MPR: MinnesotaCare's Unmet Challenge

MinnesotaCare's Unmet Challenge
by Dan Olson
March 10, 2000

More than 40 million Americans don't have health insurance. In Minnesota, somewhere between 250,000 to 450,000 lack coverage. Medicaid covers the poorest of the poor. MinnesotaCare, the state's health program reaches many others. But MinnesotaCare is not free; people pay premiums. And MinnesotaCare's eligibility restrictions put it out of reach for many low-income working people. A Twin Cities network of free clinics run by the Sisters of St. Joseph of Carondolet supplies care to those who fall through the cracks.

WHO'S ELIGIBLE FOR MINNESOTACARE?
You can get MinnesotaCare if:
You have a Social Security number.
You are a Minnesota resident.
If you are an adult and you do not have children, or if your children are over age 21, you must have lived in Minnesota for six months.
You do not have other health insurance now (this includes Medicare), and you have not had health insurance for the last four months.
This rule does not apply to some low-income children. A MinnesotaCare enrollment representative will review your application and tell you if you or your child qualifies.
You do not have current access to employer-based health insurance, in which your employer pays 50% or more, and your employer has not dropped employer-paid insurance in the last 18 months. (This rule doesn't apply to children originally enrolled in the Children's Health Plan or some low-income children.)
You are able to meet income guidelines. Figures based on 1999 Federal Poverty Guideline (adjusted annually)

Families and Children Under 21
Family Size	Income Limit (monthly gross)
2	$2,486
3	$3,128
4	$3,770
5	$4,411
6	$5,053

Adults over 21, no children
Household Size	Income Limit (monthly gross)
1	$1,174
2	$1,582

Source: Department of Human Services

RED TAPE, state officials say, discourages many who are eligible from applying for MinnesotaCare. So, the other day at a neighborhood health clinic in northeast Minneapolis, Minnesota Department of Human Services Commissioner Michael O'Keefe and Governor Jesse Ventura stretched out the 20-page-long MinnesotaCare form and hacked it down to a fifth of its size. The new application is four pages long, and officials predict the streamlined form will encourage thousands who are eligible to apply. But Cheryl LeDoucer says the MinnesotaCare premium - the average is $18 a month but can run much higher depending on income - is out of reach.

"It's frustrating," she says. "I've gone to MinnesotaCare and they wanted still way too much money than we could afford. Then I tried to get medical assistance and they said we made too much money."

Cheryl Ledoucer is a part-time cook for a school district, her husband has a full-time job. They have six children. Their combined income covers the house and the car payment and food. LeDoucer says there's nothing left over for health insurance. Her husband's employer offers a health plan but it requires a big employee contribution.

Thousands of working Minnesotans are in the same fix; earning too much to go on welfare, too little to afford MinnesotaCare premiums. Often, there's another hitch. Diane Peters, coordinator of the 11 St. Mary's free clinics operated by the Sisters of St. Joseph of Carondolet, says even if people can afford MinnesotaCare premiums they might not be eligible because they have access to another health care plan.

"If your employer has a health care plan that costs $500 dollars a month, they pay $250, they require the employee to pay $250," she said. "If you can't afford that, you still can't get on MinnesotaCare."

An obvious solution is to reduce MinnesotaCare premiums and drop the restrictions - open it to anyone without coverage, as soon as they need it. But state lawmakers don't like expanding the program for two reasons: it's expensive, and it might tempt people to drop their private health-care coverage for the state plan.

People not on welfare or MinnesotaCare often go without medical help unless they happen to hear about the St. Mary's clinics. Each year, the clinics give nearly 5,000 people, including Cheryl LeDoucer and her family, free health care. A small paid staff runs the network. The health care, ranging from treating ear infections to delivering babies, is donated by volunteer doctors and nurses. Nurse Carol Novak says most of the patients are one time users who need short term coverage.

"So many patients I see in the clinic are working in temporary jobs so they don't have health insurance," she notes. "Maybe they're going to school part-time to improve themselves but can only then work part-time. Maybe they have just recently been unemployed but cannot afford the COBRA because it is so expensive."

COBRA is the acronym for health coverage employers must by law offer to workers who are fired or laid off and is an example of the options for people in Minnesota without health care. Another option is the publicly funded version of the St. Mary's clinics - a network of 48 Twin Cities neighborhood health-care services which offer free or reduced charge medical care. Still another option is the free care offered by many private-sector Minnesota health companies.

Dr. Peter Cermak's employer offers some free care to patients, but all of the options don't reach everyone. Cermak, a volunteer at the St. Mary's Midway clinic in St. Paul, says reform is the way to patch the holes in this country's health care system. "Personally I'm in favor of some kind of universal health care. Somehow I think we have to do better to make adequate health care more universal," he said.

But health care reform is elusive and universal coverage does not appear likely anytime soon. So, people who either go without or seek out help where ever they can find it.

The St. Mary's Clinic network was started as a stopgap. Founders assumed it would be out of business as soon as the government enacted health care reform. Eight years later, the clinics are expanding their services, treating a growing number of people without health care coverage.

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