By Mathew Keller, RN JD, MNA Nurse Policy Specialist
When cuts are made to public insurance programs, we all end up paying more. Just the other day I heard the story of Mary*, a young woman who found some unusual lumps in her breast. Having already had her preventive care exam for the year, she could not afford the high cost of following up with her physician. When she was finally able to get her next annual exam, Mary got the heartwrenching news that she had Stage 4 breast cancer.
MinnesotaCare, a public health insurance program for the working poor, is under threat from state legislators in the House of Representatives. In the long run, gutting MinnesotaCare is a losing proposition for our patients, our hospitals, and our state.
MinnesotaCare is a program for those who earn between 133 percent and 200 percent of the Federal Poverty Line (FPL), which is $11,770 for an individual and $24,250 for a family of four this year. MinnesotaCare currently serves 105,000 individuals and families who work hard and yet don’t have employer-provided insurance and can’t afford coverage on the open market. The program requires enrollees to pay premiums of $15-$50, depending upon income, and to share in some of the costs of coverage.
If MinnesotaCare is repealed, its current enrollees will be forced to enroll in a private insurance plan, which will cost more and deliver less. For example, a 2015 silver plan would cost an individual earning $16,243 annually a $46 monthly premium, while only covering 70 percent of medical costs. That same individual would pay a monthly premium of $15 while receiving 98 percent coverage under MinnesotaCare. For the working poor, this is a huge difference.
As nurses, we know that the high price of healthcare is often a barrier to the working poor receiving adequate care. According to a Harvard study, unpaid healthcare costs cause more than 60 percent of bankruptcies in America, and one in five American adults struggle to pay their medical bills. The rate of unpaid medical bills is even higher among working poor earning between 133 percent to 200 percent of the FPL.
Consider, for example, the price of an emergency appendectomy. Assuming the patient gets to the emergency room before the appendix ruptures, the procedure costs upwards of $20,000. For a working-class individual earning $16,243 annually on a silver-level private insurance plan (with 70 percent coverage), the out-of-pocket cost is still an unmanageable $6,000. When that individual is unable to pay the $6,000, the hospital absorbs the cost under “charitable care,” but the hospital has to raise prices on every other patient to balance the books. Rather than cut healthcare costs, eliminating MinnesotaCare actually raises costs for all Minnesotans. It’s a gimmick that budgeters try to make it look like they’re doing a good job.
When individuals and families are afraid to go to the doctor because of what it might cost them in the long run, they put off necessary treatment. This harms our patients’ health while costing them, the hospital, and all Minnesotans more in the long run. Mary didn’t make it; let’s make sure the 105,000 working-class Minnesotans who use MinnesotaCare don’t need to face the same choices she did.
*Name changed to protect confidentiality