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Health coverage has problems but is still essential

Most Minnesotans are lucky enough to have healthcare coverage where they work, but many others have to make do some other way. Those below a certain income level can get covered by one of the public health care programs, Medical Assistance and MinnesotaCare. Those outside of the programs' eligibility limits have to find commercial insurance.

Finding the right coverage and getting on it these last few years has not always been easy. There are challenges due to technical problems, a complex structure and rising costs, both inside and outside of MNsure, the state's health exchange.

While there are challenges, the Affordable Care Act ("Obamacare") made some very important improvements, like forbidding insurance companies from rejecting people with significant medical issues. The ACA also allowed more people to get on Medicaid, known in Minnesota as Medical Assistance. And the ACA created more options for in-person enrollment assistance. (More on that in a bit.)

The MNsure website and the State of Minnesota's computer database systems for the public health care programs have been fraught with persistent technical problems. There are constant efforts to get those fixed, but they're not finished yet. Part of the difficulty is due to MNsure's need to connect with various insurance companies when people sign up for a commercial plan. The complexity is immense, precisely because our country has a health care system that involves thousands of different insurance policies from hundreds of companies.

One consequence of our fragmented and troubled system is that rates have been going up sharply and will likely do so again for 2017. A big reason for this was mentioned earlier: the insurers can no longer reject people with health issues and expensive bills. They must do what they should have been doing all along, providing coverage to everyone who needs it, including those who need it the most. Now that insurance companies have to cover the sickest people, they seem to have trouble making a profit. This problem will persist as long as people are segregated into separate insurance pools.

Despite the fact that overall the insurance companies are doing quite well, some of them stop offering whole groups of policies because they don't want to lose money. The latest in Minnesota is Blue Cross, which just announced that 100,000 of its policyholders in the state will have to switch to something else for next year, although it has $1.6 billion in reserves.

In addition to rising rates and canceling of policies, consumers increasingly have to concern themselves with limited networks and out-of-pocket costs such as co-pays and deductibles. Shoppers who don't pay close attention to these details before they buy do so at their peril.

However, there is good news: Although premiums are rising, there are federal subsidies based on income level which can deeply reduce the cost of those premiums for a great many people. Although premium rates are going up, so are the subsidy amounts.

The Minnesota Department. of Health estimates that about half the people who could be using these subsidies aren't. Many don't know that subsidies are accessible only through MNsure. Similarly, many people are unaware that it's possible to get coverage from one of the public health care programs if your income is below 200 percent of the federal poverty level. That's $23,540 per year for a single person or $48,500 per year for a family of four. Public health care programs, like federal subsidies, are only accessible through MNsure.

There is more good news: Whether you're going to get on a public program or buy a commercial policy through MNsure, free, individual help is available from local assisters, called "navigators," through the Insure Duluth coalition. Navigators are special staff at local nonprofit agencies like Community Action Duluth, the Health Care Access Office and others. Navigators will guide you through enrollment and stay involved until your coverage is active.

To get hold of a navigator for your personal, free assistance, call a navigator organization directly for an appointment or call United Way 211 (800-543-7709) for referral help. You can also find navigators by visiting mnsure.org or insureduluth.org.

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