Many Minnesotans who need health care the most are unfamiliar with how the Affordable Care Act will change their insurance, according to a University of Minnesota study published Monday.

The study found that more than 60 percent of people in Minnesota’s high-risk health insurance pool are uninformed about how health care reform will affect them.

“That’s a little bit troubling,” said Elizabeth Lukanen, a senior research fellow who worked on the study.

The high-risk insurance pool consists of people who have been denied coverage because of pre-existing health conditions. In Minnesota, they’re guaranteed coverage by the Minnesota Comprehensive Health Association, a nonprofit created by the state Legislature in 1976.

But beginning in 2014, the ACA will prohibit private companies from denying coverage to people with pre-existing conditions or charging them more than their lower-risk peers.

Because of this, MCHA will dissolve and the high-risk pool will be able to get coverage through three main options: Medicaid, private companies with federal subsidies, or private coverage without subsidies, Lukanen said.

But more than half of the high-risk pool surveyed will likely be ineligible for any government assistance in health care, like Medicaid or subsidized coverage, because they have incomes above 400 percent federal poverty level, the eligibility cap for that type of assistance.

“That’s a little surprising,” Lukanen said.

About 9 percent of the high-risk pool will likely be eligible for Medicaid, and 37 percent will likely be eligible for private insurance with subsidies, she said.

Making the transition

The study says stakeholders should implement education and outreach efforts to bring the high-risk population up to speed.

The survey was conducted late last year, though, and researcher Lynn Blewett said she thinks public knowledge may have increased since.

“I think if we took this now, they’d know more,” she said.

Since the survey was conducted, MCHA has developed a transition plan for participants, she said, and has sent letters telling enrollees what they should expect to see.

Some will have an easy transition, while others could be in the middle of treatment and won’t be able to change plans right away, said Anne O’Connor, a spokeswoman for the Minnesota Department of Commerce, which oversees MCHA. To deal with these more difficult transitions, MCHA will remain intact through at least 2014.

Another challenge will be convincing high-risk enrollees to embrace the change, Lukanen said.

The study found that four-fifths of participants said they were either somewhat or very satisfied with their current
insurance plan.

A diverse group

Though the study was conducted in Minnesota, researchers say the results are applicable across the nation.

Including Minnesota, 35 states have a high-risk pool. Lukanen said it’s likely most members across the country are somewhat unfamiliar with health care reform.

The study was also a reminder that the high-risk pool is made up of diverse members, she said.

“We thought of this group as a monolith, and the reality is they’re very different,” Lukanen said. “Sometimes you need the data in front of you to remind you of that.”