Category Archives: MNCare

Does Walz Care About ONECare?

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So far, Minnesota Governor Tim Walz has largely been a responsive caretaker governor, responding to the crises du jour rather than than actively pushing a progressive agenda and building a legacy for himself.

Governor Walz’s legacy is essentially “pissed off all sides while consumed with thankless pandemic management.” I think he did a reasonably good job managing the pandemic, but he definitely had to make enemies doing it.

One partial break from caretaker mode was his poorly named “ONECare” proposal, which would give Minnesotans the option to buy into MinnesotaCare. MinnesotaCare is a longstanding program serving low-income individuals and families who can’t get employee-sponsored health insurance and don’t quality for Medicaid, which is called Medical Assistance (MA) in Minnesota.

Giving Minnesota health insurance consumers of all income levels this additional option would ensure that every Minnesotan in every county had at least one health insurance option available to them. That’s a big deal. It also would bring more competition to an individual market that sorely needs more competition. Over time, this could result in lower premiums for consumers.

Walz has not pushed his proposal particularly hard. Meanwhile, other states’ Governors are leading their states forward.

Colorado and Nevada this year passed public option plans—government-run health insurance plans—that are set to launch in 2023 and 2026, respectively. They join Washington state, which enacted its law in 2019 and went live with its public option in January.

The early results from Washington state’s experiment are disappointing. In many parts of the state, premiums for the public option plans cost more than premiums for comparable commercial plans.

Many of the state’s hospitals have refused to take part in the public option, prompting lawmakers to introduce more legislation this year to force participation if there aren’t sufficient health insurance options in a geographic area. And consumer buy-in is also meager. In its first year of operation, the state health insurance exchange sold only 1,443 public option plans, representing fewer than 1% of all exchange policies.

Michael Marchand, chief marketing officer for the Washington Health Benefit Exchange, the state’s health insurance marketplace, said it’s premature to judge the program by its first year.

During the earlier years of Obamacare, the premiums for many commercial plans were high, he pointed out. Eventually, as insurers became more knowledgeable about the markets, prices dropped, he said.

If Governor Walz would get re-engaged in this issue and actively market his plan, they could learn from the experiences of Washington and avoid it’s mistakes. For instance, in areas where there is insufficient health insurance competition, Walz could require hospitals to participate.

A MinnesotaCare buy-in option is extremely popular — only 11% oppose it, according to a Minnesota Public Radio survey. This is probably in part because it is an option. Any Minnesotan who opposes buying into MinnesotaCare — because of conservative ideology or because MinnesotaCare turns out to be expensive or poor quality — they can vote with their feet, as consumers in the state of Washington are doing.

Fighting for a MinnesotaCare buy-in option makes sense for Walz. The polls consistently show that health care is a top issue for voters, and huge majorities consistently trust Democrats over Republicans on that issue.

Moreover, in the 2022 gubernatorial general election campaign Walz may very well be running against a physician, Scott Jensen. This will ensure that health care is high profile in the race. Therefore, candidate Walz needs to be seen fighting for better health care, and this proposal gives him that platform.

If a MinnesotaCare buy-in option passes, Walz finally has a legacy beyond pandemic management. If Senate Republicans kill it, which seems likely, Walz has a great political argument to make while running for reelection and trying to retake the Senate: “I worked my ass off to give you another health insurance option and bring you some price competition, but Republicans like Scott Jensen opposed it on orders from private insurance lobbyists. If you want to more options and more price competition, vote for me and change the Senate leadership.”

Pushing a public option is a great political option for Walz. So why is he so damn cautious about it?

Washington Passed A Public Option That is NOT a Model For Minnesota

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Give leaders in the state of Washington a lot of credit.  Governor Jay Inslee and the Washington Legislature recently passed legislation to create a public health insurance option that will save Washingtonians an estimated 5 percent to 10 percent compared to private health plans.   Starting in 2021, the privately administered “CascadeCare” plan will be available to Washingtonians in the “individual market,” those under age 65 who can’t get insurance through their employers or another public insurance plan.

That’s significant progress, much more progress than Minnesota Governor Walz and the Minnesota Legislature made during the 2019 session when they failed to even seriously consider a plan to give Minnesotans in the individual market the option of buying into MinnesotaCare.  President Trump and his followers are working overtime to sabotage and try to repeal popular Affordable Care Act (ACA) health protections, while Inslee is strengthening the ACA.

We need that kind of leadership in Minnesota.  In the 2020 session, champions of the popular MinnesotaCare buy-in option should hold critics accountable for trying to block an initiative that could save consumers at least 10 percent of their health insurance costs. 

The Fatal Flaw With Washington’s Law

I say “at least 10 percent,” because Washington leaders caved to medical lobbyists in order to get the law enacted. In the process, they sacrificed significant consumer cost-savings.

One of the primary reasons to give consumers a public option is because public health insurance programs with a huge pool of patients are in a relatively strong position to leverage lower medical costs.  You know, like Medicare does. Here’s what a recent Urban Institute study found about Medicare’s ability to control medical costs.

 “…average spending on private health insurance per enrollee grew 4.4% per year between 2006 and 2017—faster than the growth of spending per enrollee in Medicaid and Medicare, and faster than the growth of the gross domestic product per capita, which grew an average 2.4% each year.

Per-enrollee spending in Medicare grew an average 2.4% per year while per-enrollee spending in Medicaid grew 1.6% each year. Holahan said Medicare and Medicaid experienced slower spending growth than private insurance because public programs have more leverage over provider payment rates, helping them to keep costs down. Private payers end up paying higher hospital and physician prices.”

In the face of such findings, what do Washington leaders do?  They guarantee reimbursements at a rate that is much higher than Medicare.  The Seattle Times explains:

The (Washington) law will require health plans to reimburse medical providers and facilities at up to 160% of the federal Medicare rate. That is a higher rate than the original version of the bill, which capped the reimbursement at the Medicare rate.

CascadeCare champions had it right in their original bill.  The reimbursement rate for the MinnesotaCare buy-in option should be set at the Medicare rate to allow savings to be passed on to Minnesotans.  Washington leaders apparently were spooked by lobbyist threats that caregivers would deny care to patients if they got paid Medicare reimbursement rates.

Physicians Can’t Be Sacred Cows

We will never be able to significantly control health care costs until we demand savings from every part of the healthcare system — pharmaceuticals, medical devices, unnecessary procedures, administrative overhead, and, yes, caregiver reimbursements.  American physicians, particularly specialists, are being paid more than physicians around the world, so controlling that cost-driver also must be in the mix.  American doctors can no longer be treated like political sacred cows.

As long as lobbyist-cowed legislators keep carving out these kinds of special interest exceptions, medical inflation will continue to skyrocket and keep Americans from accessing health care.  Minnesota legislators need to pass the MinnesotaCare buy-in option in 2020, and they should do it without caving to any of the interests driving medical costs making health care unaffordable and inaccessible for millions.

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Drop the “ONECare” Branding of the MinnesotaCare Buy-in Option

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I’m a big fan of Governor Walz’s proposal to give Minnesotans a new MinnesotaCare (MNCare) buy-in option.  If it passes, it would be a signature part of his legacy as Governor. But he has a lot of work to do before he gets it passed, and he should start by wiping the slate clean and dropping the name “ONECare.”

To be clear, the name ONECare is hardly the biggest problem Walz faces.  The much bigger problem is an army of well-connected health care lobbyists and industry-employed donors pushing legislators to stick with a status quo that reimburses the industry at higher rates than MinnesotaCare, an argument that legislators who are serious about cost-containment must reject. 

To pass this proposal, the Governor is going to need to use his political capital and get a lot more personally engaged in the fight than he has been so far.

But the name ONECare certainly doesn’t help the cause, a cause I’ve been supporting over and over, and it’s easy and painless to fix.

When selling ideas and policies, words matter a lot. Think “estate tax” versus “death tax.” “Tort reform” versus “lawsuit abuse reform.”  “Medicare-for-all” versus “single payer.”  We’ve seen it over and over: Words impact clarity and emotions, and clarity and emotions impact voting behavior.

For three primary reasons, the brand ONECare doesn’t help Walz to convince anyone to enact perhaps the most important policy proposal on his agenda, and instead inadvertently hurts it a bit. 

ONECare DOESN’T DESCRIBE, OR DISARM MOST DAMAGING CRITICISM.  I prefer the very boring, literal name “MinnesotaCare buy-in option.” I know, I know, it obviously isn’t very lyrical or concise, but it instantly explains the patient benefit, and that’s the most important advocacy need. 

This is a concept that almost no one understands, so they need a concise description.  ONEcare is not the least bit descriptive. If a Minnesotan heard ONECare come up in a shorthand way, they would have no idea what is being discussed, and very likely would assume you were talking about a corporate health plan. 

After 27 years in existence, “Minnesota Care” has a bit of brand equity, and “buy-in option” explains the concept much more clearly than “ONEcare.” 

Even more importantly, “MNCare buy-in option” also shines a bright spotlight on that key word “option.”  The word “option” disarms the most potent critique of the proposal, the false claim that Minnesotans will be forced to use “government-run health care” against their will. 

In a year when Medicare-for-All is being lambasted on the national stage for being mandatory and coercive, it’s critically important to be repeatedly stressing the disarming key message that this is merely another “option” for Minnesotans to take or leave. Stressing that selling point in the name is the best way to achieve that kind of repetition.

ONECare SOUNDS VERY CORPORATE, WHEN IT’S THE ANTITHESIS OF CORPORATE.  Also, ONEcare sounds very much like a corporate health care brand.  In fact, if you search the internet for “onecare,” numerous private health ventures pop up. 

Adopting a corporate-sounding brand name confuses and sullies an initiative that’s actually all about providing an option for relief from corporate insurance.  That makes no sense.

ONECare IS TOO WALZ-CENTRIC AND PARTISAN IN TONE.  Finally, ONEcare politicizes the proposal by using a derivative of Walz’s 2018 campaign theme “One Minnesota.”  ONEcare comes across like a partisan advertisement, as opposed to a sincere effort to help Minnesotans get cheaper and better health care coverage. 

Governor Walz likely intended ONEcare to be unifying – “we’re ‘one Minnesota’ and this gives everyone the same option in all parts of the state, including areas where there are few options.” I get that. But the fact that the “One Minnesota” sloganeering was so central to Walz’s recent election campaign makes ONEplan feel like it belongs to one political tribe only, instead of something that people of all political stripes should support.

Again, dropping the ONECare name obviously isn’t going to guarantee passage.  For that to happen, legislators are going to need to have more courage, and Governor Walz is going to need to really use his political capital to fight for this.  But dropping “ONECare” will help make their explanation of this excellent idea feel a bit more clear, direct, disarming, and apolitical.

Championing Both Medicare-for-All and Buy-in Option

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During last night’s Part I of the Democratic Presidential debate, moderators and candidates acted as if candidates must make a choice between advocating for Medicare-for-All and a Medicare buy-in option.  It was one of the few areas of division among the progressive candidates

Why?  Progressives should be simultaneously advocating for both policies. 

Stop Bashing Buy-In Option

Medicare-for-All advocates like Sanders and Warren need to stop taking cheap shots at a Medicare buy-in option. 

The reality is, without a filibuster-proof Senate majority, Medicare-for-All simply can’t pass for a while.  Therefore, progressives need a Plan B that helps as many Americans as possible, shows that Democrats can deliver on their health care rhetoric, and advances the cause of Medicare-for-All. 

That’s what a Medicare buy-in option does. 

It helps more Americans in the short-run by bringing much more price competition to the marketplace and ensuring every American has at least one comprehensive coverage option available to them, even in poorly served areas. 

Beyond helping Americans in the short-term, a buy-in option also advances the cause of Medicare-for-All. Americans have been brainwashed by decades of conservatives’ vilifying of “government run health care,” but a buy-in option will give younger generations of Americans first-hand evidence showing that Medicare is not to be feared. It will show millions of Americans that Medicare is cheaper and better than conservatives’ vaunted corporate health plans.

And that will help disarm conservatives’ red-faced criticisms of “government run health care” and Medicare-for-All.

Stop Bashing Medicare-for-All

At the same time, champions of a Medicare buy-in option like Biden and Buttigieg need to stop railing on a Medicare-for-All. 

Even though Medicare-for-All can’t pass right away, progressives need to keep explaining what the world’s other developed nations figured out a long time ago, that a single payer government-run is the only real solution for any nation that hopes to control costs, cover everyone, and improve health outcomes.

For far too long, progressives have been afraid to educate Americans about why a single-payer system is needed.  When fearful progressives sensor themselves from explaining why Medicare-for-All is needed, they leave the stage to conservative and corporate demagogues relentlessly spreading myths about the evils of “government-run health care.” 

And when progressives leave the stage to conservative demagogues — surprise, surprise – progressives lose the debate.

Start Pushing Both

What would it sound like to advocate these two positions simultaneously? It could sound something like this:

Ultimately, we must cover everyone, control skyrocketing costs, and improve health outcomes. And you know what? Ultimately, the only way to do that is Medicare-for-All. 

In America, Medicare has proven effective and is popular with those who use it. In developed nations around the world using government-run systems like Medicare, everyone is covered, costs are much lower and health outcomes are much better. 

So Medicare-for-All must to be our ultimate goal. We have to keep our eyes on that prize. We need it as soon as possible.

At the same time, the Republican-controlled Senate won’t pass Medicare-for-All.  That’s reality folks.

Given that reality, what can Democrats do right now to both help the American people and pave the way for Medicare-for-All in the long-run?  A Medicare buy-in option.  A buy-in option has lots of public support among Republican voters, so it has a much better chance of passing the Senate than Medicare-for-All.

Let Americans choose between corporate care and Medicare. If they want to keep their private health insurance, they can. But given them another option.

President Trump is afraid to give Americans make that choice. I’m not. He knows Americans will like Medicare better, and doesn’t want to give them that option. I’m not afraid, because I know that a Medicare plan that isn’t required to profit off of patients will be cheaper and better that corporate care. So let Americans choose.

Enacting a buy-in option now will show more Americans that they have nothing to fear from Medicare coverage. And that will help us move the American people towards embracing Medicare-for-All.

Pols and pundits keep framing this issue as if it must be a battle to the death for progressives. But Medicare-for-All versus a Medicare Buy-in Option is a false choice.  Progressives should be advocating for both, and stop savaging each other on the issue.

On MinnesotaCare Buy-In Option, Legislators Must Put Patients Over Lobbyists

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Why can’t the Minnesota Legislature give consumers a MinnesotaCare buy-in option so that they have a guaranteed health insurance coverage option, more doctor choices, and much better price competition?  An army of corporate lobbyists say it’s because reimbursements to the health care industry would be lower under that approach, an argument that froze legislators into inaction during the 2019 legislative session. 

To be clear, if that argument prevails, Minnesota lawmakers will never contain health care costs.

To contain costs, policymakers have to lower the amount of money going to the major cost drivers — insurance overhead, doctors, nurses, medical devices and pharmaceuticals.  If politicians reject a reform every time lobbyists for those cost-drivers object about getting lower reimbursements, they will never contain consumer costs.

Let’s look at one of those cost-drivers, physicians.  Politicians like to complain about insurance overhead and pharmaceuticals, for very good reasons, but that’s too easy.  Let’s look at the most sacred of health care’s sacred cows.  Doctors have an abundance of fans, campaign donating power, and lobbyists, so politicians are especially afraid to direct cost-control efforts at them. 

When you look at the long list of developed nations where physicians are paid less than in the U.S., paying less for doctors seems reasonable and doable.  For example, the average specialist in the U.S. earns $230,000 per year, while the average specialist in other industrialized nations receives less than half that amount, $107,000 per year. 

Remember that the next time you hear physicians and their lobbyists complaining about reimbursements being too low.

Oh and by the way, the health outcomes in those developed countries with modestly paid physicians are better than in the U.S. So don’t buy the claim or inference that better pay automatically leads to better care.  It doesn’t.

And about those pharmaceuticals.  American patients pay much more for pharmaceuticals than patients in many other developed nations around the world.  Remember that the next time you hear lobbyists complaining about Medicare and Medicaid reimbursements being too low.

(On this front, the Minnesota Legislature needs to pass legislation to allow importation of Canadian pharmaceuticals, as I argued a while back.  Florida recently passed such a bill, but Minnesota politicians remain frozen by health care lobbyists.)

A Minnesota Care buy-in option — branded as “ONECare” in Minnesota by Governor Tim “One Minnesota™” Walz — would ensure that every Minnesotan always has at least one health insurance option available to them, which is particularly important in remote rural areas.  It would give them broader networks of caregivers, which again is important to Greater Minnesota residents.  It would provide comprehensive benefits and a service that gets good consumer reviews. It would bring better price competition to hold down the health insurance costs.  Those all would be huge benefits for hundreds of thousands of Minnesotans.

But not if Minnesota politicians get cowed into inaction every time corporate health care industry lobbyists complain about receiving lower reimbursement rates. If this group of legislators won’t do the right thing on a MinnesotaCare buy-in option, we should elect a new group who will.

Farewell Mark Dayton, The Un-Politician

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As we count down Mark Dayton’s final days as Governor of Minnesota, it’s worth reflecting on one of the more peculiar figures in recent Minnesota political history.

If mad political scientists had set out to create the perfect politician, rest assured it would look nothing like Mark Dayton.

In a profession where optimism sells, Governor Eeyore came across as perpetually gloomy.

In a job where gregariousness and charm are needed to build winning coalitions, Dayton wasn’t very willing or able to glad-hand with legislators or other power brokers.

In a business where glibness is an invaluable asset, Dayton was often difficult to understand and unpersuasive in his speaking style. (Some of this may have been due to an underlying health issue, but the political challenge remains.)

In a grueling endeavor where energy and stamina are needed, Dayton’s chronic health issues have slowed him in his job and on the campaign trail.

And in a job where charisma often wins converts, Dayton possessed all the charisma of a lump of lutefisk.

Poor Governor Dayton. He lacks the hard-wired optimism of Hubert Humphrey, charm of Tim Pawlenty, glibness of Norm Coleman, energy of Paul Wellstone and charisma of all of the above.

But somehow, some way, Mark Dayton became a successful Governor.

He raised taxes on the wealthiest Minnesotans and increased the minimum wage without crashing the economy, as his conservative critics had promised would happen.

He expanded Medicaid and faithfully implemented the Affordable Care Act (ACA), which led to Minnesota having the best rate of health insurance coverage in state history, and one of the best in the nation.

He paid back millions that Pawlenty had borrowed from schools, and increased investments in them.

He refused to use the budget gimmicks Pawlenty employed to avoid tough choices, which helped end Minnesota’s long run of budget shortfalls, and allow Minnesota to earn a coveted AAA bond rating, which will save taxpayers millions in future years.

While implementing these progressive policies, Minnesota’s economy has boomed, outperforming the national economy and the economy that conservative Governor Scott Walker built in neighboring Wisconsin.

It also should be noted that Dayton’s family inheritance made it possible for him to self-fund his rise to political power. Ordinary people with Dayton’s political disabilities could not have achieved what Dayton did in his career.  That’s a problem for our democracy.

But the fact remains, Dayton achieved all of this without a lot of political talent. He mostly accomplished those things due to his decency, candor, policymaking expertise, disciplined focus, and commitment to doing the right thing for vulnerable Minnesotans and our common good.

In the end, I’d take those things over all the optimism, glibness, gregariousness, energy, stamina and charisma in the world. Somehow, Dayton the un-politician made it work.

MN GOPers Aren’t the Health Care Saviors They Claim To Be

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Exuberant Minnesota Republicans seem to think they have a winning health care issue for the 2018 election season–reinsurance. And they do deserve a great deal of credit for helping to enact a state reinsurance program that is reducing premiums for Minnesotans in the individual market. The individual market is for the 162,000 Minnesotans who can’t get insurance from their employer or the government.

While their claim that premium increases in 2016 and 2017 were due to DFL policies is ridiculous, it is true that the Minnesota reinsurance program they helped pass is helping those consumers. As the Star Tribune reported:

Jim McManus, a Blue Cross spokesman, said that were it not for the state’s reinsurance program, the carrier’s Blue Plus HMO would be seeking an average individual market premium increase of 4.8 percent as opposed to the 11.8 percent decrease cited Friday by Commerce

Impressive, and Republicans deserve credit for this.

The Rest of the Story

But as Ricky Ricardo would say, before Minnesota Republicans can credibly brand themselves health coverage saviors, they still have some splainin to do.

Why Not National Reinsurance? First, they need to explain why their party – in complete control of the U.S. Senate, U.S. House and the Presidency and entire U.S. Executive Branch of the federal government – doesn’t enact reinsurance to help all Americans. Because of economies of scale and the need for market consistency, a national reinsurance program makes much more sense than a hodgepodge of variable state programs.

Moreover, if stabilizing the market and helping consumers pay less is good for Minnesotans, wouldn’t it be even more awesome to do that for all Americans?  That’s likely why 75% of Americans support enacting reinsurance at the national level.

Why Sabotage the ACA?  So why aren’t Rep. Erik Paulsen, Rep. Jason Lewis, Rep. Tom Emmer, Jeff Johnson or former Governor Tim Pawlenty pressing for reinsurance at a national level? Because they and their White House puppet master would rather sabotage the remarkably effective Affordable Care Act (ACA) than improve the ACA to help American families.

The list of things Trump and his congressional Trumpbulicans are doing to irresponsibly sabotage American families benefiting from ACA protections is long and breathtakingly irresponsible.  This is hurting tens of millions of struggling Americans.  Republicans are ignoring the 71% of Americans who say the Administration should do all it can to make the the ACA work, compared to just 21% who support efforts to make the ACA fail and replace it later.

Why Oppose Adding A MinnesotaCare Buy-in Option?  The other thing Republicans boasting about the state reinsurance bill need to explain is this: Why aren’t they supporting giving the 162,000 Minnesotans in the individual market a MinnesotaCare buy-in option?

The MinnesotaCare buy-in option would achieve much of what Republicans profess to support — more plan and doctor choices for consumers in sparsely populated areas, guaranteed coverage for all Minnesotans in sparsely populated areas, and more competition to control prices.

The fact that Minnesota Republicans won’t support the common sensical MinnesotaCare buy-in option proposal, won’t push for a national reinsurance program, and continue to actively sabotage the ACA makes their gloating about being health care saviors ring very hollow.

MN DFL Should Champion Importation of Canadian Medications

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Here’s a political idea for the DFL: Find a massively expensive thing that enrages voters.  Then make it dramatically cheaper. Oh, and do it without increasing government spending or taxes.

I understand the skepticism.  It does sound akin to the classic Student Council President campaign promise to reduce the cost of cafeteria soda — a crowd-pleaser but infeasible.

But there actually is such an issue available to Minnesota state leaders –empowering Minnesotans to purchase cheaper prescription medications from Canada.

According to drugwatch.com, prescription drugs are on average 65 percent cheaper in the Canada than they are in the United States. This is because Canada has huge government controlled health care plans using their purchasing power to negotiate lower prices from the pharmaceutical industry, and the U.S. doesn’t. Minnesota state lawmakers can’t change the underlying problem driving high drug prices in the U.S., but they could at least allow U.S. citizens to benefit from the more sane Canadian system.

After all, the Vermont Legislature just did it. Why not Minnesota?

In the upcoming 2018 elections, this should be the top issue Minnesota DFL state legislative candidates stress. Making more affordable Canadian medications available to Minnesotans would improve the lives of ordinary Minnesotans, and it’s a huge selling point with voters. Just ask Mark Dayton, who in 2004 made a lot of political hay by financing busloads of senior citizens going to Canada on medication shopping trips.  This proposal is similar, but it eliminates the long bus rides.

Nearly two-thirds of Americans like this idea. By an overwhelming two-to-one margin, a Kaiser Family Foundation survey found Americans support “allowing Americans to buy prescription drugs from online pharmacies based in Canada.”

This is an easy-to-understand issue to explain the difference between Republicans and DFLers to swing voters, and it especially appeals to seniors, who are the most likely to show up to vote.

This issue communicates important messages:  DFLers hear voters who are struggling to pay their medical bills; Republicans don’t. DFLers are proposing something real and tangible to control health care costs; Republicans won’t. DFLers will put the interests of ordinary Minnesotans over special interest lobbyists; Republicans won’t.

Coupled with the DFL’s MinnesotaCare for All buy-in option, offering cheaper Canadian medications would give Democrats the upper hand on perhaps the number one issue in the 2018 elections.

I can already hear overthinking DFL wonks explaining why they shouldn’t do this. President Trump won’t allow it to happen, they’ll say. I say force Trump’s hand. Though Trump’s HHS Secretary, a former pharmaceutical company executive, calls it a “gimmick,” Trump enthusiastically proposed this very idea during the campaign.

“…the last provision of his new seven-point plan is: “Remove barriers to entry into free markets for drug providers that offer safe, reliable, and cheaper products.”

“Congress will need the courage to step away from the special interests and do what is right for America,” the plan says. “Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe, and dependable drugs from overseas will bring more options to consumers.”

So, either make an honest man of Trump or expose him and his congressional Republican enablers for flip-flopping and being the cause of outrageously high drug prices.

This is the right thing to do, and it’s an extremely popular thing to do.  Empowering Minnesotans to benefit from more affordable Canadian medications should be one of the centerpieces of Minnesota DFLers’ 2018 campaigns.

A Policy Agenda For Minnesota’s Next Progressive Governor

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In 2018, progressive Governor Mark Dayton will be retiring, and Minnesota voters will be selecting a new chief executive.  To retain control of the Governor’s office in 2018, Minnesota Democrats need a compelling policy agenda. It goes without saying that they also need a compelling candidate, but this discussion is about policy.

What constitutes a compelling policy agenda? First, it’s bite-sized. It can be quickly consumed and remembered by casually engaged voters. It’s more like five proposals, not fifty proposals. That doesn’t mean leaders should only do five things as a governor, but it does mean that they should only stress and repeat five-ish policies as a candidate, so that the agenda can be remembered.

Second, a compelling policy agenda delivers relatively bold change. It’s not merely about protection of the status quo from the bad guys, or small incremental improvements (see HRC campaign). It’s aspirational, and not limited to ideas that currently have the necessary votes to pass. If a candidate has to scale it back after elected, so be it. But they should run with a bold vision.

Third, a compelling policy agenda needs to have popular support beyond the political base. After all, a campaign agenda is about winning votes.

Fourth, it’s is easy to understand. Few have the time or inclination to study the intricacies of a 15-point tax reform plan, so candidates should stick to things that most can easily grasp and embrace.

Finally, a compelling policy agenda must be directed at Minnesota’s most pressing problems. It shouldn’t merely be about kowtowing to the most powerful interest groups, as is so often the case. It must actually be about the problems that most need fixing.

What fits those criteria? In no particular order, here’s my recommendation for a progressive gubernatorial candidate’s agenda.

  • MinnesotaCare for All Option. Allow all Minnesotans to buy into the MinnesotaCare public health insurance program. This will put competitive pressure on private insurance companies to keep premiums down, and ensure Minnesotans will always have a coverage option, even if health plans pull out of the market.
  • Transportation Jobs Fund. Increase the gas tax by a nickel per gallon — one penny per gallon per year over five years — and put the proceeds into an untouchable fund that will put Minnesotans to work improving the state’s roads, bridges and transit system. This will lift up the portion of the workforce that is struggling the most, and ensure Minnesota has a competitive economy and quality-of-life into the future.
  • Achievement Gap Prevention Plan. Ensure every child under age five has access to a high quality early learning program, starting with the children who can’t afford those programs on their own. This will prevent low-income children from falling into Minnesota’s worst-in-the-nation achievement gaps, gaps that opens before age two, lead to lifelong inequity and pose a grave threat to our economic competitiveness.
  • Fair Share Tax. Create a new, higher tax bracket for the wealthiest 10% of Minnesotans.  During a time when income inequality is the worst it has been since  just prior to the Great Depression (1928), the wealthiest Minnesotans are paying a lower share of their income in state and local taxes.   Adjusting the state income tax is the best way to remedy that disparity.
  • Super-sized Rainy Day Fund. Increase the size of the state’s rainy day fund by 25%. This will control taxpayers’ borrowing costs and help keep Minnesota stable in the face of 1) an economy that, after the longest period of economic expansion in history, may be due for a downturn and 2) a federal government that is threatening to shift many fiscal burdens to states. Bolstering the rainy day fund will also communicate to moderate voters that a progressive will be a level-headed manager of their tax dollars.

Yes, worthy issues are left off this agenda.  But we’ve seen time and again that when Democrats try to communicate about everything, they effectively communicate about nothing.  Long, complex “laundry list” policy agendas may please the interest groups who are constantly lobbying the candidates and their staffs, but they are simply too much for busy voters to absorb.  As legendary ad man David Ogilvy preached, “the essence of strategy is sacrifice.”  To be heard, many things must be left unsaid.

This kind of progressive gubernatorial policy agenda would be simple enough to be understood and remembered, but not simplistic.  It would be relatively bold and visionary, but not pie-in-the-sky.  It would be progressive, but swing voter-friendly.

This agenda would put Republican opponents in a political bind, because these progressive proposals are popular with moderate swing voters.  The partial exception is the Transportation Jobs Fund, where swing voters are conflicted.   Surveys tell us that gas taxes are somewhat unpopular, particularly in exurban and rural areas, but the transportation improvements that would be funded by the higher gas tax are very popular with voters of all political stripes, as are jobs programs.  On that front, one key is to guarantee that tax proceeds could only be spent on improvements, something many skeptical voters seem to doubt.

If such an agenda were sufficiently repeated and stressed by a disciplined candidate, fewer Minnesotans would be lamenting that they “have no idea what Democrats stand for.” Most importantly, this agenda also would go a long ways toward fixing some of Minnesota’s most pressing problems.

Is Minnesota GOP Sabotaging The Individual Health Insurance Market By Rejecting MinnesotaCare-for-All Option?

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Minnesota Republican legislators spent their 2016 election campaigns expressing grave concerns about whether private health insurance companies in the individual market* have sufficient competitive pressure to keep prices down, and whether Minnesotans who live outside of the Twin Cities metropolitan region will have at least one solid coverage option available to them in coming years.

Those are legitimate concerns shared by both parties. But after Republicans won control of the Minnesota House and Senate, they have been unwilling to do one very important thing that that could achieve those two goals. They have been unwilling to give those Minnesotans the option of buying into MinnesotaCare health coverage.

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Governor Dayton’s proposed “MinnesotaCare-for-All option” would allow any individual market consumer to buy into the state government-run health plan that has served over 120,000 Minnesotans since 2006. An unsubsidized version of MinnesotaCare would be an available option for all Minnesotans.

In other words, MinnesotaCare for all would be a Minnesota-specific “public option” that would always be there for Minnesotans. MinnesotaCare wouldn’t be able to abandon individual market consumers the way corporate insurance companies can and do. Moreover, MinnesotaCare’s presence in the marketplace will pressure private insurers to offer more competitive prices, because MinnesotaCare’s prices don’t have to account for corporate salaries and profits.   Representing the buying power of about a million public plan consumers, the large MinnesotaCare plan should also have leverage to negotiate consumer-friendly reimbursement rates with health care providers, which helps keep premium costs more affordable.

In fact, Governor Dayton’s office estimates that Minnesota families who purchase MinnesotaCare coverage would pay on average about $838 per person less in 2018 than they pay for private coverage in 2017.  To secure those long-term annual savings for Minnesota families, a one-time taxpayer investment of $12 million – a relatively tiny drop in the State’s $39 billion annual budget — would be required to establish the option. In subsequent years, no additional taxpayer funds would be needed to keep the lower costs flowing to Minnesotans. The MinnesotaCare-for-All option would be self-sustainable.

If you believe that government-run operations are always less efficient and customer-friendly than corporations, here’s your chance to prove it. If that’s true, comparison shopping Minnesotans will “vote with their feet” by rejecting it en masse. But if it’s not true, Minnesotans in the individual market will finally have the peace of mind that comes with knowing that at least one coverage option will always be there for them and their loved ones.

Given that 71% of Americans support having a similar Medicare-for-All option, a MinnesotaCare-for-All option is likely popular with Minnesotans.  Still, Republican state legislators killed the proposal this year.

Minnesota Republicans can’t have it both ways. They can’t reject the MinnesotaCare-for-All option and then turn around blame others if competition is insufficient in some parts of Minnesota, or if corporate insurers’ prices prove to be unaffordable to many Minnesotans. No one can know for sure if this idea will work, but if Republicans are unwilling to give things like this a try to help vulnerable consumers, then Minnesota voters should hold them accountable for their obstructionism.

*(Note: The “individual market” is made up of the 10 percent of Minnesotans who a) can’t get insurance through their employer and b) whose incomes are not low enough to quality for either of Minnesota’s two publicly subsidized health insurance plans — Medical Assistance (Minnesota’s version of Medicare) for very low-income citizens or MinnesotaCare a subsidized option for the working poor. Last year, about 250,000 consumers bought coverage in Minnesota’s individual market.)