Category Archives: Tim Walz

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.

“No New Taxes” Is The Real Winner In Minnesota’s 2019 Legislative Session

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Today in its lead front page story, the Star Tribune trumpeted Governor Tim Walz as the triumphant victor in the recently concluded legislative session.  But the truth is, the real victor looks more like conservative devotees of a “no new taxes” pledge.

For many years, former Governor Tim Pawlenty and the Minnesota Taxpayer’s League’s David Strum enforced strict adherence to a “no new taxes” pledge, even during many years when lawmakers were struggling with huge budget shortfalls. Though Pawlenty and Strum are no longer players, and conservatives have a weaker bargaining position now than they had in those days, Pawlenty’s “no new taxes” position still somehow bested Walz’s “many new taxes.”

  • No Gas Tax Increase. Governor Walz wanted a large gasoline tax increase. He didn’t get half of what he recommended.  He didn’t get one-quarter.  He got no increase. Zip.
  • Income Tax Cut.  Walz wanted to preserve the status quo on state income taxes. That didn’t happen either.  He got a cut instead.
  • Provider Tax Cut.  Walz desperately wanted to keep the provider tax at the same 2.0% level it has been for years.  He got a 10% cut in the tax instead, to 1.8%.
  • Overall Revenue Cut.  Overall, Walz wanted to raise much more revenue to deliver much improved services.  Instead, he got lower overall revenue.  As a result, he was forced to dramatically scale back his agenda and a dip into the state’s rainy day fund to balance the budget, a fiscally irresponsible move that DFL former Governor Mark Dayton strongly opposed.

A Walz Win?

With all of this Walz losing on the taxation front, how can Walz be crowned the session’s big winner?

The Star Tribune sees it this way:  First, Walz kept legislative overtime to a minimum by capitulating to Republican demands early and often.  They seem to put an inordinate amount of value on ending on-time. Second, interest groups who either oppose taxes or support Walz declared him a great guy.  Third, Walz declared himself victorious, during a news conference in which he made a touchdown signal.  And, duh,everyone knows losers don’t make touchdown signals.

“No New Taxes” Leads To Dozens of Losses

To be fair, the Strib did acknowledge, in the 23rd paragraph where few readers read, that Walz lost on the revenue side of the ledger:

“Still, the cut in the health care tax, coupled with a middle income tax cut of 0.25%, means state government gets less money than if current taxes had stayed in place. On that, Republicans could claim victory too.”

But here’s the thing:  “No new taxes” is not just one individual issue that is equivalent to other individual issues debated at the Capitol.  Pawlenty and Strum understood that very clearly.  They understood that winning on “no new taxes” meant stopping progressives from making progress on dozens of issues.

That’s exactly what happened in 2019.

Without more revenue, Walz-backed improvements in roads, bridges and transit became impossible.

Without more revenue, the large House-passed increases for k-12 education became impossible.

Without more revenue, restoring the Pawlenty-era social services cuts became impossible.

The point: When Tim Walz lost on “no new taxes,” he didn’t lose on one issue.  He effectively lost much of his policy agenda.

Walz Reluctant to Use Negotiating Advantage

State budget negotiations can be thought of as a three-legged stool, with one leg controlled by the House, one by the Senate, and one by the Governor.  DFLers currently control two-thirds of the legs — the House and the Governor’s office — and Republicans only have one of the legs, with a narrow majority in the Senate.  This means DFLers should have an advantage in budget negotiations.

But to tap into that negotiating advantage and move a progressive agenda forward even just a little bit, Governor Walz needed to hold firm, and probably go into legislative overtime.  I understand that’s not a pleasant proposition for an affable fellow like Walz, but my guess is that a more progressive and fiery Governor Erin Murphy would have been willing to do that.  Governor Tim Walz was not.

If that “no new taxes” trend continues over the next three years, the Walz era may not be as different from the Pawlenty era as progressives like me had hoped.  Somewhere I have a suspicion that David Strum and Tim Pawlenty are smirking to themselves.

Easing The Harms of Legalizing Marijuana In Minnesota

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I’m a strong supporter of legalizing marijuana in Minnesota, and nationally.  As I’ve written before, legalized marijuana “will make Minnesota a more sensible, just, fiscally sound, humane and free state.”  The evidence is overwhelming.

But let’s not be naive or dishonest here.  As with any vice, there are also huge problems associated with legalization that need to be alleviated.  To me, the most troubling downside of legalization is harms to minors, transportation users, and seriously ill patients.

Disadvantages of Ending Marijuana Prohibition

Damaging Minors’ Brains. First, credible researchers are finding that marijuana use by minors appears to be much more damaging than it is for adults. For an example, an article in an American Psychological Association publication reports numerous alarming research findings:

Heavy marijuana use in adolescence or early adulthood has been associated with a dismal set of life outcomes including poor school performance, higher dropout rates, increased welfare dependence, greater unemployment and lower life satisfaction.

Duke University psychologist Terrie Moffitt, PhD, and colleagues… found that persistent marijuana use was linked to a decline in IQ, even after the researchers controlled for educational differences. The most persistent users…experienced a drop in neuropsychological functioning equivalent to about six IQ points (PNAS, 2012). “That’s in the same realm as what you’d see with lead exposure,” says Weiss. “It’s not a trifle.”

There are some reasons to think that adolescents may be uniquely susceptible to lasting damage from marijuana use. At least until the early or mid-20s, “the brain is still under construction,” says Staci Gruber, PhD, a neuroscientist and director of the Cognitive and Clinical Neuroimaging Core and the Marijuana Investigations for Neuroscientific Discovery (MIND) Program at McLean Hospital/Harvard Medical School…

Also immature in teens is the endocannabinoid system. As its name implies, this system comprises the physiological mechanisms that respond to THC. That system is important for cognition, neurodevelopment, stress response and emotional control, and it helps to modulate other major neurotransmitter systems, says Krista Lisdahl, PhD, director of the Brain Imaging and Neuropsychology Laboratory at the University of Wisconsin, Milwaukee.

Repeated exposure to marijuana can dial down cellular activity in the endocannabinoid system. Such interference might be a bigger problem for immature brains, says Lisdahl. “That sets the stage for why adolescents may be more sensitive to the effects of repeated marijuana exposure, from a neuroscience perspective.”

So, should we oppose legalization of marijuana?  Not unless we also want to bring back alcohol prohibition, because alcohol also is extremely damaging to the brain and many other parts of the body, and alcohol leads to countless more deaths than marijuana.

Still, in the rush to legalize marijuana, these kinds of findings shouldn’t be shrugged off by legalization enthusiasts.  We need to shine a light on these findings to encourage young people to delay marijuana usage until later in life, and to encourage everyone to not overdo it.

More Traffic Fatalities.  Second, legalization of marijuana also will increase the number of impaired drivers, which will likely lead to more traffic injuries and fatalities. USA Today reports the expert findings from states where the drug is now legal:

According to research from the Insurance Institute for Highway Safety and the Highway Loss Data Institute, the frequency of collision claims filed to insurers were higher in four states where marijuana is legal: Colorado, Nevada, Oregon and Washington.

The Highway Loss Data Institute study focused on collision claims between 2012 and October 2017, and compared against four control states where marijuana remains illegal: Idaho, Montana, Utah and Wyoming.

A separate study conducted by the Insurance Institute for Highway Safety focused on police-reported crashes before and after retail marijuana was allowed found Colorado, Oregon and Washington saw a 5.2 percent increase in the rate of crashes per million vehicle registrations, compared with neighboring states.

Law enforcement officials and others are using these kinds of findings as a reason to oppose legalization.  That’s absurd.  No one, including law enforcement officials, wants to bring back alcohol prohibition because of the staggering number of serious drunk driving problems, so we shouldn’t keep marijuana illegal because stoned driving problems are in the mix.

At the same time, we also shouldn’t deny the existence of the problem, and be passive about harm reduction.

Destroy Medical Cannabis Program For Patients.  Finally, ending marijuana prohibition could inadvertently harm or destroy Minnesota’s fledgling medical cannabis program, and consequently harm the seriously ill Minnesota patients benefiting from it.

According to Minnesota Department of Health (MDH) patient surveys, many Minnesota patients are benefiting from precisely dosed, tested, and customized cannabis-based capsules, oils, tinctures, and topicals. Across a wide variety of qualifying conditions, two-thirds of patients report significant benefits, while only 10% report little to no benefit.

When it comes to chronic pain patients, the MDH surveys show that 63% of patients who had been on highly lethal, addictive opioid medications were able to reduce or eliminate their use of opioids after moving to much less addictive, lethal cannabis-based pain relief medicine.

Many seriously ill patients desperately want to hold onto those successful medicines, but worry that the post-legalization availability of cheaper, unprocessed raw marijuana plant material will put the manufacturers of their precisely dosed and formulated medicines medicine out of business.

Many Minnesotans probably won’t care too much that those manufacturers would go out of business.  But the problem is, if they do go out of business, patients would suffer.  That is, patients who are currently benefiting from those precisely formulated and dosed medicines would be forced to use raw plant material that they and their caregivers consider to be less safe, pure and customized form of medicine.

Mitigating the Harm

We can’t wish these problems away.  Therefore, the law ending marijuana prohibition should set aside a reasonable amount — for the sake of argument, let’s say five percent to ten percent of the revenue raised from legalizing marijuana — for  a Marijuana Harm Reduction Fund.  The lion’s share of the revenue raised by legalizing marijuana still could be allocated however lawmakers and their constituents see fit.  But a mitigation fund could be used for harm reduction projects like:

  • Medicine Affordability Assistance. Some type of patient-friendly sliding scale subsidy to make precisely dosed, tested and formulated cannabis-based medicines available and affordable to all Minnesota patients who, according to medical caregivers, need them.
  • Youth Brain Impact Public Education Campaign. A multi-media public education campaign aimed at teens, young adults and parents to raise awareness about the heightened dangers of marijuana use at an early age.
  • Stoned Driving Public Education Campaign. A multi-media public education campaign aimed at raising awareness about the very real dangers of driving while under the influence of marijuana.

A couple of important caveats about this fund:

  • Evidence-based campaigns. The content of the public education campaign should be overseen by inter-disciplinary experts to ensure campaigns don’t become Reefer Madness-like misinformation campaigns, and are instead based on the consensus of the best available scientific evidence.
  • Subsidy oversight. The subsidies of patients using cannabis-based medicines should be monitored to ensure physicians are verifying that patients are benefiting from the medications and the amount of patient subsidies are kept at a reasonable level.

Again, cannabis is much less addictive and deadly than already legalized alcohol.  Again, marijuana prohibition has been horrific for communities. of color.  Again, marijuana prohibition is very bad, and legalization is much better.  Don’t get me wrong.

But that can’t be the end of the debate.  Citizens like me who are advocating to end marijuana prohibition must own these problems, and do what we can to reduce the associated harm.

Disclosure: The author is a public relations consultant who helps one of Minnesota’s two manufacturers of cannabis-based medicine share patient success stories with the news media.  He doesn’t lobby for that company, and the public policy opinions expressed here are his own, not the company’s.

If You Like TrumpCare, You’ll Love JohnsonCare

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Minnesota gubernatorial candidate Jeff Johnson (R-Plymouth) is crying foul over an Alliance for Better Minnesota television ad that says Johnson’s health care proposals would take health care away from Minnesotans who need it.

But the Alliance’s ad is accurate. Without question, the health care “reform” approach candidate Johnson is promoting during his campaign would take health care away from Minnesotans who need it.

Let’s break down the proposed JohnsonCare plan, piece-by-piece.

Johnson Eliminating ACA Protections

Johnson wants to make the Affordable Care Act (ACA) a thing of the past in Minnesota, via a federal waiver granted by the Trump Administration. More specifically, Johnson wants to eliminate the ACA approach that has:

  • Protected Record Numbers of Minnesotans. Under the ACA framework, Minnesota achieved the highest rate of health care coverage in state history.
  • Made Previously Unaffordable Protections Affordable. For lower and middle-income Minnesotans who don’t get coverage through their employer, the ACA has provided hundreds of millions in financial assistance to reduce or eliminate premium costs.
  • Strengthened Minnesotans’ Protections. The ACA also banned the hated preexisting condition denials, insurance payment limits, and dangerous junk coverage.  Because fewer Americans are no longer living one illness or injury away from being crushed by a mountain of bankrupting medical bills, personal bankruptcies have decreased by 50 percent during the time the ACA has existed.

If Johnson eliminates the increasingly popular ACA protections in Minnesota, that all goes away.  So yes, in several different and dramatic ways, Johnson absolutely would take health care away from Minnesotans who need it. The ad is correct about that.

Johnson’s False Claims

Johnson’s criticism of his opponent’s health care proposal is also utterly ridiculous.  Johnson says claims opponent Tim Walz “wants to eliminate private health insurance and force all Minnesotans onto one government program.”

The reality is, Walz supports a MinnesotaCare buy-in option. Under that approach, Minnesotans would have the option of either buying private plans or buying into the MinnesotaCare program, which is a government program operated by private health insurance programs.

In other words, Johnson’s claims that Walz wants to “eliminate private health insurance” and “force all Minnesotans onto one government program” are flat wrong.

If Walz is proposing a government-run single payer plan in the short-term, I’m not aware of it. Even if that were true, Johnson’s inference that eliminating private insurance in favor of government run health care would hurt Minnesotans is also wrong.  After all, Medicare, a government-run health plan, is popular and effective.  Medicare is helping Minnesotans, not hurting them.

Moreover, government run health plans are used in many other developed nations. Compared to the United States, consumers in those nations have 1) universal comprehensive coverage, 2) lower overall health costs and 3)  better overall health outcomes.

JohnsonCare and TrumpCare

Instead of the ACA, Johnson wants to back a high risk pool program that was very expensive for both consumers and taxpayers when it was used pre-ACA. Minnesota Public Radio reported:

Craig Britton of Plymouth, Minn., once had a plan through the state’s high-risk pool. It cost him $18,000 a year in premiums.

Britton was forced to buy the expensive MCHA coverage because of a pancreatitis diagnosis. He calls the idea that high-risk pools are good for consumers “a lot of baloney.”

“That is catastrophic cost,” Britton says. “You have to have a good living just to pay for insurance.”

And that’s the problem with high-risk pools, says Stefan Gildemeister, an economist with Minnesota’s health department.

“It’s not cheap coverage to the individual, and it’s not cheap coverage to the system,” Gildemeister says.

MCHA’s monthly premiums cost policy holders 25 percent more than conventional coverage, Gildemeister points out, and that left many people uninsured in Minnesota.

Johnson also wants to promote “junk,” “short-term,” or “skinny” plans, which are cheap because they don’t cover basic protections.  Promoting junk plans to reduce health care costs is like promoting cheaper cars lacking seat belts, airbags, crumple zones, safety glass, and anti-lock brakes. They look good if you’re only considering the price tag, but they’re a disaster when you and your family are in dangerous situations and desperately need those life-saving protections.

On health care, as with so most other issues, Jeff Johnson is aping Trump. President Trump is obsessed with eliminating Americans’ ACA protections in favor of a skimpy TrumpCare replacement. Trump insists that TrumpCare will cover everyone and cut costs, while the nonpartisan Congressional Budget Office finds that 23 million Americans would lose their protections, and millions more would pay higher premiums.

So Minnesotans, if you like TrumpCare – and only 17% of Americans do – you’re going to love JohnsonCare.