ST. PAUL (AP) -- The state of Minnesota is becoming far stingier with the health insurance it provides to low-income adults who don't have children. The poorest will face new co-payments, many will pay more for less coverage and thousands will lose state-sponsored insurance entirely.
According to the state's projections, changes that take effect Wednesday will mean 5,585 people will lose coverage in this fiscal year and nearly as many will lose coverage in the next. They count among some 38,000 people expected to go without state-sponsored health insurance by 2007 as a result of various policy changes enacted this year.
Officials with the Department of Human Services say they had to make the cuts to balance the state's budget, and they're counting on health providers and nonprofits to help keep the safety net intact.
Many doctors, hospital officials and advocates for the poor, however, say the changes represent a step back from a long-standing state commitment to increase the ranks of the insured. They also warn that the changes could cost the state more in the long run.
"It's strictly a financial issue," said Brian Osberg, assistant commissioner for health at DHS. "We were facing the budget deficit and we needed to come up with proposals that would protect and preserve coverage for the elderly, disabled and children."
He noted that, under proposals first considered by the Legislature, the programs could have been eliminated entirely.
Under the changes:
-- Adults without children who learn less than $6,744 in a year -- 75 percent of the federal poverty level -- and don't have more than $1,000 in assets will keep full coverage. They will, though, face new co-payments such as $25 for any nonemergency use of emergency rooms and new payments for prescription drugs.
-- Those earning between $6,744 and $15,720 per year will have the option of purchasing a new, limited option health care policy intended to cover outpatient hospital visits and physician services. Enrollees will pay slightly more for the reduced package -- about $36 per month for someone earning $12,000 a year -- and total benefits will be capped at $5,000 a year.
-- Anyone earning more than the $15,720 cutoff will lose coverage entirely. Enrollees previously have been able to continue to purchase insurance for a limited time even as their income exceeded the cap.
"It's hard as a practicing physician to all of the sudden lose contact with a patient because they've lost medical coverage," said Dr. Patricia Lindholm, a family physician in Fergus Falls. "The worst of it is, they are going to get care but it will be when things have gotten a whole lot more complicated and a heck of a lot more expensive."
She noted that Minnesota has long prided itself on having among the lowest rates of uninsured people in the nation. "I think that is in jeopardy," Lindholm said.
Hospital officials expect to see more of the newly uninsured showing up in emergency rooms for treatment.
Bruce Rueben, president of the Minnesota Hospital Association, said because of costly emergency treatment, people should expect to pay more for their private insurance as hospitals shift costs that the state is no longer paying to others.
But Osberg said that, even with the changes, Minnesota will remain more generous in the insurance it offers to childless adults than most other states.
"We're asking hospitals and other providers to become creative in how they can provide primary care to the uninsured," he said. "We believe that there will be other ways by which people can access care in a timely basis."
Advocates for the poor say the new policy, with its sharp cutoff for people who earn too much, will lead people to stay on low-prospect jobs because earning slightly more money could cut them from health care entirely.
And Lindholm said she worries that the policy changes will hit especially hard in rural areas, where amenities such as free clinics, staffed by physician volunteers, are not as widely available as they are in metro areas.
In all, about 660,000 people remain enrolled in Minnesota health care programs ranging from Medical Assistance, the state's version of Medicaid, MinnesotaCare, aimed primarly toward low income working people with children, and the state's prescription drug program for seniors and people with disabilities.
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