This week at the Capitol

Health care analysts says a large number of Minnesota's uninsured have jobs. They say workers don't make enough money to cover the cost of health care but make too much to be eligible for public insurance programs.

Barbara Fors is a perfect example.

"I'm one of these people that fall right between the cracks," Fors said.

The 50-year-old single mother of two makes $15,000 dollars a year as a cook at Mankato State University. She says her employer, Chartwell Food Services, offers health insurance but she can't afford it. Fors says she would have to pay close to $600 a month to get coverage. "It's hard to live if I would have to put $600 every month out for insurance out of my own pocket. It's probably been that because I have no insurance," Fors said.

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Fors has to scramble to find ways to obtain health care for her family. She often takes her children to the free health care clinic in St. Peter or pays for the care out of her own pocket. She hasn't had health insurance in five years. "There's times where I find myself crying because I don't know what would happen if they really got sick or if mom really got sick, what's going to happen to my children," Fors said.

A number of health care analysts say Fors' situation is becoming more common. They say rising health care costs along with the struggling economy and government budget deficits are creating a so-called, "perfect storm" in health care.

Michael Scandrett, a consultant for Halleland Health Consulting, says the situation could get worse as the struggling economy forces employers to make cutbacks.

"When the economy gets weak, employers are less able to afford to offer coverage. There are fewer jobs out there and most people get their coverage through their employer. So if most people don't have a job you're very likely to be unisured. If you do have a job it's more likely that your employer won't be able to help pay the costs than in the past," Fors said.

The Minnesota Department of Health says health care premiums have increased at annual double digit rates over the past three years. Employers are forced to eat the higher cost, cut back on coverage or pass more of the costs onto the employees.

"Ultimately, if we continue to see 26 percent increases, we will reach a limit on the amount of benefit that we'll be able to provide," according to Mark Hottinger, treasurer of St. Paul based National Checking Company.

The printing company employs 180 people and supplies products for restaurants through the foodservice distribution industry. Hottinger says his company saw a 46 percent increase in health care costs over the last two years. Hottinger says his company absorbed the costs by paying more and passing some of the costs onto employees. Now, for example, employees have to pay higher prescription drug co-pays.

Hottinger says company managers are struggling with ways to deal with the rising costs. He says the challenge is to manage increasing employee benefits while keeping company products at a reasonable price for their customers.

"We go back to limited resources, they truly are," Hottinger said. "There's only so much money, in let's say the budget, and where should that money go?"

Other companies are making more dramatic cuts in employee benefits.

Employer groups, labor unions and social advocacy organizations say an increase in the number of uninsured will lead to bigger problems. They say, for example, more people will show up for treatment at hospital emergency rooms, the most expensive part of health care. If they can't pay, hospitals maybe forced to pay for it through charity care. County hospitals say they'll likely offset the cost through higher property taxes.

Scandrett, who once served as the executive director for the Minnesota Council of Health Plans, says the concern by such a broad variety of groups should initiate some change. Both Scandrett and Hottinger agree the consumer more responsibility in the cost. Scandrett says consumer demand for the best treatment, drugs and care are compounding the problem and have to be addressed.

"The underlying problem for rising health care costs is our unlimited expectations that we all feel and want to get every possible thing that could be a benefit to us in the health care system at whatever price that may be. Inevitably we're going to have to make some tough choices about what's important to us because we just can't continue to pay for everything that's out there in the system," Scandrett said.

Scandrett believes the number of uninsured is certain to increase as a result of Gov. Pawlenty's budget proposal.

Governor Pawlenty has said the state can't handle the projected 20 percent increase for health and human services programs. He's offering an eight percent increase in his budget. Pawlenty is recommending that the state eliminate General Assistance Medical Care and roll the eligible participants into MinnesotaCare, the state sponsored health insurance program he wants to scale back. He's also proposing cutbacks to General Assistance.

State estimates project 34,000 people will lose their state sponsored coverage this year under Pawlenty's budget. The projections estimate that number will double to 68,000 by 2007.

"Given the financial circumstances we cannot continue to afford to subsidize premiums for working age adults and that's who get impacted most by this," said Brian Osberg, Assistant Commissioner for Health Care in the Department of Human Services.

Osberg wasn't specific on what the governor plans to do to address the uninsurance issue. Osberg says his department hopes to work with the private sector to come up with alternatives.

"What we need to do is find ways in which we can provide some assistance for people in enrolling into private insurance arrangements. We don't believe, necessarily, that the answer is for people to be enrolled entirely in public health care programs," Osberg said.

Osberg says the administration is also encouraging hospitals to provide additional charity care. He says he hopes people without insurance can use the charity care for primary care services, not just hospital stays.

Several social justice advocates say the Pawlenty approach is short sighted. Jim Koppel, with the Children's Defense Fund, says cutting off people from public programs will cost more money down the road.

"It should not be treated as a safety net program because when you treat it as a safety net program it becomes a crisis, emergency room, high health care cost, back end loaded system. It deals with the sickest people who put off care, have worse outcomes, cost the most and it's the worst way we can deliver health care," Koppel said.

Koppel says the governor should reverse his plan to not raise taxes, something Pawlenty has says he will not do.

Cover the Uninsured Week will hold a number of forums and townhall meetings to discuss the problem over the next week.