Improving Minneota’s Health Insurance Market With A “MinnesotaCare for All” Option

For Minnesotans who can’t get health insurance from an employer, Minnesota Republican legislators have been demanding improvements.

where-mn-get-insurance-donut-graphic-254x300_jpg__254×300_Out on the campaign stump, Republicans say they want more health plan options than are currently available. They want health insurance companies to feel more competitive pressure to keep a lid on premiums. They want consumers to have a broad network of health care providers available to them. They want assurances than there will always be at least one solid coverage option available to every Minnesotan, even when health insurance companies decide to pull out of the marketplace, as they have in recent years. Those are all good goals.

To achieve them, Republican state legislators should work with Governor Dayton to give Minnesotans a MinnesotaCare for All option.

Background

Currently in Minnesota, those who can’t get health insurance from an employer can get coverage from one of three sources:

  • TOP TIER. For Minnesotans who can afford premium costs, they can purchase coverage from nonprofit health plans – UCare, HealthPartners, Medica, and Blue Cross. (As part of the federal Affordable Care Act, about 60% of those buying from these companies through the MNsure online shopping tool are offsetting premium costs with federal tax credits, which this year are averaging over $7600 per year.)
  • MIDDLE TIER. For Minnesotans who can afford some, but not all, of the premium cost, they can purchase MinnesotaCare at a subsidized rate that varies depending on household income.
  • LOWER TIER. For the poorest Minnesotans who can’t afford any of the premium cost, they can get Medical Assistance at no cost to them. Medical Assistance is Minnesota’s version of the federal Medicaid program.

MinnesotaCare for All Option

Governor Dayton proposes to give those in the top tier an additional option.  He wants to give those consumers the option of buying into that middle tier — the public MinnesotaCare program.

Adding a MinnesotaCare for All option would achieve what Republicans say they want – more options for consumers, more marketplace competition to drive down prices, a guarantee that at least one plan option will always be available to Minnesotans, and consumer access to a broad network of Minnesota health care providers statewide.

A fact sheet from the Governor’s office elaborates on the consumer benefit:

Purchasing quality health coverage through MinnesotaCare is less expensive than buying coverage directly from a private insurer, because it leverages the buying power of more than 1 million Minnesotans enrolled in public plans.

Minnesotans who purchase MinnesotaCare would get high-quality health coverage for approximately $469 per month, on average. That is more than 12 percent ($69) less than the average statewide premium of $538 for private insurance in 2017.

Under the Governor’s proposal, families would spend on average $838 per person less in 2018 than in 2017 on their health insurance premiums.

After a one-time startup investment ($12 million), the cost of Governor Dayton’s plan would be funded entirely by the premiums of Minnesotans who choose to buy MinnesotaCare coverage. If the Legislature enacted this proposal by April 1, Minnesotans could purchase MinnesotaCare coverage as early as the 2018 open enrollment period.

Having this MinnesotaCare option would likely be very popular with Minnesotans.  After all, a national poll found that an overwhelming 71 percent of Americans support a similar Medicare for All option, while only 13 percent oppose the idea.

Let Consumers Choose

Why would Republicans not want this for Minnesota consumers? If the Governor’s claims about the MinnesotaCare option turn out to be accurate, many of the Republicans’ stated goals for the individual market would be achieved.

At the same time, if the Governor’s MinnesotaCare-related claims about lower prices and better health care network turn out to be inaccurate or inflated, Minnesotans will surely reject the MinnesotaCare option. If it is to their advantage, consumers will choose a nonprofit health insurance company, or a for-profit health maintenance organization (HMO), which the Governor recently agreed to authorize as part of a compromise with Republican legislators.

With the addition of the MinnesotaCare option, private, nonprofit and public options all would be available to Minnesotans who are shopping and comparing via MNsure. Then the politicians could get out of the way, and let the consumers choose the option that works best for them.

Minnesota Health System Needs Obamacare Too

On a weekly basis, Garrison Keillor reminds Minnesotans that we are above average.  But we didn’t need him to tell us that.  We’re a pretty innately smug bunch when it comes to our state.  Call it “Minnesota Exceptionalism.”

We’re especially smug about our health care system.  Therefore, some of us were not all that sure we needed Obamacare’s private health insurance mandate, which is presently the only politically feasible way of improving health insurance coverage and banning pre-existing condition restrictions.

But we do.

It is true that Minnesota is better off than the rest of the nation. Nine percent of Minnesotans lack health insurance coverage, and that’s much better than the nation as a whole, where 16% are uninsured.

We can rest assured that we aren’t suffering nearly as much as many other states, such as Texas (27% uninsured), Mississippi (24% uninsured), Louisiana (22% uninsured), Nevada (22% uninsured), and Oklahoma (22% uninsured). These GOP strongholds are suffering more at the hand of the GOP’s shameless health reform stonewalling than we are.

But let’s not delude our exceptional selves.  Minnesota needs the private insurance mandate too.   After all, using the same kind of health insurance mandate the Supreme Court just upheld, Massachusets has a much better record than Minnesota.  Under ArneCare in Minnesota, we have 9% uninsured, which is better than average.   But under ObamneyCare in Massachusetts, they have only 5% uninsured.

Moreover, we self-congratulatory Minnesotans should never forget that in the shadows of Minnesota’s overall 9% uninsured rate are pockets of much deeper health care despair. For instance, more than a quarter (27%) of low income adult Minnesotans are uninsured. That’s a little bit of Texas in our midst.

No, 9% is not good enough. That’s 463,100 of our Minnesota friends, neighbors, and coworkers who are just one metastasized cell or black ice sheet away from a mountain of medical bills, and the bankruptcy that so often goes with it.

That’s 463,100 Minnesotans delaying medical care until medical care becomes much more expensive, and often much less effective.

That’s 463,100 Minnesotans who obviously don’t stop getting hurt or ill, and therefore are forced to shift their enormous medical expenses to the rest of us, which in turn forces more of us to drop our own coverage.

That’s 463,100 Minnesotans — the population of Rochester, Duluth, St. Cloud, Eagan, Plymouth, Lino Lakes, Willmar and Ramsey, combined.

That can’t be ignored.  Minnesota needs the insurance mandate, and the rest of Obamacare too.  So thank you Heritage Foundation, Newt Gingrich, Don Nickles, Mitt Romney and, now, John Roberts for giving it to us.

– Loveland

Note:  This post also was featured as a “best of the best” on Minnpost’s Blog Cabin feature.