An independent analysis released this week by the Minnesota Department of Commerce found that up to 151,000 Minnesotans could be helped if the Minnesota Legislature gives health insurance consumers of any income level the option of buying into the public MinnesotaCare health insurance plan. MinnesotaCare has been operated by the Minnesota Department of Human Services since 1992 but has only been available to about 83,000 people who make too much to qualify for Medical Assistance (Minnesota’s Medicaid program) but earn less than 200% of the federal poverty level.
The Commonwealth Fund explains what little is known about the MinnesotaCare buy-in option proposal that will be considered by the Minnesota Legislature in the coming months:
Minnesota is also considering a buy-in option but is focusing on expanding MinnesotaCare, the state’s Basic Health Program. The Basic Health Program was created by the Affordable Care Act and allows states to leverage federal financial assistance typically used to subsidize private insurance purchased through health insurance marketplaces to instead fund a state coverage program for individuals with incomes up to 200 percent of the federal poverty level. MinnesotaCare and the state’s Medicaid program are run by the same agency; MinnesotaCare provides more generous benefits than marketplace coverage at lower premiums. The state’s recently enacted law allows the state to study and pursue different public option models in addition to the MinnesotaCare buy-in.
As the Legislature prepares to debate this issue in coming months, lobbyists for insurance companies, doctors, and hospitals are howling, which confirms to me that the Legislature is on the right track.
Hospital and doctor lobbyists are predictably complaining that they will get reimbursed less by MinnesotaCare for medical services. Health insurance lobbyists are predictably complaining that they will earn less by being forced to compete with MinnesotaCare.
I don’t doubt that what the lobbyists are saying is true. But their complaints should lead Minnesota legislators to ask themselves this key question: How can we possibly make insurance more affordable for struggling consumers if doctors, hospitals and insurance companies don’t get paid less?
We can’t.
If medical industry lobbyists lose on this, ordinary Minnesota insurance customers will win. It’s pretty clear that hospital executives, specialty doctors, and health insurance company executives are in a better position to make do with a little bit less money than 300,000 uninsured Minnesotans who are just one injury or illness away from medical bankruptcy or going without life-saving care.
According to the Commonwealth Fund, health insurance consumers are winning in Washington and Colorado, states that have already gone down this public option road:
“Washington and Colorado, which have operational programs, are seeing incremental progress. In Washington, public option plan rates will increase in 2024, but at a slower pace than non-public option plans (+5% compared to +8%). Similar to this past year, in 2024 they are expected to be the lowest-cost silver plan in most counties (to which premium tax credits are pegged). Public option plans will be offered in 37 of 39 counties, up from 34 in 2023.
Despite opposition from the insurer and provider communities, the Colorado Option program has generated savings for consumers while offering more comprehensive benefits and increasing transparency around health insurance premiums and provider reimbursement rates. Requested increases for Colorado Option plans were more than 30 percent lower than non-Option plans and, following the state’s subsequent rate review and hearing processes, the state announced that 25 individual market and 24 small-group market Colorado Option plans will meet the state’s target of a 10 percent reduction in premiums compared to 2021 levels. The federal government also recently affirmed that the program is expected to generate savings from reductions in plan premiums.”
That’s very encouraging progress. It’s not a cure-all, but it is progress.
Do Minnesota legislators care more about the financial bottom line of insurance companies, hospital companies, and specialty doctors than they do about the pocketbooks of Minnesotans struggling to afford health protections? In the coming weeks, we will find out.
I go back and forth in my head about which is the more damaging: the role of money in politics or the weaponization of gerrymandering. I mostly come down on the side of money but it’s a closer call than one might think.
If I were – to channel my inner Trump – dictator for a day, I would revamp our elections by:
– Making ranked-choice voting the default election method for every public office. If s city, state, etc. want to use another method, let them pass that.
– Go to full public funding of elections and outlaw contributions to candidates. If people want to participate in the political process, they can give to the party of their choice.
– Eliminate PACs, SuperPACS and all the other mechanisms of funneling money in the system in unaccountable ways.
– Instant transparency. If we can accurately process a billion – or whatever it is – financial transactions a second, we can have a system where a contribution (which in my world would be limited as to who could accept it) is instantly posted to the FEC’s database. No more waiting a year or whatever it is to get a trailing report and no more donations from “Citizens for an Honest Vote” LLCs.
– Shorten the election cycle. Campaign activities limited to eight (or ten or twelve) weeks before an election. Maybe even adopt the British method of calling for elections.
– Require each state to establish a non-partisan redistricting method. A standing commission, a non-partisan board appointed every decade, etc.
There are, I’m sure, lots of reasonable “whatabouts” from my list but this would be a good start.
A public option will likely pay hospitals and physicians similar to what Medicare pays so they have a limited beef. It should also provide better transparency about pricing, which is nearly impossible to get out of the private sector. There is little enough consumer advocacy in the current system as it is, which seems unconscionable when you consider that we’re talking about basic health care.
Well! The medical and insurance industry own a whole lot more legislators than the poors.