It’s winter in Minnesota, and those in our state who buy health insurance on their own are feeling left out in the cold. Every month, when they pay their health insurance premiums, they feel just how expenses for medical care directly affect our daily lives. Because unlike Minnesotans who get insurance through work, Medicare, Medicaid or MinnesotaCare, most people who buy health insurance on their own also pay for it all on their own.
The angst and anger are real. Most of us are insulated from how expensive care really is, but about 5 percent of Minnesotans buy health insurance on their own and they have no protection. For the last few years, the price of insurance was mostly within reach and much lower than in other states. But in the last year, the price shot up while options for where to get care shrunk.
What changed? How can prices go up so much and options be so limited? To help us get at the root of the problem, Minnesota’s insurers asked independent health experts at the Wakely Consulting Group to dig deep into our problems. Unfortunately, the answer is not comforting.
First, Minnesota regulators and health insurance leaders miscalculated when setting Minnesota’s 2014 and 2015 premiums. We greatly overestimated how many people would buy health insurance, while underestimating how much care the people who did sign up would need. And we assumed that the federal government would make good on its commitment to reimburse insurers for unexpected medical expenses.
Those mistakes created at $500 million hole that led to the startling premium increases of 2016 and the truly shocking jump for the year ahead.
And this is the hardest part: Doubling premiums between 2014 and 2017 simply put them where they should be. About average. Not the highest in the region, not the lowest.
On average, in 2014, the premium a Minneapolis resident paid each month was $86, or 36 percent, below the regional average. For 2017, the local premium is $1 above the regional average.
We know “average” doesn’t equal affordable. Early 2017 enrollment numbers show thousands of people dropping health insurance policies. And while more people will get federal help paying their premiums this year — better late than never, I suppose — most Minnesotans are footing the bill on their own.
And this is where Wakely’s second finding is critical.
The 276,000 people who bought health insurance on their own split a $1.6 billion total medical bill in 2015. But a quarter of that bill, more than $400 million, represented care for about one-half of 1 percent of the people, just 1,600 Minnesotans. Their medical expenses averaged $250,000 each for the year, compared with about $4,300 each for all others who buy their own insurance.
In the past, we had ways to help share these high medical bills. But not anymore. The bills are paid only by people who buy on their own.
Wakely’s two findings — 2017 premiums aren’t out of line when compared with the medical bills paid, and fewer than 1 percent of people have conditions that need extremely expensive care — pinpoint the problem policymakers must solve when the Minnesota Legislature comes together on Jan. 2.
There seems to be agreement that all Minnesotans should help care for our most vulnerable family members, friends and neighbors. How our legislators, governor — all of us — turn this consensus into reality gets at the heart of who we are — our care for each other, the kind of society we aspire to be.
The data may show that Minnesota’s problems are common, but we still have potential to be exceptionally good at finding solutions. Our community’s tradition of practical health care policy needs to be quickly reinvigorated to get at the root of the problem if we want Minnesotans to be able to buy health insurance on their own in 2018, and not be left out in the cold once again.
Jim Schowalter is president of the Minnesota Council of Health Plans.