In Wisconsin, health coverage comes at a heavier costThe new world of health insurance, ushered in by the Affordable Care Act, looks much different in Superior than it does from Duluth.
By: John Lundy, Duluth News Tribune
The new world of health insurance, ushered in by the Affordable Care Act, looks much different in Superior than it does from Duluth.
“It’s hard to look across the bridge and know I can’t have access like those people can,” said Paula Gayle, who helps people apply for insurance in the Lake Superior Community Health Center’s Superior office. “It’s actually really sad.”
Insurance brokers and social service workers agree that Northwestern Wisconsin residents are getting a harder deal than those in Northeastern Minnesota.
Premiums and deductibles are higher, choices are fewer and help is less accessible.
When it comes to premiums and deductibles, “Minnesota is definitely substantially lower,” said Sherri Freeman, an insurance broker with Holden Insurance, which serves clients in both states.
A News Tribune analysis of individuals and families choosing the lowest-priced bronze plan showed higher premiums in Douglas County in every instance.
At the high end, a family of four headed by two 30-year-old adults would pay a premium of $492 per month in St. Louis County and $742 in Douglas County.
The analysis assumes no one smokes and that no one is eligible for subsidies. Households with incomes up to about $46,000 for individuals and up to about $94,000 for a family of four qualify for lower costs, according to the federal health insurance marketplace website HealthCare.gov.
In a similar analysis, the Minnesota Department of Commerce compared premiums for a 27-year-old nonsmoker in both counties at all three “metal” levels of the marketplace. Premiums are lower but
deductibles higher for the bronze level; premiums go up and deductibles down through the silver and gold levels.
The 27-year-old in St. Louis County had a choice of nine bronze plans ranging from $140 to $165; his or her counterpart in Douglas County had three choices ranging from $220 to $240. The silver plan choices: Nine in St. Louis County from $170 to $207; three in Douglas County from $277 to $292. The gold plan: Six in St. Louis County from $199 to $249; one in Douglas County at $325.
One versus five
Why the difference? Those involved in the marketplaces note two key differences:
Gayle said she sees the differences every time she goes to work.
In Duluth, 12 “navigators” — individuals trained to help people navigate the marketplace — are available at places such as the Lake Superior Community Health Center in West Duluth, the Duluth Public Library and CHUM.
In Superior, it’s just Paula Gayle and Nancianne Witt, working in a basement office of the community health center, which is just across the street from Essentia Health-St. Mary’s Hospital-Superior.
And they’ve been busy.
“Let’s just say I didn’t see sunlight every day last week,” Witt said on a recent day.
Technically, Gayle and Witt aren’t navigators, they’re certified application counselors. The difference, they said, is that navigators are trained for outreach events in which they go into the community to let people know about the new marketplace.
The entire state of Wisconsin has only six navigators, they said — or did have until recently, when one of the six stepped down.
“In Minnesota it’s just … nicer,” Gayle said.
“I live in Minnesota. So I kind of have my own struggle about working over here in a system that isn’t what I would like it to be,” she said.
A spokeswoman with the Wisconsin Department of Health Services defended the state’s outreach efforts.
The number of navigators is determined by the federal government, Claire Smith said in an email response to questions from the News Tribune. But the state has engineered a significant enrollment campaign of its own, she said.
The state set up 11 regional enrollment networks to “assist transitioning members and uninsured Wisconsin residents to enroll in the appropriate public or private health care coverage,” Smith wrote.
One of the challenges for Wisconsin is that the state’s decision to use the federal marketplace meant using HealthCare.gov — which got off to a disastrous start. The Minnesota site, MNsure, ran relatively smoothly after a few early glitches.
“There’s been more success earlier in people getting from start to finish on the state marketplace in Minnesota as compared to the federal marketplace,” said Dan L. Conrad, an agent and partner with Mediqwest, who has clients in both states.
But that isn’t to say that Conrad is sold on MNsure. He was among 1,600 insurance agents whose personal information — including Social Security numbers — inadvertently was released because of a MNsure security breach in September.
“As someone who is supposed to advise consumers and reassure consumers, that caused me to pause,” Conrad said. “And I received really no reassurance after the fact that it wouldn’t happen again or that they were even going to do anything about it.”
MNsure spokeswoman Jenni Bowring-McDonough said in an email that the data breach had nothing to do with the website’s enrollment system.
Lack of choices
Conrad said the major difference between the two counties is in the number of providers.
“Competition generally lowers prices and raises benefits,” he said.
For one of Freeman’s clients, the new law meant she was among those whose plans were canceled. Her client, who didn’t qualify for a subsidy, went on the federal marketplace only to find that her $4,000 deductible would grow to $6,300, and her monthly premium would grow by about $200.
“She was livid,” Freeman recalled.
Dr. Hans Rechsteiner, a general surgeon in Spooner, said his premium will be lower under the marketplace than he’s paying this year. But he’s still not happy about the lack of choices.
“I was very disappointed because the whole idea was that it was going to be like Amazon.com,” Rechsteiner said. “You could go on there and shop all day long and compare apples to apples and oranges to oranges and it was going to be great fun. When I got there, there was one company.”
As in Douglas County, the only provider in Washburn County — where Rechsteiner lives — is Security Health. In fact, 14 counties across northern Wisconsin have only one provider, according to information from the Wisconsin Department of Health Services.
Rechsteiner is president of the Tri-County Medical Society in Burnett, Barron and Washburn counties, which passed a resolution last week proposing additional health care reforms. One of the resolution’s planks would mandate that all consumers have choices from more than one company, although it doesn’t say how that would be implemented.
‘Sit back and wait’
In the meantime, many insurers have remained on the sidelines because they don’t know what to expect, Freeman said.
“They’re going to sit back and wait and see what’s going to happen, and then they’ll jump in next year,” she said. “But they don’t want all that risk.”
Many consumers should sit back and wait as well, Conrad said. Only those who might qualify for subsidies should consider the marketplace. Otherwise, he said, don’t bother. The private market has more choices presented more clearly online.
Witt and Gayle said they encounter people who are angry about the Affordable Care Act itself. But despite their frustration with the rollout, they tout aspects such as coverage for 10 essential benefits and coverage for individuals with pre-existing conditions.
“(We) hear from people who are angry, who do make a little bit more money and they don’t want to pay for others,” Gayle said. “But people don’t understand that if we have a healthier populace, everything is better.”
But when such “bells and whistles” as maternity care and drug and alcohol counseling are added to everyone’s insurance plan, they add to the premiums everyone pays, Conrad said.
“I describe those benefits as bells or whistles not because they’re not essential,” he added. “But when you add to the basic nature of an insurance policy additional benefits, it increases the cost.”