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Minnesota regulators and insurers scrambled Friday to figure out how to implement President Obama's offer to let consumers keep plans that don't meet the federal health care law, and whether to try.
In the words of one Minnesota insurance executive, Obama threw a "big monkey wrench" into an already uncertain marketplace this week when he decided that consumers could choose to hang onto existing policies for another year.
"The worst-case scenario," said Medica's Geoff Bartsh, "is that this creates a bigger mess, and people will roll through now to the end of the year, forget to either renew or make a coverage determination and are stuck on Jan. 1 without coverage, even if they have it today."
Obama's Thursday announcement left it up to state insurance commissioners to decide whether they will temporarily allow insurers to extend coverage for plans that don't comply with the federal health law. And even if the Minnesota Department of Commerce decides to grant the option, it's unclear whether the insurance companies will do so.
Officials at the Department of Commerce didn't provide a timeline on a decision. Commissioner Mike Rothman issued a statement saying the agency was "working quickly" to respond to the president's announcement and that its goal was to provide more choice and affordable options.
About 140,000 Minnesotans have plans that fall short of the health law's requirements.
Insurers spent a year creating new plans based on the more stringent rules of the Affordable Care Act. Starting in 2014, insurers can no longer deny coverage for pre-existing conditions, and have to cover a long list of basic health care needs, such as childbirth, mental health care and prescription drugs.
For many people who are sick and who qualify for tax credits, the new policies under Obamacare are welcome relief. But insurance carriers fear that if young and healthy people decide to hang onto their current plans, the pricing assumptions to spread the cost of medical coverage among more people no longer work. The result, they warn, would be a destabilized insurance market and soaring premiums.
Most current policies don't even meet the requirements of the new "bronze level" plan offered on the law's insurance exchanges. Bronze plans offer the lowest premiums and highest out-of-pocket costs.
"These changes will have a very profound implication for the market, not just in 2014 but in 2015 and beyond," said Scott Keefer of Blue Cross and Blue Shield of Minnesota. "There's a real long-term issue looming here."
Sue Abderholden, executive director of Minnesota's National Alliance on Mental Illness, wasted no time sharing her disappointment in e-mails to Gov. Mark Dayton and the commerce commissioner.
"These policies that didn't meet the new standards, I'm guessing a fair percentage didn't cover mental health and substance abuse treatment," she said. "We don't think, frankly, that continuing discrimination is a good idea."
She noted that some counties in the state have already set budgets expecting that insurers would shoulder more costs of caring for those with mental illness.
"If you're a man, you know you don't need maternity care," Abderholden said. "But with one in four adults experiencing mental illness in any given year, who knows if it's going to happen to you. Especially young people. We've had families go into bankruptcy and face huge bills to pay out-of-pocket for this treatment."
Meanwhile, confusion reigns among consumers. At Medica, the call center was "getting slammed" on Friday, a day after Obama's announcement.
"It's a big monkey wrench," Bartsh said. "People don't know what to do. They don't know what it means to them. The hard part for us is we still don't have the ability to answer a lot of their questions yet."