Value of health insurance could be tough sell to some uninsured

November 6, 2012

Link to full article with audio

Elizabeth Stawicki, Minnesota Public Radio

ST. PAUL, Minn. — Going without a health plan is bad for your personal and financial health. Lack of health insurance increases an individual's risk of dying prematurely and being unable to pay for housing or food due to medical bills.

The federal health care overhaul aims to drastically reduce the number of Americans who don't have insurance. But as Minnesota officials gear up to promote the importance of health insurance, market research indicates even subsidized health plans will be a tough sell with some people.

You may wonder why states need to proactively sing the praises of health insurance. Wouldn't the uninsured just sign up? After all, the law provides free or low-cost coverage through government programs such as Medicaid and will include financial help through tax subsidies for many others.

Not necessarily, according to Maria Ruud, a nurse practitioner who treats uninsured patients at an Uptown Minneapolis clinic, the Neighborhood Involvement Program.
"A lot of our patients live in poverty and when you live in poverty, sometimes just getting through your day is a struggle," Ruud said.

Her patients often work several part-time jobs and live paycheck to paycheck, Ruud said. Health insurance, particularly if they don't get sick all that often, is not an immediate concern, but buying food and paying rent are.

Market research indicates many uninsured people are deeply skeptical of health plans, public and private. Some have been dumped out of government programs because of changes in their finances. Others have been denied coverage due to pre-existing health conditions. And some just found coverage too expensive or not worth the cost.

Peter Mitchell runs a marketing firm the state hired to survey attitudes about health insurance. He said most uninsured Minnesotans feel priced out of coverage; the belief is so deeply ingrained that many forgo even applying because they assume they won't qualify.

"There's a low level of trust among a lot of the uninsured, especially. There's this feeling 'I've heard promises like this before; I'm not sure it's going to come through,' " Mitchell said. "So you have a skeptical public."

Lack of trust isn't the only problem. Insurance is complicated and laden with technical terms like "rider," "co-insurance," and "guaranteed issue." How do you explain those terms to people whose first language is something other than English? How do you explain the difference between a co-pay and a deductible, or how to budget for them?

Those concerns are so important the state has a study panel looking at the best ways to reach out to people who lack insurance.

"There are going to be some people who are going to need a lot more hand holding," said Elaine Cunningham of the Children's Defense Fund - Minnesota, who is on the study panel. "You have to look at how you provide your services so you're reaching the person who needs a lot of hand holding or you've lost that person."

The health care overhaul law requires states to reach out to the uninsured and help them enroll in health plans.

One idea is to take advantage of community service groups that already serve low-income people, such as The Pantry food shelf in Eagan.

Program manager Mary Freeman said the center is used to helping clients with more than food.

"When they make their first initial appointment, we require them to sit down with a family advocate and the family advocate's role is to determine if there are other benefits or other needs that a family might qualify for," Freeman said.

In addition to food shelves, a state study panel has identified more than 100 potential Minnesota channels to help with outreach. That list ranges from Portico HealthNet, which already links the uninsured with health care to the Minnesota Farm Bureau to the Minnesota chapter of the Federal Bar Association.

Elaine Cunningham of the Children's Defense Fund - Minnesota said tapping organizations that individual communities already trust will be key.

"Those community-based organizations, they're on the ground working with families in need and they're really important; that's what works," she said.

While the state tries to figure out the best way to reach people who may be reluctant to buy health insurance, there's another problem--how to pay for the outreach. Washington has sent mixed signals on whether states can use federal funding provided in the health care law to help people sign up for insurance.