Michelle Van Auken has put up with pain and digestive problems for 16 weeks, while going without a drug she is supposed to get every eight weeks. So whether or not her new health insurance card arrives in the mail in the next few days, she is going to the doctor on Wednesday.
"I'm more than ready," the 62-year-old said.
Van Auken is among the first of what Minnesota doctors and hospitals believe will be a steady stream of patients to show up in coming weeks — patients who have been uninsured but are now seeking overdue checkups and prescriptions because as of Jan. 1 they have coverage through the MNsure state exchange.
Whether that stream breaks into a rush is unclear.
So far this year, hospitals and clinics haven't noticed unusual increases in patient volume from the MNsure effect; January is always busy with the spread of influenza and cold weather conditions that lead to injuries. Clinic and hospital leaders believe they are in good position to handle the increased demand from the roughly 72,000 Minnesotans who have acquired coverage on MNsure so far.
But they'll know more in coming weeks, after more people complete MNsure's quirky sign-up process, which has enrolled some people for benefits, but locked out others or left consumers such as Van Auken waiting for confirmation of benefits that were supposed to kick in Jan. 1.
Some upturn in patient volumes is expected. A November report by the Minnesota Department of Health found that 7 in 10 patients overall sought a doctor's care during a six-month period in 2011, compared to just 4 in 10 of those without insurance.
"Since it's so new, we don't know what the impact is going to be yet," said Anthony Yanni, the point person for Hennepin County Medical Center on MNsure enrollment matters. "We just know there is going to be a larger number of patients."
A primary goal of MNsure, the insurance market created under the federal Affordable Care Act, was to cover the state's 490,000 uninsured people and improve benefits for the sick and self-employed. The assumption was that coverage would drive more people to primary and preventive care services, and reduce their need for expensive emergency room visits and avoidable surgeries.
While no one has projected the increase in patient demand due to MNsure, state officials are watching the example of Massachusetts, which enacted a health insurance mandate in 2006 that presaged the federal version.
Newly insured patients strained that state's network of primary care clinics to the point that Massachusetts made emergency investments to recruit and train more doctors in internal and family medicine. The lack of primary care ended up being counterproductive, because many patients couldn't find doctors willing to accept new patients, and they ended up returning to expensive ER care for lack of alternatives.
Hospital and clinic leaders in Minnesota said they are watching patient behavior carefully, but believe the problems in Massachusetts won't be repeated here. At three large Twin Cities clinic systems — HealthEast, HealthPartners and Fairview — executives said they hadn't added patient care staff for 2014 in anticipation of more patients.
For one thing, Minnesota already had a low uninsured rate — around 9 percent in 2011-2012, compared to 15 percent nationally — partly because of its more generous Medicaid rules and its MinnesotaCare program for the working poor. The state also added thousands of people to the insured pool with provisions in the Affordable Care Act that allowed parents to keep their children on their plans into their mid-20s, and expanded Medicaid eligibility in early 2013 to offer coverage to 35,000 more adults.
"[Massachusetts] didn't have a MinnesotaCare program like we had," said Donna Zimmerman of Bloomington-based HealthPartners. "So they actually brought more people into insurance for the first time than we probably will here."
In addition, Minnesota recently ranked ninth-best for its availability of primary care providers, meaning it has more capacity to handle any rush in newly insured patients.
Buying 'platinum' plans
So far, MNsure has at best dented Minnesota's uninsured tally. Enrollments as of Jan. 4 covered 71,982 Minnesotans — some who were uninsured, and some who had private market coverage before 2014. Open enrollment on MNsure continues through March 31, though, and another 70,000 people have applied on the exchange but haven't completed enrollment for benefits yet.
Among people who bought private plans on MNsure so far, nearly a third selected "platinum" plans with the highest premiums but best benefits — an indication they are selecting plans they intend to use.
Coverage is coming a bit late for Jamez Smith, who lost his health insurance in 2013 when he was laid off from a nonprofit agency and then suffered a severe dog bite that left him with steep medical bills.
Still, the coverage Smith gained through MNsure will allow him to seek care he had put off — monthly visits his doctor recommended to manage high blood pressure.
"After I lost my job, I explained to him that I couldn't afford to see him once a month," said Smith, who is 50.
Van Auken was working in quality control for a hearing device company when she took a second job as an at-home caregiver; that pushed her income above the threshold for state-subsidized benefits. Then she lost her second job because her neglected health deteriorated.
Suffering an immune disorder that attacks her digestive system, Van Auken is supposed to take a $17,000-per-infusion drug, Remicade, every other month. But after she lost coverage, she received one infusion in September and put off another until she could obtain benefits under MNsure. In the interim, she was hospitalized for kidney stones and amassed $20,000 in medical debt.
"I'm relieved to have insurance," she said. "At my age anything can happen, and it did happen."