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Minnesota already had a ‘high-risk pool’ and it didn’t fix health care

Most politicians will agree that sick people should have access to affordable health care. They just can't agree on how to do that.

Most politicians will agree that sick people should have access to affordable health care. They just can't agree on how to do that. Getty Images/iStockphoto

There’s a lot both parties can agree on when it comes to health care.

Yes, health care is expensive. Yes, people who are unfortunate enough to be sick should still be able to get health insurance. But as soon as you utter the phrase “pre-existing conditions,” it’s all political deadlock.

Democrats maintain that there should be mandated coverage for people who are already sick and therefore “uninsurable.” Republicans say that would be too expensive, usually with the phrases “socialized medicine” and “Obamacare” thrown in. The cost of caring for the expensive few shouldn’t burden the healthy many, they say. Surely, there can be a sort of monetary “pool” to take care of these “high-risk” individuals?

As it turns out, we don’t have to weigh one hypothetical health care system against another with the power of our imaginations alone. Minnesota used to have a “high-risk pool” for people with pre-existing conditions. Like most of the state’s health care systems, it went by a cumbersome acronym: MCHA (pronounced “EM-cha”) or the Minnesota Comprehensive Health Association.

MCHA, created by the state legislature in 1976, was for anyone who was denied coverage by a health insurer because they were already sick. Minnesota was something of a pioneer in this approach to health care. By the time the program ended, it was the nation’s oldest and second-biggest state-based high-risk pool.

It was run kind of like a nonprofit, except it was controlled by the insurance industry. Premiums were set somewhere between 101 and 125 percent of the market rate.

“MCHA was not affordable for many,” according to an overview of the policy by the Minnesota Department of Health. “Premiums were expensive for individuals by any standard (and to the system).” Many patients, it said, went into medical debt despite having insurance.

Plus, the coverage had a cap: Everyone got a $5 million lifetime maximum, no matter what condition you had or what it costs to manage.

“That sounds like a lot,” Democratic United States Senator Tina Smith said at a recent MPR debate. She’s currently battling Minnesota Sen. Karin Housley, a Republican, for her seat, and she and her opponent differ on how best to handle the pre-existing condition problem. Housley brought up MCHA as an alternative to the “unaffordable” Affordable Care Act.

But the thing is, Smith said, $5 million isn’t a lot when, say, your baby is born with a heart defect. She recalled talking to a woman on the campaign trail whose grandchild was unfortunate enough to be in that position. This girl’s life had barely begun, but she’d already racked up $1 million in health care costs.

MCHA ended in 2014 with the arrival of the Affordable Care Act -- which, to be fair, is expensive, and will continue to be if young, health people continue to go without insurance rather than opt in.

But if we’re talking about cost, let’s compare apples to apples.

A report published in 2017 by the Minnesota Department of Health figured out what MCHA would cost if it were still in operation. If a 40-year-old person living in Morris were in the high-risk pool, she would have paid almost $6,000 in premiums in 2017. That’s about $400 more than what a “bronze plan” would cost under the Affordable Care Act, and it would only cover about 38 percent of the average claims costs.

MCHA, the report said, would charge about four times as much as the average premium for employer-sponsored coverage.

If there’s a lesson to take from MCHA and the Affordable Care Act, it’s that providing health care for everyone who needs it is expensive. But the alternative is to simply forget about the sick, the injured, the babies born with struggling hearts. Let them fend for themselves, and let those who can pay get the care they need to survive.

Caring comes with a price tag. Heartlessness is cheap.