Until health law takes hold, many grapple with insurance limbo

For some people, big changes under the federal health care law cannot come soon enough.

The law takes full effect in January, and before then many people will enter health insurance limbo as they lose coverage, including some who will age out of their parents' plans. The precise number of those losing coverage is unclear, but researchers indicate it could be in the hundreds of thousands nationwide.

In Minnesota, one young woman, Laura Haynes, will soon face the expiration of her health insurance, leaving her to decide whether to buy an individual policy to carry her through until January.

Then, like most Americans, she will be required to have insurance or pay a penalty. For an individual, the penalty in 2014 will be $95 and will rise in subsequent years.

Under the federal health care law, Haynes, a 25-year-old Minneapolis resident, can stay on her parents' health plan until she turns 26 in June. Then she's on her own.

She sees strong arguments both for and against buying health coverage then.

"I know how easy it is to have any accident or have something go wrong, and to be stuck with that kind of bill would be insurmountable for me," Haynes said. "No, because I'm young and healthy. I exercise, I eat well."

Haynes has had trouble finding a full-time job with benefits, like many young adults trying to find work in the aftermath of one of the worst recessions in U.S. history. She graduated in 2009 with a degree in mathematics and women's studies and has cobbled together part-time jobs at nonprofits, which provide experience but not health insurance.

Haynes has done some shopping for health plans.

"I've found some now that are seemingly affordable," she said, "but then their deductible is so high that it's almost like I'd still have to pay so much that it wouldn't be worth it for me to have that insurance."

Some plans had a $100 monthly premium but an annual deductible of $10,000.

Haynes has another option -- but that, too, is imperfect. She could enroll in MinnesotaCare, the state-subsidized health plan, which covers people under age 65 who earn too much to qualify for Medicaid but not enough to afford health insurance.

MinnesotaCare would be affordable for Haynes, with a monthly premium of less than $50. But it would not cover her in June because it has a four-month waiting period; the earliest she could access it would be October. And then, if she needed to be hospitalized, MinnesotaCare would pay bills only up to $10,000.

Gov. Mark Dayton has proposed eliminating those restrictions, and a key lawmaker said the Legislature will probably do so.

Minnesota Human Services Commissioner Lucinda Jesson said: "Starting in January 2014, there is no more $10,000 hospital cap for MinnesotaCare, and starting Jan. 1, 2014, the four-month waiting period goes away all together."

All the changes in the works make an already complex system even more difficult to navigate, even for people who do it for a living.

"We're hearing so much about 2014 and health reform, and it's very exciting. I'm very excited about it," said Leigh Grauman, an outreach worker at the nonprofit Portico HealthNet in St. Paul, which helps uninsured people find coverage. "But there are still so many little details that need to be figured out. And until then, we have all of these questions, and it's hard to find really concrete answers."

One question is what health plans will cost on MNSURE, the state-run online marketplace where Minnesotans will be able to comparison shop for coverage.

But MNSURE won't be up and running until October, and coverage will begin Jan. 1.

The situation has left Haynes with a great deal of uncertainty.

"If at least I had more information about it and [could] feel more prepared, I think I could make a better decision for myself," she said. "I'd like to know what the costs are looking like; that's really the biggest thing. What are the subsidies?"

The MNSURE website does have a calculator where individuals and small groups can get a sense of what their subsidies and costs may be. It says Haynes could expect to pay $48 a month for health coverage.

That's affordable, but it is difficult to determine if that is a reliable number because the estimates are based on projections from the Congressional Budget Office that are about a year old. Even if it is a firm number, depending on her income, state rules may require her to get insurance through MinnesotaCare, anyway.

Moreover, if MinnesotaCare exists in January and Haynes' income stays the same, she will likely have to get her coverage through MinnesotaCare. She would have the option to buy commercial coverage on MNSURE, but those individuals who qualify for MinnesotaCare and opt out will not be entitled to the tax subsidies on MNSURE.

The story was produced with help from the Public Insight Network. To become a source, visit MPR News online.

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