Tag Archives: MinnesotaCare

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?

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

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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 that 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.