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How They Would Change Health Care: McCain

(By Nikki Kahn -- The Washington Post)
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By Amy Goldstein
Washington Post Staff Writer
Wednesday, October 29, 2008

MINNEAPOLIS -- When Diane Derichs's husband was retiring from his assembly-line job making fruit bars for ConAgra Foods, the couple invited over an insurance agent to help her find a health plan.

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A part-time hairdresser, Derichs, at 58, was too young for the Medicare that her husband, Vernold, could already get. Sitting at their kitchen table in a St. Paul suburb, Derichs told the agent about the back surgery she had once needed for her scoliosis, the bad tendons in her feet, the lupus that causes painful sores on her skin.

Blue Cross Blue Shield, the agent discovered, wouldn't accept her. Nor would Mutual of Omaha. Or any other company he checked. "It's like, whammo, don't get sick," Derichs said. "As soon as I said 'lupus,' it was just like: 'Red flag. Sorry, can't do anything.' "

And so, on the agent's advice, she signed up for the Minnesota Comprehensive Health Association, a last-ditch chance at coverage that the state offers to those the insurance industry does not want.

How well this nonprofit corporation -- and similar ones set up by nearly three dozen other states -- can serve insurance castaways such as Derichs is a test of Sen. John McCain's road map for the nation's health-care system. High-risk pools, as such arrangements are known, are a linchpin of the Republican presidential nominee's thinking about how to make health insurance more plentiful and less expensive.

If McCain is elected president next week, he has said, he would work to remove the tax preference for company health benefits and offer Americans tax credits to put toward any health plan they choose. He wants to let people buy health plans from insurance companies anywhere in the country, preempting state regulations that spell out whom insurance carriers must cover and what kinds of benefits they must provide.

McCain acknowledges that such a free-market climate would inevitably freeze out some people with serious medical problems who are looking for insurance on their own. So he is calling for a guaranteed access plan, a federal effort to share the cost of high-risk pools and dramatically expand their reach -- from fewer than 200,000 Americans in state plans today to perhaps 5 million.

A philosophical difference between the presidential candidates over health insurance comes down to this: Given that relatively few people have extremely expensive medical problems, is it better to require insurance companies to include them with everyone else, as Democrat Barack Obama favors, or to separate them, as McCain prefers, in insurance pools just for them?

Among the high-risk pools in 34 states, Minnesota's is the oldest, largest and, many believe, the most successful. "It just seems to work," said Doug Holtz-Eakin, senior policy adviser to McCain.

Created in a wave of health-care changes here in the late 1970s, the Minnesota Comprehensive Health Association (MCHA) had a membership of 28,000 last year, equaling nearly 7 percent of the state's uninsured population. Small as that share was, it far exceeded any other state's, according to the National Association of State Comprehensive Insurance Plans.

The price of belonging to MCHA is lower than in most states, set one-fifth above the cost of the average individual insurance policy in Minnesota. Like all such programs, MCHA requires a waiting period for new members before it will pay for treatment of medical problems they already had -- but the six-month wait here excludes drugs and is shorter than in some places.

Its finances are strained and getting worse, but less so than in other states. California's high-risk pool is so strapped that it put a limit on enrollment this year and lowered the maximum it would spend on anyone's treatment. Tennessee's pool has had to eliminate low-income subsidies for new members. Florida's pool has not let in anyone since 1991.


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