Besides the thousands of native residents who are uninsured, a large number of nonresident workers in the Commonwealth also do not have health insurance and that, according to an insurance industry official, is ultimately harmful to the operation of the only public hospital in the CNMI.
According to Eric Plinske, Staywell Insurance branch manager for Saipan, the 2010 Census shows that more than 14,000 Asians—mostly nonresident workers—are not covered by any health insurance firms in the CNMI.
Census records show that 34 percent of the entire CNMI population is uninsured. With the Commonwealth’s population base at 52,000, that translates to 18,114 individuals with no health insurance.
Of the 34 percent uninsured people, Plinske said the bulk of them are “Asians and others” totaling 14,141—an alarming 78 percent of the 34 percent. Chamorros, Carolinians, and other Pacific Islanders, meantime, comprise only 16 percent—a total of 2,818 persons—who are not insured.
The situation was further exacerbated by the passage of Public Law 17-92 during the Fitial administration, he said. That law eliminated the employer healthcare coverage requirement for nonresident workers in the CNMI.
“Even before we had this Obamacare, there was P.L. 17-92 and I believe this local law is very detrimental to the hospital’s operation,” said Plinske.
"The logic of the law—for nonresidents to buy own insurance—sounds good, but the health insurance industry doesn’t work that way. No one can buy health insurance on their own, it has to be through an employer. So if the employer doesn’t get a policy, there’s no way they [foreign workers] can even buy, even if they wanted to,” explained Plinske.
“You cannot just come in and buy an individual policy. We used to have that in Staywell, but because of the risk that the healthcare reform is bringing with new benefit requirements, we immediately stopped enrollment to that plan,” he said.
Additionally, he said, “there’s no way to force nonresidents to buy insurance because there is no requirement here that they have to get an insurance,” which puts the hospital at risk.
“The 78 percent [uninsured Asians] is huge…we’re talking about 14,000 people, mostly contract workers here. The CNMI is one with the highest numbers” of uninsured among insular areas, he said.
Plinske said that P.L. 17-92 is something that the CNMI government and Legislature must seriously look at or it will negative ripples effects, including overburdening the Commonwealth Health Center.
“We should have something in the CNMI that protect our CHC, because it’s facing a serious risk,” Plinske said, alluding to the scenario that these thousands of non-insured will end up lining at the emergency unit of the public hospital. “When rates go up, people will cancel coverage…[and] more people will end up walking to the CHC seeking treatment for their illnesses.”
Plinske met with members of the Commonwealth Healthcare Corp. board last week to share the same information. He pointed out that the Affordable Care Act, more commonly known as Obamacare, has provisions that don’t apply to territories such as the CNMI.
Among these components, he said, are employer mandate; individual mandate; no health insurance exchange or subsidy program; no protections for health insurance companies through reinsurance, risk corridors, and risk management program offered by the U.S. Department of Health and Human Services.
Obamacare, Plinske said, even wants inclusion of coverage requirements for transplants, joint replacements, hemodialysis, genetic testing, implantable, and others.
“What the healthcare reform [law] is supposed to do is to require insurance companies to add benefits such as ‘no denial of pre-existing condition’ requirement. And there’s no way we can enforce this unless we have a balance here and that is the individual and employer mandate,” he said.
“Individual” and “employer” mandates refer to provisions that will require all individuals and employers to obtain health insurance.
In the CNMI, most health insurance clients are categorized under “small group.”
“One hundred percent of our market here are small group [with less than a hundred people] and we have zero ‘large group’ market in the CNMI,” said Plinske.
He expressed hope that calls for amending P.L. 17-92 will be supported by the CHCC board and the Legislature.