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The health insurance arm of Mayo Clinic Health System will pull the plug on its business within the next two to three years, a move that will affect almost 30,000 clients and about 30 employees.

Joe Kruse

Kruse

During a period when politics has created turmoil in the health insurance industry, the decision to shutter the Health Tradition Health Plan is based more on its business model than politics, said Joe Kruse, administration chairman for Mayo’s Southwest Wisconsin Region.

“The primary reason is that, over the course of the last four to five years, it has become increasingly difficult to manage the health plan because of its (small) size,” said Kruse, who is based at Mayo Clinic Health System-Franciscan Healthcare in La Crosse.

Asked whether the decision mirrors the action of many other companies that have pulled out of insurance marketplaces, scaled back or ended some plans and/or increased premiums and/or deductibles because of uncertainty amid threats of President Donald Trump and other Republicans to repeal and replace Obamacare, Kruse said, “I’m not sure that would have affected it one way or the other. This is pretty much a business decision.”

The decision was a difficult one for managers of Health Tradition, which has existed for about 30 years, he said.

“While Health Tradition has been a successful plan for many years, it is a very small plan by industry standards. With the uncertainty and volatility within the health care and insurance environment, after careful deliberation, we determined that the business model is no longer sustainable.”

Echoing that assessment was Brian Rotty, Health Tradition’s executive director, who said business in the “insurance marketplace is increasingly difficult to do with a relatively small pool” of clients like Health Tradition’s 30,000.

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Brian Rotty

Rotty

Insurance plans factor in the risk of all members, balancing population pools that include people with varying degrees of health — from individuals who need little health care to those with chronic illnesses that require more care. The more members, the thinner the risk is spread. Many small plans are either joining with larger consortiums or closing, according to industry observers.

For example, Quartz manages insurance services for 275,000 customers in southern and western Wisconsin and parts of Illinois, Iowa and Minnesota from offices in Sauk City, Middleton and Onalaska. Quartz does so for not only insurance companies but also self-funded plans.

Gundersen Health Plan, which had been an arm of the La Crosse-based Gundersen Health System and Unity Health Plans Insurance Corp., affiliated with Quartz in March, assuming the corporate brand and logo, while also continuing to be licensed health plans and market products under the Gundersen and Unity plans.

A Quartz spokeswoman could not be reached for comment on whether it intends to pare back any plans.

Kruse promised that Health Tradition will continue member services throughout next year and into 2019 to allow for final claim processing and to resolve any outstanding issues.

“We recognize that we have to do a good job of communicating with patients” who have Health Tradition coverage to provide “good information so they can remain Mayo-Franciscan patients,” he said.

To ensure that patients can continue their access to Mayo, Health Tradition developed contracts with other large insurance carriers, Kruse said.

Those arrangements include the following:

  • For BadgerCare members — Anthem Blue Cross Blue Shield.
  • Wisconsin state and municipal employees — WEA Trust.
  • Marketplace exchange — Engage by Medica.
  • Employer plans — An announcement is expected shortly to add options for employers in this market.
  • 65Plus — Health Tradition is seeking a partner to continue to the option for seniors.

Many Health Tradition employees will work until the company is dissolved to continue service to policyholders, Rotty said.

“We greatly regret the effect this will have on our dedicated staff,” he said, adding, “It is our hope that employees will be able to find opportunities within Mayo if they wish.”

Employees will receive help with and other job-search activities, including assistance with seeking employment opportunities at other Mayo Clinic locations, he said.

Health Tradition announced in July that it would halt individual coverage in the Affordable Care Act’s Marketplace exchange effective Dec. 31 and would not write small employer group health plans under the ACA’s Small Business Health Options Program next year. It also had declared that it was leaving BadgerCare, which is the Medicaid market in Wisconsin, as well as state employee and local group plans at the end of this year.

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Reporter

Mike Tighe is the Tribune newsroom's senior citizen. That said, he don't get no respect from the cub reporters as he goes about his duly-appointed rounds on the health, religion and whatever-else-lands-in-his-inbox beats. Call him at 608-791-8446.

(27) comments

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YellowBee

So now what are the people on Medicaid that have this insurance suppose to do?? If they switch to money hungry Gundersen it will take them forever to get appointments there, because they are on Medicaid.

Buggs Raplin

Understand there is no perfect solution. Single payer is not perfect, but it's the best solution out there. Most Canadians are satisfied. I'd say that most Americans are not satisfied with what's going on here. Shouldn't doctors be making decisions regarding a patient's care, not health insurance companies? Shouldn't health care be a right, not a privilege?

tjosiecki

If you think the Canadian plan is so great move to Canada. That won't work in the United States we already have a Doctor Shortage. Whats next are you going to Force people to become Doctors.

Buggs Raplin

So what health insurance company do you work for?

Cassandra

We don't have a doctor shortage. We have a glut of overpriced specialists and a shortage of family practitioners and generalists.

Redwall

This is an important issue for many people locally. Unfortunately, the Fibune once again proves impotent in delivering a straight news story, instead inserting its usual rancid Left political views. Tighe was going to write what he was going to write; it wasnt going to matter what the Mayo spokesman said.

I love the fourth paragraph; a real masterpiece of composition there. It would earn an F in Mrs. Johnson's freshman english class (thats high school freshman, not college).

canman

Any Canadian with money comes to the US for medical care.

Buggs Raplin

Most Canadians are satisfied with their health care. You're just repeating health insurance propaganda.

GrandpaS

Part of the "chaos" of the Trump administration is the situation for health insurance companies right now. (For the record, I don't like companies who depend on profits paid by people who have just been diagnosed with a chronic disease, been in a car accident, had a heart attack, or whatever. I don't know how a business could scrape the barrel much lower. Profit before people. ) That being said, today's insurance companies are still set up so that they have to make a profit to stay in business. Because the federal government is so totally incapable of working together to come up with something workable and sustainable, the insurance companies don't know if they're going to get the government subsidies or not, and if they don't get those, they'll have to fold their businesses. So, because the government can't come up with a plan, I have no idea if my company can continue on the ACA Market Place or not, and so I'm going to get out of it. It's okay. Conservatives will just blame Obamacare instead of acknowledging the real problem: That this Congress is absolutely incapable of coming up with a workable health care coverage system. They won't even talk to each other to just try. Politics before people.

Greengate

+10 GrandpaS, who appears to be an example of age bring wealth to the discussion as opposed to unrelenting conditioned stupidity.

JLF

"Asked whether the decision mirrors the action of many other companies that have pulled many companies have pulled out of insurance marketplaces, scaled back or ended some plans and/or increased premiums and/or deductibles because of uncertainty amid threats of President Donald Trump and other Republicans to repeal and replace Obamacare, Kruse said, “I’m not sure that would have affect it one way or the other. This is pretty much a business decision.”

I know Mr. Kruse has to be diplomatic, but his dissembling here is disappointing. Less than two months ago (July 5), the Tribune ran the story entitled "Mayo's Health Tradition insurer pulls two plans amid health care policy uncertainty" with a quote from their own statement saying, “Many national and regional health plan companies have exited the Exchange Marketplace over the past two years due to financial risk and uncertainty about the ACA’s future."

How can we come up with good solutions if the people in positions of power won't be honest about the problems?

Redwall

Actually, that was the writer inserting his own conclusion in the July article. In that article, the Fibune made the Mayo spokesman a useful idiot to the Lefty's agenda.

JLF

No, it wasn't the writer's conclusion. It was from the statement issued by the company. Here's the full quote:
"Health Tradition’s reasons for pulling out of the marketplace for the two options is not known, beyond a statement it issued saying, “Many national and regional health plan companies have exited the Exchange Marketplace over the past two years due to financial risk and uncertainty about the ACA’s future."

Buggs Raplin

That a single payer health care system has not been implemented to cover everyone is an indictment of the political system, and that includes people like Ron Kind, Jen Shilling, Jill Billings and Steve Doyle locally. I mention them specifically because they're so-called darlings of the left/liberal crowd. And for chrissakes, yes, most Republicans are also culpable as well. They're just as bad as most Democrats. They're all slaves to health insurance dollars for their re-election campaigns. The people? They could care less about the people. The people are just to supposed to sit back and take it, and keep voting for the status quo regardless of the fact the status quo is failing the people, on this issue, and so many others as well. And there's no hope at all from the mainstream media, including the Tribune, as they are just promoters of the status quo. So you'll hear no advocacy from the Tribune for single payer; you'll hear no advocacy for single payer from Ron Kind or the other local Democrats or from most Republicans. The fix is in, the people be damned.-Chip DeNure

geo

Germany, France, Netherlands and Switzerland do not have single payer health care but are regarded as having among the best health care systems: what is the basis of your fixation on single payer? Which country with a national single payer system has so impressed you that you insist that we have it? The United Kingdom?

Buggs Raplin

Canada

lostinparadize

Chip, I have gone to Canada many years on hunting trips and talked to many ranchers, farmers, small town residents including a couple of small town pharmacists. Their system is great for basic care and slow for big stuff. Several ranchers in one area of Saskatchewan told me they complained about their local physician to their health board and were told tough cookies there would be no replacing him. The pharmacist both told me their system was far from perfect and needs tweaking. This is all anecdotal I know, but first hand from them to me none the less. What say you to Medicaid (not Medicare) for all with a minimum buy in for " all" of say $50 per month and if you want better coverage buy it privately ? This could be done quickly and affordably as the template for Medicaid already exists at the federal level. The basic care is there for all and extra coverage is available privately. Win/ win, right?

Jax

Try Norway

tjosiecki

Chip is used to the Single payer system because he is or was a state Employee and was used to having everyone else pay for his insurance. Now I understand why he is in favor of Single payer system.

Cassandra

It's clear that they aren't making enough money, so they're pulling the plug. Its time to pull the plug on all the insurers and guarantee healthcare for all.

Greengate

Oh..I'd be inclined to respond to your narrow minded point(s) of view, but one can't offer, not only any new vision..but any realistic and factual vision, to someone so blinded by their conditioning so as to having "rendered".. (as in rendering plant..) to be just a part of the coralled mindless herd..of which, despite the declining numbers, there are far too many remaining. Why? 'Cause never having looked in their mirror..(taking a deep and sincere look at and themselves..) they have not seen that..yes indeed.."RENDERING" has been stamped on their foreheads. Better to donate money to buy mirrors for these folks than for the hurricane Harvey cleanup!!!

Cassandra

#wordsalad

Jax

Amen!

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