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How They Would Change Health Care: McCain

(By Nikki Kahn -- The Washington Post)
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The Maryland Health Insurance Plan, the only high-risk pool in the Washington area, has been growing so fast that it needed to raise the fees on hospitals that help pay for the program and require new members to wait longer for coverage of existing illnesses -- or pay extra for it.

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Here in Minneapolis, Lynn R. Gruber, MCHA's president, said: "We treat them like gold. It's all we do, focus on these chronically ill members, what their needs are." Members get discounts on specialty drugs. Those who are particularly sick get letters or phone calls coaching them on how best to manage their ailments.

Members must be rejected by at least one insurance company to join. Some come and go from the program, but many find it a long-term insurance haven.

Betty Clark joined 22 years ago when she left a corporate job to start her own business auditing insurance carriers for businesses. She was in her late 30s with no major health problems and was startled to be rejected for coverage because she weighed 190 pounds.

Clark, now 59, pays nearly $500 a month in premiums. MCHA has covered a hysterectomy, spine surgery, two stents in her heart and diabetes treatment. "Without MCHA, I never would have my company," she said.

Still, even MCHA's most ardent supporters believe a risk pool is not the best solution for those who are hard to insure. "It is not a panacea. . . . We need to be moving in the direction of universal coverage," said Gruber, who has run MCHA for 18 years. "No one should be rejected because of their health conditions. Our federal government has failed us . . . if we are still here in five or 10 years."

Kristin Flaten, one of two consumer representatives on the board of directors, said: "The most vocal people in MCHA are mad about being in MCHA. They don't like being told they are high risk. They don't like paying the extra money. There is a perceived unfairness they are being treated like that, and the insurance companies are getting away with it."

No one in Minnesota can say for certain how many people who need MCHA stay away because of the price or the waiting period. But the American Cancer Society says that only a tiny fraction of the more than 100 Minnesotans it has referred to the program because they were rejected by insurance companies ever signed up, according to Stephen Finan, the society's associate director of policy.

As another sign of the financial burden, an increasing number of MCHA's members lately have been choosing to pay more out of their pockets -- deductibles as high as $10,000 -- in order to have less expensive monthly premiums.

Some cannot afford MCHA at all. LaVonne Kees, 59, a widow in the suburb of St. Louis Park, was diagnosed with Stage IV colon cancer in August 2007. She was still getting chemotherapy when she was laid off in June from her job as a distribution clerk for a hospital supply company.

Along with her job, she lost the United HealthCare plan that had cost her $22.50 a month. She went on COBRA, a federal arrangement that lets displaced workers temporarily keep group health benefits, but she lost that coverage in a dispute over when her second premium was due. Her small retirement account made her not quite poor enough for Medicaid, so she called MCHA.

The woman on the phone told her it would cost $500 to $600 a month. "I thought, 'Oh, really?' " Kees said. Living on $900 unemployment checks, with rent and car payments, "there is no way I could pay that." After her last chemotherapy treatment, she got a $26,000 bill. She canceled scans in September that would have determined whether she needed more chemotherapy. She canceled an appointment with her oncologist. "As of right now," she said, "everything is kind of at a standstill."


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