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Legislative News and Views - Rep. Jennifer Schultz (DFL)

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Moving Forward on Health Care Reform; Saving the Second MN Miracle

Thursday, March 19, 2015

Watching discussion of state health care issues as a freshman legislator with a career in health care economics provides an interesting perspective. Despite the uproar at the Capitol, Minnesota is in reality a national leader in providing health care for its population.  We lead the Midwest in percentage of people with insurance and are near the top nationally.  We have the lowest costs in the nation for insurance on our health care exchange, have a program that extends coverage to low income working people at affordable costs, lead the nation in most indices of quality of care, and have a health care system that is the envy of other states.  In fact, health care economists often comment that to improve American health care quality while decreasing costs, other states should copy Minnesota.

At the same time, we are in the midst of a political battle about the future of Minnesota health care that is surprising in the face of reality.  As the StarTribune notes in its March 14, 2015, editorial, GOP proposals for health care are all over the map.

MNCare, the twenty-year-old program that has served the state so well in providing health care for low-income working people, is under attack, with suggestions that it should be ended.  MNCare provides critical coverage for people who cannot get or cannot afford other insurance but have incomes above the Medicaid threshold, and is especially important for working women in single parent families and for families in Greater Minnesota, where incomes are lower.  Proposals to end MNCare and require its enrollees to obtain private insurance would impose added cost without added value, since administration already comes from private insurers.  Preservation of this important program, another Minnesota Miracle created by bi-partisan consensus, is critical for the people it benefits.  Its funding, coming from dedicated sources outside the general fund, is safe for the future.  To destroy it would be to attempt to fix something that is not only not broken, but that is working very well.

The MNSure exchange has had severe growing pains, and continues to need technical improvement.  But it offers coverage at well below national average costs, provides access to the federal subsidies of the Affordable Care Act for people who need them, and serves as a gateway to offer people access to insurance through both public and private programs.  Since the exchange depends on marketplace competition for control of rates, it needs more competition.   We could provide that competition through addition of either co-op or public options within the exchange, using state and public employees as a core of enrollees to save government money and provide an actuarial base.

Cooperation between Affordable Care Act programs and Minnesota’s many large, high quality provider groups is already underway, with programs being created that offer comprehensive care, manage risk, and utilize global capitated budgets to save costs.  The state, through the exchange and through public programs, needs to press forward with those efforts.

Proposals to remove enrollees from the exchange to put them in the federal exchange program would risk problems from the pending Supreme Court decision and would rob Minnesotans of local contacts with Minnesota providers and insurers.  Attempting to move the insurance subsidies into the market outside the exchanges is not an alternative under existing law, and would require months to years of negotiation at best and could be impossible at worst.  Removing enrollees from the state exchange would weaken negotiations between the exchange and insurers and the ability of enrollees to shop and compare programs, including assessing whether they would be eligible for lower cost and more complete coverage through public programs.

There are ongoing problems in the transition Minnesota is making from the old system to the system created by the Affordable Care Act, but the programs are resulting in decreases in uninsured and lower costs and better coverage for thousands of Minnesotans.  There is work to be done, but the work must mean moving forward, not backward.  The DFL vision of comprehensive coverage for all Minnesotans is important for our citizens.  Minnesotans are traditional leaders in health care, and need to continue that leadership, forging a program that provides the benefits and care we all need and deserve.

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