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In Rochester, squeezed by health care costs

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by Elizabeth Baier, Minnesota Public Radio

October 28, 2013

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ROCHESTER, Minn. When insurance companies decide where to sell health plans, they look closely at what it will cost them. And in Rochester, health care is more expensive than anywhere else in Minnesota because the Mayo Clinic sets the region's prices.

That's the reality facing southeast Minnesota. Despite the federal Affordable Care Act and the new MNsure health coverage marketplace, Rochester stands as the one part of the state where prices are high and options are few.

Live here and you get Mayo's high quality care. But if you don't qualify for subsidies, and you have to pay for insurance out-of-pocket, you pay the price.

A week after MNsure launched its online marketplace, Rochester resident Sandra Toogood checked her MNsure insurance options and found just one -- a Blue Cross Blue Shield plan that would cost her more than she currently pays. She earns enough that she doesn't quality for a federal tax subsidy.

The lack of coverage options on MNsure could deter many Rochester residents from obtaining coverage, she said.

"I don't know anyone that can pay more than one of their paychecks to be able to afford health care insurance," said Toogood, an archivist at the History Center of Olmsted County who pays $350 per month for health insurance for herself and 18-year-old daughter.

The unsubsidized insurance option on MNsure for a 55-year-old like Toogood living in Rochester is $594 a month for a mid-level plan. In the Twin Cities, a comparable plan would cost as little as $268.

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In Rochester, squeezed by health care costs

Patients, firms shop for better health care deals

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Paul Freeman drove 600 miles last year to save himself and his employer thousands of dollars on his surgery.

Freeman's insurer covered his travel costs and the entire bill because a medical center in Oklahoma City could remove the loose cartilage in his knee for about 70 percent less than a hospital closer to Freeman's Texhoma, Okla., home.

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At first, the community bank CEO hesitated because he thought the lower price would mean lower quality. But he knew if he didn't make the roughly 10-hour roundtrip trek, he'd pay about $5,000 out of pocket.

"You immediately think, 'Oh they're going to take me into a butcher shop and it's going to be real scary,'" Freeman, 53, says, noting that instead he had a "wonderful experience."

People shop for deals on everything from cars to clothes to computers. Why not for health care, too?

Insurers, employers and people are shopping around for health care as they try to tame rising health care costs. Companies are doing things like paying for workers to travel if they agree to have a surgery performed in another city where the cost is cheaper. They're also providing online tools to help people search for better deals in their home market.

And some patients are bargain-hunting on their own. Through a website called MediBid, people who pay out of pocket are soliciting doctors, hospitals and medical centers to bid to perform knee surgeries and other non-emergency procedures.

Patients who shop for care represent a tiny slice of the roughly $2.7 trillion spent annually on health care in the U.S., said Devon Herrick, an economist who studies health care for the National Center for Policy Analysis. But he and other experts expect this trend to grow, especially as more companies offer insurance plans that require employees to pay thousands of dollars before most coverage starts. These so-called high-deductible plans also will be among the cheapest options available on the public exchanges set up as part of the health care overhaul to enable millions of uninsured people to shop for coverage.

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Patients, firms shop for better health care deals

Farmers sorting out impact of health care

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MIDDLETOWN, Mo. For pork producer Jim Fisher, providing health care insurance for his employees is a way to make sure he gets good workers.

He farms in Northeast Missouris Pike County with his brother, David.

The family has 2,600 sows and markets about 65,000 pigs annually. They have eight salaried, full-time employees.

Businesses with fewer than 50 employees are exempt from the Affordable Care Acts employer mandate to provide health insurance. But, for Fisher, having health insurance for employees is a good business practice.

If you want to attract employees, good employees, thats probably the No. 1 thing, Fisher says of providing health insurance. I always try to look at it, if I were looking for a job, Id be asking the same thing.

Fisher buys the group insurance policy for his employees through an agent in nearby Bowling Green.

All our employees, we pay 100 percent of their health care (insurance premiums), Fisher says.

Like most people, Fisher has felt the effects of rising health-care costs.

In the past weve had to raise the deductible, he says. . . . We try to adjust their salary to what the health care is costing us. If you get an older person, it costs more.

Fishers brother, David, gets health insurance through his wifes off-farm job. Jim Fisher buys an individual health insurance plan for himself, separate from the farm-employee plan.

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Farmers sorting out impact of health care

GOP, Obama address poor performing health care website

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WASHINGTON --

President Barack Obama's weekend media message is about the troubled health care website and he's asking people to give it a chance as experts work to fix it.

Obama vowed that "in the coming weeks, we are going to get it working as smoothly as it's supposed to." He assured citizens that "everyone who wants insurance through the marketplace will get it."

The administration says the website should be running much better by the end of November.

For the Republicans, Michigan Rep. Fred Upton, the chairman of the House Energy and Commerce Committee, wondered whether the website's troubles are a harbinger of what's ahead for the entire health care law.

He also asked how the administration can "punish innocent Americans by forcing them to buy a product many cannot afford, from a system that does not work?

Hi, everybody. A few weeks ago, we launched an important new part of the Affordable Care Act.

Its called the Marketplace. And for Americans without health insurance, and Americans who buy insurance on their own because they cant get it at work, its a very big deal.

If youre one of those people, the Affordable Care Act makes you part of a big group plan for the first time. The Marketplace is where you can apply and shop for affordable new health insurance choices. It gathers insurers under one system to compete for your business. And that choice and competition have actually helped bring prices down.

Ultimately, the easiest way to buy insurance in this Marketplace will be a new website, HealthCare.gov. But as you may have heard, the site isnt working the way its supposed to yet. Thats frustrating for all of us who have worked so hard to make sure everyone who needs it gets health care. And its especially frustrating for the Americans whove been trying to get covered. The site has been visited more than 20 million times so far. Nearly 700,000 people have applied for coverage already. That proves just how much demand there is for these new quality, affordable health care choices. And thats why, in the coming weeks, we are going to get it working as smoothly as its supposed to. Weve got people working overtime, 24/7, to boost capacity and address these problems, every single day.

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GOP, Obama address poor performing health care website

As health care marketplaces open, Vt. eyes bigger goal

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MONTPELIER, Vt. As states open insurance marketplaces amid uncertainty about whether they're a solution for health care, Vermont is eyeing a bigger goal, one that more fully embraces a government-funded model.

The state has a planned 2017 launch of the nation's first universal health care system, a sort of modified Medicare-for-all that has long been a dream for many liberals.

The plan is especially ambitious in the current atmosphere surrounding health care in the United States. Republicans in Congress balk at the federal health overhaul years after it was signed into law. States are still negotiating their terms for implementing it. And some major employers have begun to drastically limit their offerings of employee health insurance, raising questions about the future of the industry altogether.

In such a setting, Vermont's plan looks more and more like an anomaly. It combines universal coverage with new cost controls in an effort to move away from a system in which the more procedures doctors and hospitals perform, the more they get paid, to one in which providers have a set budget to care for a set number of patients.

The result will be health care that's "a right and not a privilege," Gov. Peter Shumlin said.

Where some governors have backed off the politically charged topic of health care, Shumlin recently surprised many by digging more deeply into it. In an interview with a newspaper's editorial board, he reversed himself somewhat on earlier comments that Vermont would wait to figure out how to pay for the new system. He said he expects a payroll tax to be a main source of funding, giving for the first time a look at how he expects the plan to be paid for.

The reasons tiny Vermont may be ripe for one of the costliest and most closely watched social experiments of its time?

It's the most liberal state in the country, according to Election Day exit polls. Democrats hold the governor's office and big majorities in both houses of the Legislature.

It has a tradition of activism. Several times in recent years, hundreds of people have rallied in Montpelier for a campaign advocating that health care is a human right.

It's small. With a population of about 626,000 and just 15 hospitals, all nonprofits, Vermont is seen by policy experts as a manageable place to launch a universal health care project.

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As health care marketplaces open, Vt. eyes bigger goal

Health Care Checkup: Advocates say health care industry not ready for ACA

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CARLISLE Regardless of the ongoing political debate about the Affordable Care Act, officials and advocates say the current health care industry faces challenges when it comes to making parts of the act successful in Pennsylvania.

Panelists and audience members at the Building Common Ground Summit Saturday morning at Trickett Hall at Penn State Dickinson School of Law voiced concerns over those challenges and what is actually available in the health care industry.

Panelists focused their concern on the number of primary care physicians who would be available to take on the potential increase in newly insured patients looking for the complete coverage of preventative and wellness services.

While answering a submitted question from the crowd, Becca Raley, executive director of Partnership for Better Health, said there has been a problem for years with the availability of primary care physicians a problem that will become more prominent as more people receive new Affordable Care Act plans.

Raley cited the Community Health Needs Assessment completed last year by Holy Spirit Health System, PinnacleHealth and Penn State Hershey Medical Center, an assessment that covered five counties in the Midstate. Raley focused on the data for Perry County, an area in dire need of primary care.

Its a county with basically no health infrastructure whatsoever, she said. There are more than 3,000 people per primary care physician.

Panelist Athena Smith Ford, advocacy director of the Pennsylvania Health Access Network, said movement is taking place to help address the low number of primary care physicians. Like Raley, she said many students graduating from medical school even those intending to go into family medicine are choosing higher-paying specialties. Ford said the motivation for students to choose specialty fields heavily relies on the fact those graduates will have sizeable loans to pay off.

A program that started in 2010, however, is available for graduates to help prevent that move to specialty services, Ford said.

It pays off student loans to have primary care physicians in under-served areas, she said.

Ford said measures exist in the Affordable Care Act to provide more funding for the program. It will take time to build up the available number of primary care physicians, nurse practitioners and mental health providers, but Ford said there has already been a significant increase in the number of primary care physicians available since that program was implemented.

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Health Care Checkup: Advocates say health care industry not ready for ACA


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