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Expanding MinnesotaCare would increase choice and competition

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Sen. Matt Klein
I’ll never forget the way his chest X-ray looked.

During my usual night shift at the hospital, an individual around my age came in seeking care for a bad cough. He told me he worked as a drywall installer in dusty environments and had no health insurance, much less the ability to take time off from his job to get better. The cough had persisted for the past year, he said, and was beginning to bring up some blood.

In a separate room, not long before midnight, I clipped his X-ray film to the wall. A grapefruit-sized mass in his upper-right lung glared back at me. My heart sank. When I walked back into the patient’s room and explained as gently as possible the dire situation he faced, he responded: “When can I get back to work?”

The interaction I just described occurred in 2006 – prior to the passage of the Affordable Care Act. Today, I am one of just two physicians currently serving in the Minnesota Legislature. As someone who has worked on the front lines of health care both before and after the ACA, I never want to see us go back to the dark days when private insurers canceled insurance policies, or didn’t provide them at all, for people facing serious medical crises.

If only …

If the ACA had existed when I met that drywall installer back in 2006, he could have visited his doctor for annual preventive exams at no cost. It’s possible a physician or nurse could have identified occupational health hazards, spotted warning signs, and helped that man prevent a personal health catastrophe. Perhaps his first question after I broke that horrible news in 2006 would not have been how will I pay my bills, but rather how soon he could begin treatment.

The ACA significantly reduced the number of Americans without health insurance and established important consumer protections that benefit everybody. With the steep rise in demand for medical care there have been correlated cost increases. Private insurers continue to raise their prices in the form of higher premiums and deductibles for consumers, even as they rake in record profits.

Government can and must now work to control health care costs for consumers. Our hopes that insurance companies would hold costs down has proven misguided.

I favor regulating prescription drug companies, driving doctors toward the best and most efficient practices (such as preventive medicine), and incentivizing hospitals to keep people out of beds, not fill more beds. Controlling costs can be done hand in hand with great medical care. That’s why I favor an expansion of our state’s popular MinnesotaCare program as an option for increasing choice and competition in our state health insurance market.

An opportunity to ‘buy in’

MinnesotaCare is a state program that for 26 years has provided affordable, reliable health care for eligible working families. People pay what they can toward their monthly premiums and the state helps them out based on their income level. The program is proven to control costs and drive providers toward quality health delivery. By creating an option for all consumers to “buy in” to MinnesotaCare, those who earn too much to qualify for subsidies would pay their own way, meaning the cost of their premiums would pay for their coverage just like other commercial insurance plans.

Two powerful industries oppose the MinnesotaCare Buy-In idea – private insurance companies and hospitals. Why? Because an affordable product like MinnesotaCare cuts into their profits. Any disruption to the fee-for-service model is guaranteed to result in industry pushback.

Some politicians have proposed we control the costs of health insurance by offering products that only cover some conditions, or can be revoked if a person has a pre-existing condition. As a doctor, I can attest that every one of us will have a pre-existing condition at some point in our lifetimes. Removing consumer protections for any medical condition is a shortsighted gimmick that will turn us back to days like the one when I discovered the mass in the drywall installer’s lung. When we structure health insurance to only serve the healthy, nobody who needs it will have it.

We are a strong enough and a good enough state to ensure all of us have access to health care. And we can no longer allow a person’s background or income to determine if they can receive treatment – we are better than that. Let’s move forward, not backward, with health coverage for Minnesotans.

Matt Klein is a medical doctor and state senator who represents Inver Grove Heights, West St. Paul, South St. Paul, Mendota Heights, and a portion of Eagan. He is a member of the following committees: Capital Investment; Health and Human Services Finance and Policy; and Human Services Reform Finance and Policy.


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Comments (13)

  1. Submitted by Raj Maddali on 10/23/2018 - 09:32 am.

    “increase choice and competition”

    The entire article is about increasing access to MinnCare. Fine. However how does that increase choice and competition.

    Minnesota has among the least competitive medical care industry.
    We are so regulated that we are now down to probably 3 or 4 large providers and their clinics. Where is the increased choice and competition ? How does increasing MinnCare subsidies increase them ?

    • Submitted by Raj Maddali on 10/23/2018 - 10:12 am.

      Also, if the author is indicating increased choice among insurers, he hasn’t proven his case. It increases “choice” by exactly 1.

      For example if Hamburger is $2 a pound, and their are 3 restaurants selling Hamburger. Along comes the state to sell it at $1 a pound. It will increase choice by 1 restaurant.

      However that increased choice will last a month or so while the others start going belly up. That isn’t the result of better efficieny or productivity of the new entrant. Rather the tax payer is paying for the subsidy. More so if anyone is allowed to buy at $1 a pound.

  2. Submitted by Beth-Ann Bloom on 10/23/2018 - 12:52 pm.

    With a DFLer as governor and more democrats in the House and Senate we have a chance to discuss reasonable proposals like Dr Klein’s!

  3. Submitted by Erica Ramos on 10/23/2018 - 02:15 pm.

    The ACA was ‘supposed’ to reduce the # of uninsured. I remember President Obama declaring that the 30,000,000 Americans without health insurance would now be covered.

    Today we are told we have 35,000,000 uninsured Americans.

    When is it time to admit failure with ObamaCare?

    When is it time to get R’s and D’s together to go back to the genesis of ObamaCare (RomneyCare) and start over?

    You can’t price insurance without moral hazard.
    You can’t price insurance without acknowledging women are more expensive to cover (ask my teenage son about his car insurance rates vs. his sister).
    You can’t provide coverage for pre-existing conditions without showing proof of continuous coverage (wreck your car today and call State Farm tomorrow and ask if they’ll cover that wreck).
    You can’t allow free riders to game the system. 50 states each need to have their own laws covering mandates. Nobody ever asks why Massachussetts passed a law after ACA went into effect mandating that every MA resident have health insurance.
    Leave 26 years olds on parents policies.
    Skinny up the minimum requirements for healthcare to 6 mandated things instead of 12…like Rahm Emanuel told Obama to do.
    Finally….let each state decide how to best adopt the RomneyCare model for their own state.

    Therein lies the fatal flaw of ACA. They thought they could ram this through as a federal program with a mandate that even the SCOTUS ruled 7-2 they could not enforce.
    They thought they could cover everything and anything under the guise of a fine when in fact it was the largest tax increase in US history.
    They thought poor people would sign up for subsidized policies and the fact they didn’t dumbfounds them.
    I could care less about what Mississippi or Texas does for their insurance markets.
    I care about Minnesota. It’s’ a sovereign state and it’s one in which my state can mandate that I buy health insurance or face a fine that’s equal to the premiums I should pay. We can do this..but not if you’re asking me to cover 20 million illegal immigrants in Calfiornia.

    Look….the Republicans have a huge surprise in store for Democrats if they don’t come to the table to Repair and Replace ObamaCare.

    That 40% Cadillac Tax on Health plans? It will hit union members HUGE…and the Republicans can allow that to kick in the summer of 2020…right before Trump’s rel-election.

    Democrats still own Obamcare, including this 40% tax.

    it’s time to let that tax go into effect and send a $4000 bill to every teacher and government employee in our state.

    • Submitted by Karen Sandness on 10/23/2018 - 11:52 pm.

      “But we’ll have to pay for 20 million illegal immigrants” is one of the right-wing rallying cries against universal health care.

      First of all, illegal immigrants are not eligible for any U.S. government benefits, except that their children are allowed to attend public schools, which means that they’re off the streets and learning English.

      (Yes, yes, I know. Every right-winger has a friend who has a friend who knows a family of twelve illegal immigrants who are receiving $500 a month in food stamps, Section 8 housing, TANF, and Medicaid, The secondhand “friend” is probably one of the radio demagogues who infest the AM band and spread poisonous nonsense that reinforces people’s prejudices.)

      Second, look at what happens in actual single payer countries when someone who is not a legal resident needs medical care. Since these are civilized countries, they provide true emergency care but not extended care. I personally known people who had broken bones set, severe cuts cleaned and bandaged, possible concussions ruled out, or gravel removed from their eyes while they were in a European country.

      If illegal immigrants are receiving free care in the nation’s emergency rooms it is because they give fake names and addresses, just as American citizens have been known to do. Those who are honest pay full fare. (In Oregon, I once interpreted for a Korean out-patient who spoke Japanese. They charged him $125 to clean an infected injury.)

      By the way, when people worry about “20 million illegal immigrants,” they’re probably not worrying about the Eastern Europeans or Chinese who overstay their tourist visas or the Irish who enter as tourists without a visa and quietly blend into the background.

      They’re almost always talking about Mexicans, but a Mexican would be unlikely to come here for health care, since Mexico has a public medical system that is adequate for most needs, and prescription drugs are cheap enough that American “snow birds” who winter in the Southwest often make trips across the border to buy their meds and even receive dental care.

      When it comes to health care, one major difference between left and right that I see is that the left strongly believes that ensuring access to health care is simply the humane thing to do for everyone, while right-wingers would rather do without health care themselves than let people they despise have it.

      By the way, if you object to paying for other people’s health care, take time to review how private insurance works.

    • Submitted by Raj Maddali on 10/24/2018 - 07:52 am.

      Your “facts” are deceptive.

      “The ACA was ‘supposed’ to reduce the # of uninsured.” – Yes it has. The percent of Americans uninsured after ACA has fallen since 2010. Prove it otherwise.

      “When is it time to admit failure with ObamaCare?” – Prove success before ObamaCare ? The percent of uninsured has fallen.

      “You can’t provide coverage for pre-existing conditions without showing proof of continuous coverage (wreck your car today and call State Farm tomorrow and ask if they’ll cover that wreck).” – You can’t have continuous coverage unless you mandate coverage. And the Republicans have been the biggest opponents to mandating coverage.

      “You can’t allow free riders to game the system. 50 states each need to have their own laws covering mandates. Nobody ever asks why Massachussetts passed a law after ACA went into effect mandating that every MA resident have health insurance.” – You can’t have it both ways. First you claim the fine is a tax and now you complain there are free riders. That is talking from both sides of your mouth.

      “Therein lies the fatal flaw of ACA. They thought they could ram this through as a federal program with a mandate that even the SCOTUS ruled 7-2 they could not enforce.” – And you complain about free riders !!! You can’t have it both ways Ms Ramos.

      “They thought poor people would sign up for subsidized policies and the fact they didn’t dumbfounds them.” – Lots of poor signed up. Its hypocritical for Republicans to choke off the program and then claim people aren’t signing up.

      For all the blather about the ACA why is it that Republicans on TV are saying Pre Existing conditions are covered no matter what ? Hypocrisy much on their part ?

  4. Submitted by Mark Kulda on 10/23/2018 - 04:32 pm.

    Expanding MinnesotaCare would mean expanding a low cost but low quality plan. Dr. Klein talks about the lung cancer diagnosis of one of his patients.
    He says we should expand MinnesotaCare so that we can get more people insured.
    What he doesn’t tell you is the coverage limit for hospital care under MinnesotaCare? Just $10,000 total, which with today’s hospital charges would barely pay for a sick patient to come in and be diagnosed with lung cancer must less be treated by the hospital for it.
    He seems to blame insurers for raising premiums yet he doesn’t mention how profitable the health care providers he works for are. Sure insurers do add a layer into the system but their role is to keep medical providers from charging even more than they already do. Insurer overhead is strictly limited by the ACA which really points to provider overcharging and drug company profiteering as the major cost drivers in the system and expansion of MinnesotaCare does not solve either of those problems. With such low quality coverage, people would get tricked into thinking they have good coverage when they don’t.
    Dr. Klein’s big problem with pre-ACA insurers was the pre-existing condition issue.
    Yet one of the best ways of dealing with pre-existing conditions in Minnesota was through the program known as the Minnesota Comprehensive Health Association (MCHA). The policies were very high quality and allowed sick people to get coverage with a premium that was only 125% of what the private marketplace premiums were. And since these people were sick and consumed a lot of health care, it was an excellent deal for them.
    As you can imagine, these sick people didn’t pay nearly enough in premiums to run the program and it eventually built up an annual deficit of almost $100-million a year, which was paid by assessing the deficit to the rest of the fully insured market place. While a noble idea, the deficit was only paid by non-public (Medicare/Medicaid) and non-large employer sponsored plans. This deficit was borne by small group health insurance plans (small businesses) and individual plans. A better solution would have been to have it paid from the state’s general fund.
    MCHA, despite its easily correctable funding flaws, was a model of success. It offered a way for people to get excellent insurance coverage without the need to worry about pre-existing conditions. Most health experts said MCHA was the best type of its program in the country and probably should have been used as model of how the US could deal with the issue.
    But the ACA’s designers, rather than use what worked, outlawed MCHA and programs like it and eventually it was forced to run itself out. Had MCHA-like programs been allowed to continue, then we wouldn’t even need to have a discussion about maintaining pre-existing condition coverage, it would have already been taken care of.
    People with pre-existing conditions make up a small portion of the overall marketplace but yet they consume an ever-growing amount of health care expenditures. People who want to make sure that pre-existing conditions stay included in health care coverage benefits need to realize that is yet another significant reason for increasing health insurance premiums.
    Expanding MinnesotaCare, much like Medicare for All, is a great rallying cry because it sounds like a good idea. Until you actually stop to consider what it means. It would be a bad outcome.

    • Submitted by Matt Haas on 10/23/2018 - 07:01 pm.

      1. Upwards of 40% of the populace have some form of pre-existing condition.
      2. MCHA was a failure, in that many of the folks forced into it could not afford its “excellent” coverage.
      3. Funding it from the general fund is a TERRIBLE idea, as it would make life or death care subject to the whims of each and every legislative budgeting session.
      4. There is no INSURANCE, anywhere, that will be solvent if its forced to cover ONLY sick people. It simply defies the principle of what insurance is. Either you choose to let the sick suffer and die, or you pay for everyone through taxes. Any attempt at half measures is simply delaying the inevitable.

      • Submitted by Bob Barnes on 10/31/2018 - 11:01 pm.


        Your solutions are very flawed.
        1. Many pre existing conditions are curable without much medical care simply by healthy eating (diabetes leads to lots of other serious problems).
        2. It was a failure because no one in govt or even on this site will actually address the real problems with healthcare and health insurance…. anti trust violations and monopolistic practices. Prices are so high that we simply can’t afford it anymore because of these practices.
        3. Govt shouldn’t be funding anything related to healthcare in the first place.
        4. You left off the single biggest and best answer… the free market. Govt has mandated insurance companies pay for basically every doctor visit (with only a small copay usually). That means insurance isn’t insurance anymore.. it’s basically prepaid medical care. In a free market, the only claims being paid out would be the very expensive things (heart attack, stroke, cancer etc) which means the risk pools would be very large and premiums very low. The fewer claims insurance has to pay out, the less they need in premiums. Of course those with an existing condition will pay more but they would still have very affordable premiums to cover their needs (again due to large risk pools and much less money being paid out in claims due to most paying out of pocket for most things).

    • Submitted by Raj Maddali on 10/24/2018 - 07:57 am.

      “What he doesn’t tell you is the coverage limit for hospital care under MinnesotaCare? Just $10,000 total, which with today’s hospital charges would barely pay for a sick patient to come in and be diagnosed with lung cancer must less be treated by the hospital for it.”

      Can you prove this. I pasted a link to the Blue Cross Minn Care booklet. It states none such.

    • Submitted by Paul Copeland on 10/24/2018 - 01:23 pm.

      For the ACA era, the MinnesotaCare program was converted to an ACA Section 1331 compliant “Basic Health Program”. In a BHP, “The monthly premium and cost sharing charged to eligible individuals will not exceed what an eligible individual would have paid if he or she were to receive coverage from a qualified health plan (QHP) through the Marketplace”. The pre-ACA MinnesotaCare coverage limit for hospital care of $10,000 is long gone.

      The MCHA policies were quite good but many of the people who needed them couldn’t afford the premiums and had no insurance. Some people who could buy non-MCHA individual insurance also couldn’t afford the premiums. Once the ACA premium subsidies became available, more lower income people could afford the premiums and bought insurance. These new policy holders were a lot more expensive than the insurance companies initially projected and it has taken years for the insurance companies to gain the experience needed to appropriately price individual policies.

      Finding money to pay for high expense patients is not fundamentally different today (with the current temporary, state funded reinsurance program) than it was in the past (with MCHA losses being quietly and automatically charged to other insurance companies/policyholders). The big issues are still who pays and whether to set up a dedicated funding source.

      The ‘low quality plan’ comment about MinnesotaCare is unsupported. I would be curious to know if there is any objective data to support or refute that assertion. If this is based strictly on anecdotes, my own personal observation is that the small number of people I know (that all used to have employer sponsored plans) who now use MinnesotaCare have all described it as “the best health insurance I have ever had”.

  5. Submitted by Curtis Senker on 10/23/2018 - 06:45 pm.

    Best rebuttals I’ve ever seen on Minnpost. Informative, succinct and includes solutions.

    Bravo Mark and Erica, and thanks.

  6. Submitted by Bob Barnes on 11/01/2018 - 03:05 pm.

    I disagree. Expanding govt run (a few providers subsidized by taxes) insurance will reduce choice and reduce care quality and options. Private business cannot compete with govt. Expanding a govt run system will drive competition out leaving just 1 choice eventually.

    Competition is the only way to increase choice and reduce costs. MinnesotaCare is nothing more than a govt sponsored monopoly that will remove competition and choice while driving costs up.

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