Byline: Casey Selix
Mar. 3--James Roberson spent more time watching than skiing while chaperoning his future stepson's field trip to Afton Alps last month.
'I have what I call 'no-insurance-itis,' ' said Roberson, who lost his job as a Northwest Airlines mechanic in the aftermath of Sept. 11. 'I was very much afraid that if I got hurt, I'd have no insurance to cover it.'
Though Roberson could continue his Northwest insurance under federal law, he can't afford the $500 monthly payments. He can't afford to take out a new policy, either. He also isn't eligible for a low-cost state insurance program called MinnesotaCare. And even if he were, he'd have to go four months without any insurance to qualify.
For Roberson and thousands of others new to the ranks of the unemployed, finding and paying for health insurance presents hugely conflicting priorities: They typically can't afford to pay under the federal program, but ultimately can't afford to be without it or some policy, especially if they have a pre-existing medical problem.
'The insurance affordability issue is the most predominant problem people face when they're unemployed,' said John Gross, director of health care policy for the Minnesota Department of Commerce, which regulates the insurance industry in the state.
While 312,000 initial claims for unemployment benefits were filed in 2001 in Minnesota, there's no measure of how many unemployed people now lack health insurance, state officials say. But with a 50 percent jump in jobless claims since 2000, it's likely the numbers of uninsured are rising.
The Kaiser Family Foundation found recently that for every percentage-point increase in the national unemployment rate, 860,000 people would become uninsured.
Applying that formula to the change in Minnesota's unemployment rate between January 2001 and January 2002, about 13,000 people and their families could have lost health benefits, said Jay Mousa, research director of the Minnesota Department of Economic Security.
'There's absolutely an increase in the number of uninsured we're seeing at our clinics,' said Deanna Mills, who runs the Neighborhood Health Care Network, 75 low-cost community health clinics in Minnesota that provide primary care for low-income, uninsured people and serve as a safety net for people between jobs and health benefits.
The increasing numbers of uninsured come at a difficult time in Minnesota.
With the state facing a $2.3 billion deficit, no spending increases are budgeted for MinnesotaCare, though legislators are looking at waiving the waiting period for those who lose their jobs. Community health clinics are also facing a $4 million loss in state grants.
While Minnesota has the lowest rate of uninsured residents in the nation -- 5.4 percent of the population, or 266,000 people, as of June 2001 -- the unemployed and uninsured find little comfort in such measurements.
Living without health insurance can mean making tough choices: between physical health or financial health, between buying groceries or prescribed medications, between getting preventive care such as a Pap test or risking cervical cancer.
Berilynn Corcoran, a single, unemployed parent of two boys, is taking a spiritual approach.
'I've been praying, 'Please kids, don't get sick,' ' said Corcoran, who lost her clerical job at Northwest Airlines and insurance benefits after Sept. 11.
And for some, the financial burden of receiving health care is too much. Medical bills were cited in 43 percent of 141 bankruptcy filings for a week in November studied by the Pioneer Press. The median medical bill was $1,850, while 11 percent had medical bills exceeding $5,000.
For society at large, an uninsured population results in an unhealthy population, and an unhealthy population eventually results in an unproductive population, said Mills.
The impact of 'no-insurance-itis' hits not only the budgets of nonprofit clinics and families; it also drains government health programs such as MinnesotaCare and Medicaid.
Eventually, it will result in higher costs or taxes for consumers, said Julie Sonier, assistant director of the health economics program for the Minnesota Department of Health.
The plight of Roberson and his fiancee, LeAnn Roen, is a vivid example of the dilemma faced by unemployed workers.
Roberson, the Northwest mechanic, plans to check out the Neighborhood Health Care Network. His health benefits through Northwest Airlines ended Dec. 31.
He receives $452 a week in unemployment benefits, about half his former pay, but he still needs to help pay the Cottage Grove family's $1,800 mortgage and other bills.
Roen and her two sons are stuck, too.
She can't afford the $800 monthly payment she needs to make to keep her insurance under the federal law, which is called COBRA.
Roen is also a Northwest mechanic but is out until the summer on worker's compensation because of back surgery. Though her back injury is covered by worker's comp, which pays her $467 a week, other health expenses are not.
COBRA -- the federal Consolidated Omnibus Budget Reconciliation Act of 1985 -- requires employers to offer up to 18 months of the same insurance benefits to former employees. The goal is to provide continuous coverage until people begin a new job and are presumably covered by a new insurance plan.
But the cost of COBRA is high, especially for the unemployed, once they discover they're responsible for the entire cost of the premium. Northwest, for example, paid the total health insurance premiums for working mechanics.
'The first question from the airline people is: How will they make the insurance payments or COBRA?' said Jean Dunn, executive director of the Minnesota Teamsters Service Bureau in Minneapolis. 'No matter what it is, it's more than they've ever had to pay, and it's a shock to them.' The COBRA affordability issue is not limited to airline employees.
'Unfortunately, people have sticker shock once they find out what the true cost of the premium is' through COBRA, said Gross of the Commerce Department.
About 15 percent of people offered COBRA actually sign up for it, in the experience of HR Simplified, said Rudy Allebach, director of operations for the Minneapolis-based company, which administers COBRA plans for employers across the nation.
The people who elect COBRA coverage usually have pre-existing health problems, said Allebach. Premiums handled by HR Simplified typically range from $200 to $300 for a single person to $1,000 for a family.
After the massive layoffs post-Sept. 11, President Bush and Congress came up with economic stimulus plans that included assistance with COBRA, either through direct payments to people or tax credits on health insurance.
But none of the plans has made it through Congress because of disagreement between Republicans and Democrats on tax cuts.
One glimmer of hope for the uninsured is that Bush's budget includes increased funding for federal community health centers, said Mills of the Neighborhood Health Care Network.
'There's a lot of support for community health centers on both sides of the aisle (of Congress) because they'd rather fund them than deal with the whole troublesome issue' of providing universal coverage, Mills said.
The inaction is especially frustrating for Corcoran, who lost her job because of Sept. 11. She has testified before committees of the U.S. Senate and the Minnesota Senate about her efforts to keep continuous health coverage for herself and two young sons.
Continuous health coverage is critical, because one of her sons had cancer a few years ago. If he goes without coverage for 63 days, a future insurer can refuse or delay coverage for any cancer-related expenses for up to a year.
Corcoran immediately started looking for jobs offering health insurance because her $600 monthly unemployment benefit wouldn't cover the $709 COBRA payment.
Though she found a low-paying part-time job at the airport, she still can't afford either the COBRA payment or the premium from the new, nonunion employer.
'I know that county hospitals have to take kids, and that's probably the only other choice I would have,' she said. 'Hopefully, we'll all be healthy for four months.' TURNING TO THE STATE Four months is when they would qualify for MinnesotaCare, which was set up in 1992 to offer low-cost insurance.
Initially, it insured just children of the working poor, but now it also covers adults. In fact, MinnesotaCare has helped certain populations, said Sonier of the health department, most notably the working poor.
Researchers see yet another group that in time could need help from MinnesotaCare: middle-class families, which are increasingly going without insurance because of rising health care costs and insurance premiums.
Minnesota appears prepared, though, offering access to more safety nets, such as MinnesotaCare, than most states.
The problem with MinnesotaCare, critics say, is the four-month waiting period.
'The intent (of the waiting period and the higher percentage fee for upper incomes) is that they would be a barrier to prevent people from dropping coverage in the private market ... to enroll in MinnesotaCare,' said Jane Wilcox Hardwick, health care eligibility manager for the state Department of Human Services. The state didn't want to set up unfair competition with the private market, she explained.
The program is financed by a tax on health care providers and by enrollees' premiums, which range from 1.5 percent to 8.8 percent of an individual's or a family's gross income.
Enrollment in MinnesotaCare has grown about 14 percent annually for the last three years, which was anticipated as the program expanded to cover more age groups.
If the waiting period were waived, nearly 15,000 more residents would become eligible in 2003, resulting in an extra cost of $30 million, Hardwick said.
That money is nowhere to be found.
'Frankly, the state is experiencing a deficit, so legislators are having to look at how to trim some state expenditures at the same time people in Minnesota would like broader coverage' under MinnesotaCare, said Mary Kennedy, assistant commissioner for health care for the Minnesota Department of Human Services.
'It's a dilemma,' Kennedy said.
In Big Lake, Minn., Joseph Wellcome parked his sons' motocross bikes during the months the family waited for MinnesotaCare.
Wellcome, a tool-and-die worker, lost his job at American Mold and Engineering because of a layoff in July. His wife lost hers a few months before.
Their COBRA bill would have run $650 a month.
'We had no serious illness -- knock on wood,' said Wellcome, who is about to complete a bachelor's degree through the state's Dislocated Worker Program.
At one point, Wellcome considered quitting school to get a job with health benefits, but decided that would hurt his employment and earning prospects in the long term. His wife is also retraining, to become a nurse.
Living without insurance 'altered our lifestyles, but the boys understood what was going on,' he said.
Roberson and Roen already have found out that they bring in too much money monthly to be eligible for MinnesotaCare. And individual policies on the private market also seem relatively steep given their other bills.
For example, individual Aware Care policies through Blue Cross and Blue Shield would cost the family $469 a month. And a $500 deductible on each person would have to be paid before reimbursement of 80 percent of expenses.
'Something has to go, and right now insurance is the only thing,' Roberson said. 'Yes, we would like the kids to be insured, but they've got to eat.' Roen adds: 'They need a place to live, too.'
Roberson and his future family are being cautious, also.
They're limiting athletic activities. No more trips to the rock-climbing wall at the REI store for the boys, for example. The ski outing was a rare exception because it was a school event.
When the sixth-grader cracked a rib after falling in his physical education class at school, the couple worked out a plan to gradually pay off the $360 for X-rays and doctoring.
But the everyday health costs add up.
Both of Roen's sons take the prescription drug Claritin for allergies, which used to cost $10 per prescription under Northwest's insurance. The recent bill for a 30-day supply for both: $184.50.
'It's still cheaper than COBRA would be,' Roen said.
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(c) 2002, Saint Paul Pioneer Press, Minn. Distributed by Knight Ridder/Tribune Business News.
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