This summer, as national health-care reform is embroiled in a fierce partisan debate, Minnesotans can look back to the early 1990s when a remarkable era of bipartisanship enabled this state to move ahead with its own health-care overhaul plan.
Initially dubbed HealthRight when its authorizing legislation was adopted in April 1992, the plan become MinnesotaCare three months later when a California agency notified state officials that it held the federal trademark for the Minnesota program’s original name.
The stage had been set for enactment of this ambitious new initiative when Gov. Arne Carlson vetoed a more extensive health-care reform bill a year earlier. In his veto message, Carlson signaled that he was willing to work with the Legislature on a more targeted plan.
The ‘Gang of Seven’
Over the next nine months, Carlson’s staff worked with legislative leaders to come up with a proposal that preserved many of the features of the earlier measure. Spearheading this legislative effort was a bipartisan legislative group that came to be known as the “Gang of Seven.” The group included State Sen. Linda Berglin and Rep. Paul Ogren, two DFL legislators who had championed the early health plan vetoed by Carlson. Berglin and Ogren were joined by Republicans Duane Benson, the legislative leader for his caucus in the Senate; Dave Gruenes, a health-care expert in House; and a second House Republican, Brad Stanius, who ended up withdrawing his support for the health plan before its final passage. Rounding out the Gang of Seven were Rep. Lee Greenfield and Sen. Pat Piper, both DFLers.
In the early 1990s, as they developed the plan that became MinnesotaCare, these state leaders grappled with the same issues that are confronting legislative architects today: how to expand the system to provide health care for the uninsured while controlling costs and streamlining the health-care delivery system.
In its final compromised form, MinnesotaCare provided subsidized health insurance for thousands of low and moderate income Minnesotans who were unable to access affordable insurance on their own. The plan also imposed new regulations on private insurers and created a commission to set targets for reducing health-care expenditures by eliminating unnecessary and ineffective medical procedures.
Fierce opposition
As the plan moved toward final action in the House and Senate, it aroused fierce opposition from the Minnesota Medical Association and the Minnesota Hospital Association, both of which objected to the proposed 2 percent tax on health-care services, intended to finance the new system of subsidized health insurance.
But the two powerful trade associations were ultimately unsuccessful in eliminating the 2 percent tax, which became a permanent feature of the new state health-care system.
Roadblocks in the House
While the HealthRight legislation easily passed the Senate, the bill encountered more roadblocks in the House where some out-state legislators were concerned about the plan’s impact on rural hospitals.
As House Speaker Dee Long prepared to close off House voting on April 16, the bill had only generated 62 yes votes, six fewer than were needed for final passage. But a concerted lobbying effort by Gov. Carlson and his legislative agents delivered some additional Republican votes, and the bill finally passed the House with 17 Republicans and 53 DFLers voting for the landmark legislation.
At a signing ceremony later that month, Carlson declared that the new law “significantly redefines and broadens the definition of the quality of life in Minnesota.”
While MinnesotaCare may not have reformed the delivery of health care in this state, as its architects might have hoped, the statewide program has made health insurance available to thousands of the Minnesota families who had been priced out of the private insurance market.
In the final analysis, the 1992 legislation may be significant mainly in terms of political history. It demonstrated that bipartisanship was able to help this state overcome the swirl of competing pressures that impede any effort to move beyond the status quo.
As Congress heads toward its August recess in this politically polarized era, it remains to be seen whether bipartisanship can help propel health care reform forward on a national level.
It would seem that commitment on the part of all to a common goal is what is needed for serious bi-partisan negotiations.
MinnesotaCare turned out to be very successful (if not yet universal) until Tim Pawlenty regularly raided its DEDICATED FUNDS for other purposes so he could tell the world he balanced the budget without raising taxes, thus harming those whose premiums would yield them nothing and those providers whose patients could no longer afford to seek care from them. Kind of destroyed the original agreement, did he not?
In Washington, the ideological commitment to corporate America rather than to Americans seems to be leading toward a “bi-partisan compromise” that will favor the corporate wishes while drowning out with rhetoric the real needs of the people. (And the real preference of the people for universal single-payer health care.)
This is not the 1990’s, and our problems are completely different. It really isn’t about just insuring everyone. It is about health care costs crippling the middle class, small businesses, and education. Minnesota Care was great for solving a problem we had a decade ago. Today’s problems are not going to be solved just by making sure everyone is covered. It’s not that simple anymore.
Alec T: The key would seem to be simplification rather than adding more complexity and bureaucracy to the current system.
At the state level, check out John Marty’s Minnesota Health Plan (SF118/HF135), which would make the state the single insurer/payer for all Minnesota residents. It would cover all medically necessary treatment as decided by you and your doctor as well as preventive care. Funds from progressive taxation and premiums based on ability to pay would be managed by an independent board. Neither the governor nor the legislature could steal money from the fund to use for other purposes. The savings are estimated at around 9 percent, but an extensive study will soon be done to arrive at a more exact figure.
Nationally, HR 676 would make the federal government the single payer. No one left out. No yearly rises in insurance premiums and reductions in benefits paid. Savings? $400 billion per year, mostly from eliminating the horrendously bureaucratic private insurance industry (but to do so over 10 years to avoid a sudden shock to the industry and the economy).