stage breast cancer when she was 35. But her monthly premium of $343 is more than two-thirds of her condo payment, plus a $2,000 deductible. On the MNsure exchange, she will qualify for subsidies that might reduce her costs.
She looks forward to being in charge of her own health care choices.