Shared from the 10/30/2016 Star Tribune eEdition

Looking death (and ACA) in the face


Anne Barta was diagnosed with stage four cancer in January 2015, news that devastated her family. Doctors first diagnosed her illness as ovarian cancer, but later determined she had a rare form of the disease that originated in her appendix. They said she might have 12 to 16 good months left. There was nothing more they could do.

So John and Anne Barta sought a second opinion at the Mayo Clinic in Rochester. Doctors there attacked the cancer aggressively with a chemotherapy program that stopped the spread of the disease and allowed her to live past predictions. She was able to see her son get married and her daughter enter medical school. She is even able to work part time as an art teacher between treatments.

“We owe it all to her team at Mayo,” said husband John. “Her goal is to see our daughter graduate medical school and get married.”

But that may now be in jeopardy because of dramatic changes to the individual insurance market.

John Barta, a former CFO of a graphics firm who is now in semiretirement, has heard all the talk about soaring insurance premiums. But he and his wife, a part-time art teacher, planned for retirement and put enough away to absorb reasonable insurance rates and copays. They are not in the MNsure program, but they’ve quickly learned that the problems are systemwide for the 5 percent of people who buy their insurance independently.

John and Anne recently learned that Mayo will soon be considered outside the network of their provider, Blue Cross Blue Shield. To continue to get the care at Mayo that they believe is keeping Anne alive, the Bartas would have to re-enroll in a plan that has no cap on out-of-pocket expenses. The coinsurance would be 50 percent after the deductible is met. John has estimated his wife’s care could be $300,000 next year, meaning he would have to come up with $150,000 a year.

The Bartas seem to have done everything right. They always bought the best health care plan while working, and did so again when John lost his job. The industry has changed on him, and now the Bartas may have to decide whether to continue treatment at the risk of quickly depleting the family retirement savings.

Eileen Smith , director of communications for the Minnesota Council of Health Plans , said that before passage of the ACA, the Bartas would have been able to buy a policy through the Minnesota Comprehensive Health Association . The state’s high-risk pool, where people with preexisting conditions who were turned down by insurance companies could buy a policy, allowed patients to go to the hospital of their choice.

So, at a time he should be focusing on his wife’s health, John has been going to insurers and legislators looking for answers. “How do you think this makes [Anne] feel?” he said. “As a spouse, I am forced to ask the question, ‘What’s the value of my wife’s health?’ ”

Blue Cross Blue Shield said in a statement Friday : “We are reaching out to this family to better understand their situation and to help them determine the best path to covered care. We know how changing doctors and having health records transferred from one hospital to another can be challenging to navigate, especially when dealing with a serious health issue. However, we strongly believe the health care systems available through all of our Blue Plus ACO plans are among the very best in the state.”

Robert Nesse , a Mayo physician who is on the board of governors, said Friday that the Bartas’ situation is “heartbreaking.”

“Mayo Clinic has always been patient-centered,” said Nesse. “It’s one of those tragedies that don’t fit on a spread sheet. We will not abandon them.

“We will see more of these” as providers limit networks, Nesse added. “It’s one of those acute situations where policies have gotten really personal.” Not considered, said Nesse, was “how much was spent on ineffective care ... before she got here?”

John Barta notes that the state has injected millions of dollars into the Destination Medical Center plan to help the hospital expand. “It’s one of our state’s biggest assets,” he said. “People from all over the world come here and we can’t go there? If insurers are going to exclude the Mayo Clinic from their networks, it’s no longer available to a lot of Minnesotans.”

John Barta said he hoped there could be exceptions for rare cases like theirs that allow some patients to remain with their caregiver. “If we are an insignificant percent of the total market, then there should be a ‘continuity of care’ exception if you meet the criteria. It’s life-altering for those families,” he said.

The situation the Bartas are in is possible in a backward country — yes, backward — where health care is not seen as a right, but rather, a political wedge issue. “If one side proposes a solution, the other side has to be against it,” John Barta said.

With the enrollment period fast approaching, Barta feels he has no alternative but to re-enroll in his current plan and decide what to do by January. Meanwhile, he said, he and his wife are trying to enjoy their lives and their two children.

“We’re trying to lead as normal of a life as we can.” • 612-673-1702

Follow Jon on Twitter: @jontevlin

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