Here’s hoping real people and their circumstances are kept front and center in rest of health-reform debate

Sens. Joe Lieberman and Ben Nelson
REUTERS/Jonathan Ernst
Sens. Joe Lieberman and Ben Nelson have figured prominently in the health debate.

Dan Gerber is what I’d call “insurance poor.”

You’ve heard of people described as “house poor,” i.e. a huge chunk of their income goes to their mortgage payment and a bottomless pit of home repairs.

Dan, a 54-year-old Minneapolis resident, is insurance poor.

He says he spent close to 40 percent of his $20,000 annual income this year on health-insurance premiums, the deductible, out-of-pocket costs and co-pays. He is covered by the Minnesota Comprehensive Health Association, the high-risk pool for people denied insurance for pre-existing conditions.

Some health-policy wonks would say Dan meets a common definition of underinsured — he spends more than 10 percent of income on health care.

For a number of years, Dan was eligible for MinnesotaCare, the premium-based insurance program for low-income residents, but he was “dis-enrolled” because a boost in income pushed him over the income limit. “It was probably less than 100 bucks,” he said of the increase in income. Before the dis-enrollment, he started draining his savings to pay down his home mortgage in order to stay within MinnesotaCare’s asset limits.

Will final bill help these people?
With the U.S. Senate poised to pass its reform bill by Christmas Eve, Dan is among the people on my mind. Will the Senate and the House conferees be able to pass a final bill that will help Dan and the many people I’ve met in 18 months of covering health policy, reform and state programs? Here are a few others on my mind:

Lucy Buckner-Watson
MinnPost photo by Casey Selix
Lucy Buckner-Watson

Lucy Buckner-Watson and her 20-something daughter, who was uninsured when she found a lump in her breast and was afraid to tell her mom.

Karen Sandness, who carries a high-deductible individual insurance policy but hasn’t had a colonoscopy because it costs more than her monthly rent. Dan came to my attention as a commenter on that story.

• A retired insurance broker who emailed that he was turned down for an individual policy by the insurer for whom he sold policies.

• Homeless advocate Monica Nilsson, who tirelessly fights to save Minnesota’s endangered General Assistance Medical Care program to help the poorest of the poor at St. Stephens Human Services, and her charges, who eventually could be helped by Medicaid in 2014.

Monica Nilsson
Scott Theisen, courtesy of Greater Twin Cities United Way
Monica Nilsson

• An uninsured self-employed friend who died 45 days after he was diagnosed with colon cancer. Since he couldn’t afford an individual policy, he didn’t get the colonoscopy that might have prevented his death. (And even if he’d been able to obtain an individual policy, he still might have had to pay for a colonoscopy because of a likely high deductible.)

These people and others have helped me focus on what’s at stake in this national reform debate.

I come from the school of journalism that believes a journalist’s role includes, to borrow an old phrase, comforting the afflicted and afflicting the comfortable. I’ve had the privilege of talking to people from both groups – along with many others from all along the political spectrum – to get their knowledge, insights and views. Having done that, I won’t apologize for concluding that our nation should have some kind of universal health care, for digging into why we’re not there yet – and for questioning whether reform proposals will improve affordability.

Smaller premiums, out-of-pocket costs
The other day, Dan and I chatted over the phone about his experience with MCHA and MinnesotaCare, as well as the good news that his employer, a “very small medical-device company,” will start offering health insurance to its fewer than 20 workers. The premiums and out-of-pocket costs won’t devour as much of his income.

But how has Dan managed to fork over that much money for his MCHA premium and out-of-pocket costs this year?

“My income isn’t huge,” he said. “It’s typically less than $20,000 a year, but I’m a pretty good saver. … It’s [health care] expensive but I don’t know how long I can keep it up.”

State law allows MCHA to charge its 27,000 enrollees as much as 125 percent above the market for individual insurance. According to Minnesota Department of Commerce estimates, MCHA received about $123.1 million in premiums and interest income in 2009 and claims of $245.8 million. The difference, about $122.7 million, comes from a 2- to 3 percent assessment on insurers’ premiums, a cost passed on to individuals and employers buying insurance in the private market.

“Commerce occasionally receives requests to have the commissioner review MCHA’s rates,” communications director Nicole Garrison-Sprenger wrote in an email. “In the last nine years, in most cases, we’ve accepted MCHA’s proposed rates. The accepted rates are generally in the 117 percent to 123 percent range.”

Besides MCHA, Dan and I talked a bit about the relief that federal reform might bring to people in his boat, which got me to thinking that I’ve met so many people who also might benefit from some aspect of health-care reform.

Deep in the 2,700-page latest Senate bill and the 2,000-something House bill are provisions to help low- to middle-income Americans buy insurance and to clean up some of the abuses in the individual market.

Subsidies, limits and prevention
For one thing, Dan and others wouldn’t be denied insurance because of pre-existing conditions if they lost a job and employer-based insurance in the future. Once reform is implemented, MCHA might not be needed. A layoff from a 20-year employer is what led Dan to MinnesotaCare and MCHA in the first place. Dan would qualify for a federal subsidy through a health-insurance exchange and there would be limits on deductibles and out-of-pocket costs, though there is still concern about affordability. Karen could get her colonoscopy because preventive care would be covered independent of any out-of-pocket costs or deductibles.

Dan and Lucy would be able to carry their young adult children until age 26 or 27, depending on which chamber’s provision makes it into the final bill. (Minnesota already requires employer-based policies to carry children until age 25.)

“I’ve been watching federal reform,” Dan said the other day. “When the Senate was thinking of opening Medicare to age 55 I thought, ‘Yah!’ Then what’s-his-name — [Sen. Joe] Lieberman — had to shoot it down.”

If only members of Congress and the president would keep front-and-center all the Dans, the Lucys, the Karens and our friends and neighbors, my inner idealist wants to think our lawmakers would have an easier time of bringing some relief to millions of Americans.

Instead, my inner skeptic frequently worries that they are getting lost in the politics and the high-dollar lobbyists for the insurance industry, the pharmaceutical industry, our homegrown medical-device industry, doctors and providers who don’t like what Medicare pays or under-pays, and lobbyists for baby boomers like me who don’t want anyone messing with Medicare or Social Security.

Big spenders
In June, Common Cause estimated that health-industry lobbyists had spent about $1.4 million a day so far on Capitol Hill. Multiply that daily amount by however many days Congress is in session and the total might well come close to covering the annual expenses for Minnesota’s GAMC program for the poor.

And, it seems to me, Dan, Lucy, Karen and others are getting lost in various attempts to hijack the legislation for political causes. For example, health-care reform was held up for millions of Americans because of two anti-abortion Democrats (Rep. Bart Stupak and Sen. Ben Nelson)? Seriously? Shouldn’t that be a debate for another day?

Stupak, Nelson and 8 million federal employees are covered by the Federal Employees Health Benefits Program, at times described as the most generous health care in the nation. Day to day, they probably aren’t worrying whether they can afford their premiums, a colonoscopy, co-pays for prescriptions and any out-of-pocket costs.

I, too, have been blessed with good health coverage all my life, starting with government care for military families. Taxpayers paid for my tonsillectomy at age 6 and the removal of my wisdom teeth at age 18 and all the shots in-between. Growing up with that kind of health care, I’ve found myself at times completely flummoxed that the United States of America doesn’t offer universal health care. I could get free shots on an Army base in Okinawa long ago, but some of my taxpaying friends and story subjects can’t get accessible, affordable care in the United States?

In my adult years, I’ve been covered by employer-based insurance plans that cost half of what Dan or Karen pay. The highest deductible I’ve ever faced is $1,000; the highest monthly premium was about $560, when I was on COBRA for several months between jobs.

In June 2008, my uninsured friend died of colon cancer. I wrote about the pain and the questions prompted by his preventable death at age 60 and I promised to ask more questions. Judging from some of the comments on my stories and the emails since then, it appears I’ve afflicted a few of the comfortable. If I’ve also occasionally managed to comfort the afflicted in the process I’m doing my job.

As senators prepare to pass a bill and to meet with House conferees in the New Year, my inner idealist and my inner skeptic are slugging it out, one hoping the afflicted will win and the other fearing politics and the comfortable will prevail.

Casey Selix, a news editor and writer for MinnPost.com, can be reached at cselix[at]minnpost[dot]com. Follow her on Twitter. 

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Comments (8)

  1. Submitted by Richard Schulze on 12/23/2009 - 09:57 am.

    Everyone is focusing on the costs, but nobody seems to be discussing the lack of doctors to care for all these people. Particularly, the lack of primary care physicians. Health insurance reform is not enough, you also need to reform the medical profession. The number of spots in medical schools across the country has stagnated for years, and fewer new physicians go into primary care because of the burden placed on them by high patient load, low reimbursement for anything that doesn’t involve a procedure, and excessive paperwork.

    A Republician might use this as an excuse to scuttle the whole endeavor, but Democrats need a plan to cope with these issues that their bill will bring to a head.

  2. Submitted by Jeremy Powers on 12/23/2009 - 12:46 pm.

    Thank you for writing about this and thanks to the people who let their names and stories be used. I know of several people who suffer under our terrible systems of “don’t get sick; die quickly.” But their stories too often are of a missed premium payment or choosing an insurance company that went out of business, and it opens them up to ridicule for making a mistake – essentially making it their fault. Or they have to explain that they have spent most of their spare time during the last several years changing adult diapers or bathing their spouse because of an illness they don’t want to talk about. Or they have to confess to hocking their home to pay medical bills, which in this society “lessens” them in the eyes of their neighbors.

    These stories are real and unless you are rich or on Medicare, these stories could be yours with just a twist of fate.

  3. Submitted by Ed Felien on 12/23/2009 - 01:55 pm.

    In his article “Deep in Health Bill, Very Specific Beneficiaries” in the Monday New York Times, Robert Pear didn’t note the irony that the greatest beneficiary of the health bill would be Dick Cheney and George W. Bush. Max Baucus’s amendment to help asbestos workers in Libby, Montana, is actually the way to kill the class action lawsuit asbestos workers brought against Dresser Industries when it was owned by the Bush family. When Cheney, as CEO of Halliburton, bought Dresser for $8 billion in stock in 1998, he was essentially turning over control of Halliburton to the Bush family because Halliburton was only worth about $8 billion at the time. When Halliburton assumed Dresser it also assumed the multi-billion dollar potential liability of the asbestos class action lawsuit. Dick Cheney tried for eight years as Vice President and President of the Senate to pass legislation that would limit Dresser/Halliburton’s liability. He couldn’t do it—not even with Bush in the White House and a Republican Congress for six of those eight years. Now, he will get his Christmas present from a united Democratic Congress and a Democratic President, and every Republican will get to vote against it.

    Ed Felien

  4. Submitted by T J Simplot on 12/23/2009 - 02:15 pm.

    Mr Schulze,

    You bring up good points. In addition, I want to add that if MN were to go to a single payer plan where the state can dictate reimbursement rates, good luck attracting the best and brightest MDs. They will likely want to go to states where they can make more money as they will have huge debts.

  5. Submitted by Marlin Henjum on 12/23/2009 - 04:28 pm.

    I hope you will continue to afflict the comfortable with informative and insightful reporting. It seems the national media is only interested in the disgusting political gamesmanship that has dominated this debate.

  6. Submitted by Bernice Vetsch on 12/23/2009 - 04:35 pm.

    Like the doctors at Mayo Clinic, those in countries like France are on salary rather than being paid per visit or per procedure. They all live well, primary care physicians and specialists. Here, primary care physicians have to struggle with high medical school debts and office expenses while surgeons and other specialists become wealthy.

    I don’t think the new legislation addresses this.

  7. Submitted by Rebecca Hoover on 12/23/2009 - 07:58 pm.

    The New England Journal of Medicine recently had an excellent essay on health care reform and suggested that we need to frame this health care debate in terms of our values.

    A great majority in the USA support two related values: (1) universal access to quality, affordable health care, and (2) good stewardship of health care resources.

    It is interesting that while government can and should mandate universal access (not 94%), it takes all of us to be good stewards of our health care resources. We all need to adopt healthy life styles which include not smoking, eating a healthy low-fat diet, exercise, etc. If you put on 10 pounds over the holiday season, most likely you are not doing yourself or the health care system any favors.

    Personally, I am furious that the government seems to be ignoring our values on this health care reform issue. First, I want universal access to quality, affordable health care. There should be no ifs, ands or buts. Those who do not support universal access in my view should volunteer to go without heath care themselves.

    Also, I think we need to talk about stewardship and conducting massive public education programs for individuals of all ages. We are literally digging the grave of our nation with our teeth, knives, forks and spoons.

    We need to address both universal access and stewardship. These are our values. They are right and the policies they suggest are right.

  8. Submitted by Rod Loper on 12/28/2009 - 10:17 am.

    Thank you Casey. There is a tendency for real
    stories to be lost and the lessons distorted
    when the dominant narrative is “we have the best system in the world” and “people make the wrong choices sometimes”.

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