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Lawmakers have fear of limited health care choices in rural areas

State regulators approved enrollment caps that could cut care options in rural areas.

With most of the state’s insurance companies imposing emergency caps on enrollment, lawmakers on Wednesday said health insurance shoppers in rural areas could face sharp limits next year in their choice of health plans, doctors and hospitals.

Last week, the state Commerce Department approved the caps as well as steep premium increases for 2017 in order to keep health insurers from abandoning the state’s individual market, where about 5 percent of state residents buy coverage.

Four of five health insurers in the market will stop offering coverage once they hit their enrollment cap, meaning consumers could find their only option is the health plan without a cap — the Blue Plus HMO from Eagan-based Blue Cross and Blue Shield of Minnesota.

During a committee hearing Wednesday, Republican and DFL lawmakers said some key regional hospitals and clinics outside the metro area aren’t part of the Blue Plus network.

“We’ve got a really scary situation going on,” said Rep. Greg Davids, R-Preston, describing a scenario that could impact how his constituents receive treatment at Olmsted Medical Center in Rochester.

Sen. Tony Lourey, DFL-Kerrick, agreed with the point, saying there is also a question about access to Duluth-based Essentia Health under certain enrollment scenarios in northeast Minnesota.

“This is going to be a very difficult period,” Lourey said during a meeting near the Capitol of a legislative oversight committee on MNsure, the state’s health insurance exchange.

MNsure is an option for the roughly 250,000 people in the state’s individual market, which is undergoing significant changes with the federal Affordable Care Act.

The premium jumps and enrollment caps don’t apply to Minnesotans covered by employer plans, Medicare and other government programs aren’t affected.

In response to lawmaker questions, Commerce Commissioner Mike Rothman said the enrollment caps would create scenarios where consumers might not have the sort of access to health plans, doctors and hospitals that they might want. That’s why regulators are encouraging people to shop early once open enrollment begins Nov. 1.

“Consumers will have access to a plan, but I want to emphasize: It may not necessarily be with the specific insurer or provider network people would prefer,” Rothman said. “I urge Minnesotans to shop early.”

In response to questions from the Star Tribune this week, a Blue Cross spokesman said that Blue Plus subscribers have access to out-of-network hospitals and clinics — it’s just that the health plan picks up a smaller share of the tab.

During Wednesday’s committee meeting, Sen. Michelle Benson, R-Ham Lake, argued that the state’s shop early message to consumers could create a technical challenge at MNsure.

Blue Cross for next year has pulled health plans that currently cover about 103,000 people, Benson noted, so those enrollees will be searching for a new plan. That’s also true for about 9,100 people with HealthPartners coverage that isn’t being renewed.

Considering the influx of shoppers, Benson said: “MNsure can’t do it.” She also questioned whether MNsure’s technology could handle the need for real-time data communication so that the state and insurers can manage the caps.

Insurers will need to let the state know when caps have nearly expired, or have been hit, so that MNsure pulls down the health plan as an option for shoppers. The situation is particularly distressing, Benson said, because Republicans for more than a year have been pushing the state to get a federal waiver that would let shoppers access tax credits when purchasing plans outside MNsure.

Rothman sent Republicans a letter this week saying the chances for the federal government granting the current waiver request are remote.

“Here’s the disaster that’s coming: 100,000 new people are flooding in. The only place they can get [a tax credit] is on the exchange,” Benson said. She added: “MNsure is not stable.”

But Allison O’Toole, the MNsure chief executive, said in an interview that MNsure is up to the task. The health exchange has known for months about the Blue Cross pullback, O’Toole said, so there’s been time to prepare.

MNsure’s call center will be staffed to handle the challenge, she said, and will be staffed differently to handle an expected early surge of calls. In previous years, call center traffic has spiked at enrollment deadlines, rather than at the beginning of sign-up periods.

Finally, MNsure’s technology has improved, O’Toole said. The exchange can now better handle people who want to simply renew their current coverage, she said, and there’s better technology for insurance agents and navigators to help people sign up for a plan.

“Our website has been stable for some time, and can handle the load that’s coming,” O’Toole said.

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