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Mini-Med Policies: Is the Government Telling Us Something We Don't Already Know?

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The new health reform bureaucracy at the U.S. Department of Health and Human Services has announced that it will now require employers, health insurers and union welfare benefit funds to disclose to policy holders that the health insurance they have may not be real health insurance at all. They now have to tell us if their coverage does not meet minimum benefit standards required by law and by how much they fall short. So those who have mini-med policies will now get a notice telling them that their policies cover very little. As if people don't already know.

Not long ago I interviewed a young woman named Etoie Edwards-Edlind who was widowed two years ago, at age 32. She had good health coverage from her husband, but when he died unexpectedly she had to rely on her own plan from her union welfare benefits fund. It is one of those mini-med deals. Her drug coverage is capped at $5,000 a year. (The cap was $10,000 a few years ago.)

Drug coverage is vitally important to Edwards-Edlind. Since she was 18, she has suffered from chronic illness. She doesn't produce enough red blood cells. Her blood doesn't clot properly, leading to paralysis of some of her organs. She's anemic and requires frequent hospitalizations. She already has had two hip replacements. Her monthly expense for drugs totals $1,400. She reaches the limits of her policy in March and has to dig deeply in her household budget to find a way to pay for medicines she must have to survive.

Edwards-Edlind doesn't need a piece of paper from the government telling her that her coverage is not adequate. She knows that. What she needs is for those drug expenses to be covered, which they are supposed to be according to the new health reform law. Health reform did away with annual limits on coverage. That means she should have adequate drug coverage throughout the year.

It seems, though, that the government thinks disclosure is an acceptable substitute for outlawing limited benefit policies. HHS bureaucrats have decided to give exemptions to 222 health plans, union welfare funds and employers at least through 2011. HHS is worried that those providers of health coverage cannot meet the federal standards and believes that some coverage is better than nothing.

Those exempted include some of the biggest names around: Aetna, Cigna, McDonalds, Universal Orlando, Waffle House, a Service Employees International Union local, a Catholic Charities organization, a Teamsters Health Benefits Fund. It kind of makes you wonder why they can't comply. When Jamie Dupree, a columnist for the Atlanta Journal-Constitution asked a Waffle House official why they needed an exemption, he replied: because Waffle House is a private company we are going to decline to comment.

It's not clear whether Edwards-Edlind's welfare benefit fund will seek an exemption. I asked a lawyer for the fund, who didn't want to talk much about it, either. He simply said: It's premature to discuss what they are going to do. Officials at the fund have told Edwards-Edlind that her drug benefits will continue to be capped next year.

HHS is defending its position. Steve Larsen, a deputy director in the Office of Consumer Information and Insurance Oversight, told Kaiser Health News. This is clear notice that you have a policy that does not comply with the Affordable Care Act. Really? What is Edwards-Edlind supposed to do?'  Scream and yell? Buy new insurance with money she doesn't have?

It seems that the best consumers can do is check the government's list of exemptions and plan their finances and budget accordingly for the New Year.

But to me, offering exemptions from minimum health insurance requirements revives a larger debate in American health care'that old issue about equity. We don't have health care equity in America, and health reform didn't do much to change that. Apparently, its okay for part-time hamburger flippers at McDonalds, short-order cooks at Waffle House, or someone who stocks grocery shelves to get almost no coverage and workers who have more benevolent employers or lots of money to get all their care covered. Something to think about in this Christmas season.

More Blog Posts by Trudy Lieberman

author bio

Trudy Lieberman, a journalist for more than 40 years, is an adjunct associate professor of public health at Hunter College in New York City. She had a long career at Consumer Reports specializing in insurance, health care, health care financing and long-term care. She is a longtime contributor to the Columbia Journalism Review and blogs for its website, CJR.org, about media coverage of health care, Social Security and retirement. As a William Ziff Fellow at the Center for Advancing Health, she contributes regularly to the Prepared Patient Blog. Follow her on twitter @Trudy_Lieberman.


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