Health insurance news is a gift to Republican candidates

NRCC
The National Republican Congressional Committee was quick to seize on the bad Affordable Care Act news, releasing an ad this week attacking 2nd District Democratic candidate Angie Craig for her support of the law.

When the 2016 election kicked off, health care was far from the hottest topic in Minnesota congressional races.

With terror attacks and Donald Trump dominating the headlines, candidates weren’t talking about plans and premiums as much as they had in elections past.

It’s not as if Republicans had begun to accept Obamacare, but after several cycles of pushing the repeal-and-replace messaging — without delivering results — GOP candidates were eager to take on other issues.

How things change: in the span of a few fall weeks, Minnesota authorities announced rising premiums for MNsure, the White House said Obamacare premiums would spike nationwide in 2017, and Gov. Mark Dayton himself said the Affordable Care Act was “no longer affordable to increasing numbers of people.”

All of a sudden, health care has moved from the sleepy section of a stump speech to the sleeper issue of the cycle. Republicans are determined to make the most of this late-October gift — does that put any Democrats running for Congress in real trouble?

Republicans find a winning issue

Republicans are wringing all they can out of this turn of events, gleeful to find that their repeal-and-replace Obamacare messaging is more salient than it has been in years.

Some Minnesota GOPers describe the stream of news as a game-changer for their candidates, and those involved in campaigns say it’s the main thing people want to talk about at events and on their doorsteps.

Republicans feel the issue is giving them much-needed ammunition that could potentially make a difference in a close race.

In each of Minnesota’s three most competitive U.S. House races, October public polling from KSTP/SurveyUSA backed up that sentiment.

In the 8th District, the poll found that health care was the top issue for voters, with 26 percent saying it was the most important topic to them, edging out national security. Forty-five percent of those surveyed said they supported repealing Obamacare.

In the 2nd and 3rd Districts, the polls found health care was the number three issue, behind the economy and national security. In both districts, over forty percent of respondents said they wanted to repeal the law, while pluralities of respondents wanted to keep it with changes, or expand it.

When Minnesota insurers announced potential premium hikes for MNsure participants in early September, Republican congressional candidates pounced.

On September 1, 8th District GOP candidate Stewart Mills had his first press release that explicitly attacked Rep. Rick Nolan over his support of Obamacare. On September 6, 2nd District GOP candidate Jason Lewis had one of his own hitting Democrat Angie Craig on the issue.

Minnesota was buzzing over health care already when Dayton made his comments, which attracted national attention — and even a favorable retweet from Donald Trump. The White House’s announcement on premiums rising in 2017 only added fuel to the fire.

Republican campaigns and national GOP groups doubled down on anti-Obamacare messaging: the National Republican Congressional Committee, which has poured millions into Minnesota’s three most competitive races, has bankrolled hours and hours of TV ad time to hit Democrats on Obamacare.

They have focused particularly on Craig: one NRCC ad features a quote from Craig in support of the Affordable Care Act, immediately followed by Dayton’s quote.

“Even Governor Dayton admits, we’re already getting crushed,” a voiceover says ominously. “And Craig would double down, costing families thousands more.”

The health care issue has also been a useful weapon for 3rd District Rep. Erik Paulsen in his race against state Sen. Terri Bonoff. In ads and mailers, the Republican incumbent has been emphasizing the rate hikes and seeking to pin blame on Bonoff, who has served in the legislature since 2005.

Democrats respond cautiously

The health care news of the past two months represents a perfect storm at the exact wrong time for the Democrats, said Steven Schier, a professor of politics at Carleton College.

Schier said that Craig and Nolan are particularly vulnerable to this line of attack from the GOP. Citing Craig’s background in health care and past support of Obamacare, he said “this is the first time you’re seeing negative ads on a salient issue that might work against Angie Craig. It may serve to tighten the race.”

Schier added that the ACA news could be a “really serious problem” for Nolan, compounded by polls showing the 8th District favoring Trump over Clinton.

In the face of an all-out assault from Republicans, some Democrats in tight contests are dialing back their praise of the law.

Nolan is typically a reliable defender of Obamacare, and supports an expanded federal government role in increasing access to health care.

He was quoted on Wednesday, however, by Tom Coombe of the Ely Echo saying that while the ACA did a lot of good things, “what it didn’t do was get costs and premiums under control.”

In a statement to MinnPost, Nolan said that House Speaker Paul Ryan should open up the legislative process to allow legislators to amend Obamacare to make it more affordable.

“Overturning the Affordable Care Act without ensuring that children can stay on their parents’ insurance until the age of 26, without guaranteeing that those without preexisting conditions will have access to care, or without ensuring that women do not pay more for health insurance than men would be a step backward for the American people,” Nolan said.

Most DFLers are toeing a similar line, saying that Obamacare has helped people access much-needed care, and now work should begin on making the system more affordable.

But there’s nuance there, and less than two weeks before the election, Republicans are going to keep going for the jugular.

In a statement to MinnPost, Mills referenced Dayton’s remarks, saying Obamacare and MNsure are “melting down…  as this devastating health care experiment collapses, Nolan stubbornly is doubling down for an even more extreme, expensive, and expansive single payer government takeover.”

According to Schier, though the timing is bad for Democrats, they still hold advantages that will help them weather the storm. “You’ve got a Republican Party organization that is grossly deficient compared to the Democratic organization,” he said. “Perhaps that can blunt or limit the degree of DFL losses.”

But Schier maintained that though many Democrats are saying the right things, “people are so fed up with government… it’s just so easy to get people pissed off. This is a great provocation for Republicans.”

Correction: A previous version of this story mischaracterized Dayton’s comments on the Affordable Care Act.

Comments (37)

  1. Submitted by Mike Schumann on 10/28/2016 - 11:47 am.

    Health Care

    The Democrats have their heads in the sand. While they are talking about cost and premiums, they are completely ignoring the HUGE problem coming on Jan 1: 70,000 + Minnesotans are not going to be able to get health insurance at ANY price, given the enrollment caps that on the remaining non Blue Cross plans.

    What’s going to happen to these people? There is no plan B…..

  2. Submitted by Bill Gleason on 10/28/2016 - 11:50 am.

    Why is it?

    that the Minnesota GOP currently has an ad out that states:

    Minnesota, highest Obamacare rate increases in the Midwest

    ND 7%
    SD 39%
    MN 59%
    IA 25%
    WI 16%

    It would seem that some states seem to have a better control on this situation.
    It doesn’t appear that all the blame should be on “Obamacare.”

    Perhaps the obstructionist tactics – until right before election – of the Minnesota
    GOP may have something to do with this.

    • Submitted by Robert Moffitt on 10/28/2016 - 12:17 pm.

      I believe none of the other states listed have their own plan…

      …as Minnesota does. They use the federal marketplace. Also, we started with among the lowest costs in the nation, so the percentage of increase is going to seem higher as costs level out.

      A better question might be: “Why do health care costs vary so much from place to place, long before the ACA?”

    • Submitted by Jack Daw on 10/28/2016 - 04:44 pm.

      MN rates were lower to begin with

      The reason Minnesota’s percentage increases are larger than those of surrounding states is because our previous rates were significantly lower than those of surrounding states. While Minnesota is seeing a greater *increase* in both absolute and percentage terms, when considering the final rates *themselves* for 2017 Minnesota’s rates will be roughly equivalent to those of the other states listed.

      So those other states are not better off than we are; they were relatively worse off in previous years.

  3. Submitted by Ray Schoch on 10/28/2016 - 11:55 am.

    It says much

    …about the current Republican Party that they’re rejoicing over the cost overruns of a health insurance program (it’s important to note that this is not about health CARE, it’s about health care INSURANCE) they’re primarily responsible for. The ACA is based on Mitt Romney’s health insurance plan, put into place in Massachusetts while he was Governor. While the cost spikes are severe in some cases, they affect a small portion of the general public (about 5% in Minnesota) who are buying their health care insurance through the individual market. Cost increases are fairly minimal for the vast majority of people, who still get their health insurance through their employer. In some cases, premiums will even go down. To that extent, GOP finger-pointing is sophistry.

    Perhaps equally to the point, and despite the glee with which recent Republican ads take Democrats to task for supporting the ACA, there are two other factors to consider:

    First, the ACA has made it possible for millions of people to have health insurance who could not afford it previously;

    Second, after several years of “Repeal, Repeal, Repeal” from Republican critics – ample time, one would think, to devise something better – there is still NO Republican alternative to the ACA. “Repeal and replace” is credible only if there IS a replacement, and no such policy is evident.

    Our previous system was a disaster acknowledged by both major parties, and only Libertarians are of the view that, if you can’t afford health care, you should have the freedom to simply die. What’s telling is that, after years of criticism and finger-pointing, the GOP, whether in the form of Stewart Mills or Paul Ryan or Mitch McConnell or Donald Trump, have no viable alternative plan. A return to our previous “health care for those who can afford it” policy is not going to fly, I don’t think, in the current electoral climate, and at present, that’s all the Republican Party has to offer.

    • Submitted by John Appelen on 10/28/2016 - 12:19 pm.

      Note

      Just a note… Most of the people added to the “insured bucket” were because of the expansion of Medicaid. This could have happened separately.
      http://kff.org/uninsured/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/

      Self employed friends of mine who had insurance before ACA are now dropping it because of the high cost…

    • Submitted by Sean Olsen on 10/28/2016 - 12:49 pm.

      The cost spikes in the individual market are minimized for those who receive subsidies (about 80% of all who buy through the individual market), too. So, it’s a small number of people who are experiencing the cost spikes and there are some fairly easy mechanisms to help it get better (strengthen the mandate to encourage more people to get in the pool, expand the subsidies along the lines of what the DFL has proposed here, by capping your expense as a % of income).

      • Submitted by Steven Bailey on 10/28/2016 - 01:29 pm.

        subsidies are not a solution

        Taking more money and throwing into the hole is not a solution. Our healthcare system costs far too much and costs need to go down, not have more controlled increases. As far as the pool being made larger there is no backing that up. One of the complaints from people who wanted healthcare reform was that the pool was sufficiently large and adding to it wouldn’t make any difference. There were no economies of scale to be taken advantage of. The ACA can not be fixed and everyone involved in the passage of it knew it. Single payer is the only way to control costs and anyone who said it was impossible to get done has been ignoring the TTP and TTIP showing how relentless Obama is to jamb something through when he actually wants it.

        • Submitted by Sean Olsen on 10/28/2016 - 02:05 pm.

          The way you make health care less expensive is to either use less of it or to pay less for what you use today. How do you propose we address that issue?

          The comparison to trade makes no sense. Obama has people in both parties willing to work with him on trade. When it comes to health care, the GOP opposes whatever the Democrats propose.

          • Submitted by John Appelen on 10/28/2016 - 10:56 pm.

            Option

            I think the GOP would support shrinking government and cutting taxes so citizens would have more money to pay for their own insurance…Maybe the Democratic politicians could propose that? 🙂

            Then there is that selling across state lines, limiting law suit settlements and how much ambulance chasers can make in that business… (imagine… no more 1 800 ask gary commercials) Just think… We citizens are paying for all those types of commercials indirectly.

    • Submitted by Tom Anderson on 10/29/2016 - 03:47 pm.

      Actually

      “the ACA has made it possible for millions of people to have health insurance who could not afford it previously;’

      The reality is that EVERYONE is required to purchase health insurance courtesy of the ACA, and “affording” it is not part of the requirement.

  4. Submitted by John Appelen on 10/28/2016 - 12:01 pm.

    Excellent Piece

    It is interesting that even though we have all been paying more because of ACA for years, it has taken these large rate hikes experienced by the relatively few citizens who use the exchanges to get citizens to notice the topic.

    It is also interesting the Liberal solution is to increase the credits / subsidies being given to those people. (ie increase taxes on the majority)

    • Submitted by Sean Olsen on 10/28/2016 - 12:50 pm.

      Actually most of us have been paying less under the ACA than we would have otherwise. Premiums in the employer-paid health care market have been increasing at much slower rates since the ACA than in the decade prior.

  5. Submitted by Steven Bailey on 10/28/2016 - 12:08 pm.

    ACA 🙁

    I voted for Obama in 2008. The ACA is a disaster. It did nothing to control costs. The single biggest problem with American Healthcare is the cost! It re-affirmed the ban on Medicare negotiating drug prices along with any type of drug re-importation. It stuck many of the people struggling to afford health insurance with paying for the newly insured. I can’t think of any way the ACA could have been more cynical. The Healthcare Industry gave over 20 million to Obama in 2008 and it was money well spent. What tragic lost opportunity. It did accomplish one thing. It probably eroded any trust that even most Democrats had (I being one) that the Democratic Party has what it takes to reform healthcare. Page and Gilens were spot on when they showed our government works for the 1%, always.

    • Submitted by Mike Schumann on 10/28/2016 - 08:05 pm.

      Health Care Costs

      Not only did the ACA not control cost, it actually increased the cost of health care by eliminating the caps that insurance companies had on their policies. Now there is no limit on what can be spent on an individual’s end of life care.

      Whoever came up with this crazy idea completely ignored the technological advances in medicine. We are now entering an era where you can keep someone alive in the ICU indefinitely if you are willing to spend enough money. How many families are going to resist pulling the plug on grandma in hopes that a miracle cure will be developed 5 or 10 years down the line?

      As an individual policy buyer, I’m forced to pay for this BS. I don’t have a problem with people deciding to pay extra to buy a policy with unlimited coverage, but why should I be forced to pay for other people to subject their relatives to medical treatments that I wouldn’t subject my dog to.

  6. Submitted by Bill Kahn on 10/28/2016 - 12:47 pm.

    The ACA certainly could have worked as well as its archetype in Massachusetts under Romney save for the roadblocks and sabotage put into place by Republicans in Washington, D.C. and around the country, but the only workable alternative is single payer that neither major party is crazy about since it will torpedo the health care insurance industry that every year is enjoying record profits that they want to keep at all costs.

    All Republicans can do is rant and rave, however, so unless voters are immune to such inane tactics, we will see the same fight for the foreseeable future.

    What all folks need to consider is that modern medicine may be on the threshold of a major change that could recreate the landscape in the coming decades: integration of microbiome health into medicine. There is a pretty good case that all or most of the chronic medical conditions that are driving growing costs of health care are preventable.

  7. Submitted by Kevin Watterson on 10/28/2016 - 01:06 pm.

    Would you mind posting a before-after of how you originally charcterized the Governor’s statements?

    • Submitted by Sam Brodey on 10/28/2016 - 01:21 pm.

      Previously, I wrote that Gov. Dayton had called the ACA “unaffordable.”

      While I don’t believe that strays far from the essence of what he said, it was a mistake to put the phrase in quotes, since he didn’t actually use the word.

      So, we updated the post to include a fuller reflection of his remarks. 

  8. Submitted by john brodey on 10/28/2016 - 01:10 pm.

    a complex issue

    It is naive to think that any game changing legislation is perfect in it’s original form. No Democrat should be maintaining that the ACA doesn’t need some serious adjustment. But it’s also important to remember that the program is about a lot more than just premium pricing. Given how reluctant our elected officials have been to tackle health care reform, it’s foolish to reject the entire concept. It seems the Democratic candidates should be reminding the voters of the positive changes it has initiated while acknowledging that even their party’s candidate for president has called for the kinds of reform that will allow Congress to address the ongoing inadequacies where they exist,

  9. Submitted by Joel Stegner on 10/28/2016 - 01:31 pm.

    Solutions from Republicans? Not likely!

    The shame and blame party is back in business. What have Republicans ever done to insure more people?

    States where Republicans are in charge have the highest uninsured rates. The last Republican governor, Pawlenty, called health insurance for the poor “welfare medicine” and took insurance away from 70,000 Minnesotans – his “reform” program.

    These rate increases are market driven – insurers aren’t making enough money. Dayton has a plan ready to help the approximate 1% of Minnesotans who won’t get subsidies – just needs Republican votes in a special session.

    Will Republicans step up and act? Not likely – they complain and campaign, but never get around to doing their jobs. If that it good enough for you, then cast your vote accordingly.

  10. Submitted by T J Simplot on 10/28/2016 - 02:07 pm.

    Rep. Nolan forgets

    Rep. Nolan states:

    1. Keeping children on parent’s plan up to age 26 needs to remain. He forgets that prior to ACA, Minnesota children could stay on their paren’t plan to age 25.

    2. Females need to continue to pay the same as males. Prior to ACA, Minnesota rates were already gender neutral. Males and females paid the same rates based on their age.

    3. Pre-exisiting conditions need to be covered. Prior to ACA, Minnesota had MCHA which covered those who have pre-existing conditions who could not get individual coverage elsewhere.

    Minnesota should have been exempt from ACA as we had a good thing going already. It was a step back for MN but a step forward for many other states.

    • Submitted by Sean Olsen on 10/28/2016 - 02:34 pm.

      Revisionist history

      MCHA was a program that faced many challenges. It wasn’t reaching everyone that it should have been (enrollment had stayed essentially flat for years while the uninisured rate in the state rose) and costs were rising far more rapidly than the population as whole. Going back to MCHA wouldn’t make things better.

      • Submitted by Jim Million on 10/29/2016 - 07:34 pm.

        We Were Well Ahead of the Nation

        With some exception, Minnesota was the leader in health insurance market reforms over at least 20 years.
        Tim is correct there. Those many enhancements did boost premiums, mainly for group contracts, where much of the enhancement was directed.

        To pull MCHA into the discussion takes us all off center too much. It was truly a “catastrophic” plan, specifically for those who had certain defined conditions or were rejected by the standard market due to extrememly high risk of claims expense. The program ran very well. In fact, MCHA leadership very much wanted this program to survive as supplement to any global revisions here. More than anything, the “sticker shock” of MCHA premiums was its enrollment issue. No direct premium subsidy was available. Premiums were set annually based on pool experience and projection (as with any other commercial plan). MCHA operating deficits were then annually recovered through proportional assessments to other Minnesota health insurance providers (most significantly against Medica, BCBS and HealthPartners based on their proportional market share.)

        MCHA offered three significant virtues: Excellent coverage with fully open provider access (at member cost-sharing structures very similar to current ACA plans, by the way); internal self-sustaining industry operating subsidy; specialized pooling for discrete data analysis and planning.

        The single hurdle for (probably) many who qualified was the “sticker shock” of individual premiums. Those were well above prevailing market rates for “healthy” subscribers. Given that MCHA subscribers were potentially (if not regularly) high expense claimants, premiums were respectively high; although, they were age rated as other individual issue plans but also driven by older age distributions.

        For patients, MCHA worked as fluidly as the best open access HMO programs. Perhaps the true lost benefit of MCHA with respect to ACA is the source data of high risk pooling. One must believe similar database delineation would improve ACA in terms of health/claims cost analysis. Perhaps that virtue of MCHA will come back to the minds of realistic planners. There still would be no discrimination except for premium pricing…and that simply would be a matter of subsidy allocation, the key to ACA subscription.

        My only concern here has been the likelihood ACA evolution will continue to focus on “Insurance” rather than on “Care,” as its name proclaims.

    • Submitted by Jim Young on 10/29/2016 - 02:43 pm.

      Mostly wrong on items 1 & 2

      You are mixing state insurance requirements vs. federal. Most Minnesotans are covered by plans that are governed by federal law, not state law. When my two sons graduated from college, their medical insurance terminated “at midnight of the day they graduated.” I was living and working in MN at the time but my employer’s plan didn’t have to follow state rules. I assume the same is true for gender cost rules too but don’t have any first hand experience with that since the plan was already gender neutral.

      • Submitted by Jim Million on 10/29/2016 - 07:25 pm.

        ERISA

        Jim, you seem to have been covered by a self-funded employer plan. The mandates referenced fell under Minnesoat Dept. of Health (mainly) and Dept. of Commerce regs. for Minnesota fully-insured plans. There were also differing regs., to some extent, for small and large group plans. Various provisions of ACA have indeed incorporated such stricter provisions from Minnesota and other advanced states.

  11. Submitted by Mike Schumann on 10/28/2016 - 08:11 pm.

    Health Care

    What’s going to happen to the 70,000 Minnesotans who are being dropped by Blue Cross on Jan 1 and won’t be able to buy other coverage??? Many of these people had insurance for years before the ACA and as a direct result of this disaster are loosing their coverage.

  12. Submitted by joe smith on 10/29/2016 - 09:38 am.

    The ACA could never work due to math!!!

    It never was about GOP holding back Democrats from getting the bill they wanted (Dems wrote the whole bill along with lobbyists, DC elites and health insurance companies) or about lowering costs. It was about a Govt takeover of 17% of our economy and more DC control. Nobody who researched how many people, ages 26-45 insure themselves, believed they would suddenly all sign up to offset the subsidies given out like candy. If you can’t afford the monthly premiums how can you afford the 5-8 thousand dollar deductibles. Check out how many folks who have insurance are defaulting on their Doctor/hospital bills due to not being able to afford deductibles.

    It was never going to work, forget the keeping your Doctor lie, due to math not racism as those on the left claimed!!

    If you think this was a gift to the worse GOP candidate I have ever seen, how about the FBI’s re-opening the investigation into Hillary’s email cover up..

  13. Submitted by Jon Kingstad on 10/29/2016 - 08:10 pm.

    ACA doesn’t “make” anyone buy insurance

    I agree with the comments above pointing out that the GOP’s use of this issue is consistent with its typical hypocrisy, pretending to care for people while opposing every legislative effort to come up with helpful solutions. I remember well the battle for what became the ACA, where no public option was proposed and progressives were promised if they got behind this reorm, it would be the first step toward that goal of universal care or single payer. Which in my mind still remains the end game. These rate increases only underscore the need to eliminate the insurer middleman from health care or at least reduce it to the same level as exists under Medicare. In other words, make Medicare available to all citizens regardless of age.

    I sympathize with families who are facing a choice of what to do about these outrageous premium hikes. If these actions plus the decision of all insurers but one (if I’m not mistaken) from the MnSURE exchange doesn’t prove that this “industry” is a cartel, like OPEC, I don’t know what does. But the government doesn’t really “make” anyone buy health insurance. There is a penalty to be sure but the last time I checked,that penalty is a lot less than paying these outrageous premiums. If I were not thankfully now under Medicare, I’d be looking seriously at simply paying the penalty for being uninsured and taking my chances with catastrophic illness until the government figures this out.

    • Submitted by John Appelen on 10/30/2016 - 08:48 am.

      As I mentioned elsewhere. Government “figuring out” ACA drove big enough price increases that some of my self employed friends who always had insurance have stopped carrying health insurance and started paying the penalty. I am not sure how much more “figuring out” they can afford? 🙂

    • Submitted by joe smith on 10/31/2016 - 07:55 am.

      Jon, they are doing their flat out best to try to make

      folks buy insurance through increasing the penalties for not buying in. Jonathan Gruber, (yes, he of the statement “ACA was passed because of the stupidly of American people) one of the architects of Obamacare said higher penalties are needed to make this terribly flawed law viable. How are GOP folks being hypocritical about letting the people choose a plan that fits them, open up the markets to buy across state lines and get the inefficient Federal Government out of their business.

      On a side note, my favorite complaint from the all knowing liberal left was folks shouldn’t buy catastrophic insurance because it is not good for them….. Now with Obamacare and the ridiculous premiums, subsidies, unreal high deductibles more folks have catastrophic insurance than ever…. Way to go DC!!!

      • Submitted by John Appelen on 10/31/2016 - 10:23 am.

        Personally I think the requirement to that everyone carry health insurance is the best thing about ACA. It is kind of like requiring every car owner to carry liability insurance.

        Somehow all the rules, regulations, etc seem to be getting in the way of keeping it affordable.

  14. Submitted by Dennis Wagner on 11/01/2016 - 06:28 pm.

    Yes, I am still waiting!

    Foe the brilliant Republican plan that is going to solve all these health care problems. Years and years the “R”s have been whining about how bad Obamacare is! Now is that big opportunity for a November surprise! Or is it going to be just more whining, complaining and vacillating? Come on guys do you have what it takes? Give us the killer solution; that lowers taxes, increases overall benefits, reduces costs and covers every one! 1 week to win my vote.

  15. Submitted by kaimay terry on 11/02/2016 - 11:25 am.

    Some answers to ACA woes

    Brodey’s article was timely and on target. Governor Dayton’s recent comment that “affordable care” has become unaffordable for many (and his desire to help) was seized immediately by Republican candidates as a weapon in their campaign against their opponents.

    Minnesota voters and those who are facing a 25% premium rate increase deserve a more in depth answer. An easy to understand explanation would be Affordable Care Act succeeded in opening up access to over sixteen millions of Americans who were uninsured and those who were undesirable for insurance companies due to their health conditions. Just like auto insurance, to spread the risk, the Act also requires all to purchase insurance.

    What was missing in the ACA was cost control. The Obama administration and Democrats in Congress had literally expended all their political capital to get the ACA passed in 2010. The powerful model of for-profit medical-industrial corporations from insurance companies to medical device manufacturers and the pharmaceutical industry remain in place. A profit driven model of health care means guaranteed price increase as there is no meaningful competition, thus meaningful choices for the “consumers”.

    With a huge surge of newly insured (16+ million since 2010) many of whom had serious and and/or chronic untreated conditions, the consumption of healthcare services exploded. With insufficient number of healthy enrollees in the mix, and steep increase in areas such as pharmaceuticals, some major for-profit insurance companies such as United Health quit and non-profit organizations like HealthPartners have increased their premiums sharply. Minnesotans who are not part of an employer’s group plan or not qualified for State aid or Medicaid are squeezed the most.

    To return to a broken and egregiously expensive health care system and while ignoring the existence of successful universal health care in every other advanced country on Earth is “throwing the baby out with the water.” Regrettably, the wrong issue is being pushed forward in the remaining days before our national election. The main reason Americans have unaffordable health insurance is our unchecked for-profit health care industry.

    One local example is United Health Care. For the fourth quarter 2016, analysts estimate it will earn a profit of $2.07 per share, an increase of 47.74% over the prior year’s fourth quarter results. It will generate $48.88 billion revenue in all its profit centers, an increase of 7.4% over prior year quarter. Yet because United Health Care saw losses in participating in the MNSure Exchange, they pulled out despite its glowing profits as a whole. Business is business.

    Similarly, the medical device industry has been hugely profitable. A Fidelity Medical Device mutual fund has a year-to-date return of 18% and its top holding is Medtronic which has engineered itself to be merged into a small Irish company for tax avoidance of hundreds of millions a year. Medtronic was also a leader in getting bi-partisan political support to delay the miniscule 2.3% medical device tax. Starving the government of revenue needed to finance Affordable Care Act was not part of the bottom line for profit calculation.

    Unlike other consumer goods or services, health care is not discretionary. With the ACA health insurance, it is a requirement. Yet it is far from a level playing field with the supply side being profit driven with the sky as the limit where the minions are facing the decision of disobeying the law, and a potential fine or sacrifice other necessities to support the insatiable bloated beast –health care American style.

    Estimates go as high as 6.6 billion for cost of presidential election only. A sizeable chunk comes from the health care industry, flowing into local elections. As long as we have a “donor driven” democracy, money will talk. We have a long way to go to make health care equitable for all. How will you make America great again?

    Kaimay Y Terry, MPH Johns Hopkins University Bloomberg School of Public Health.
    Wayzata, MN 55391

  16. Submitted by Paul Udstrand on 11/03/2016 - 09:32 am.

    No, the way the media covers stories like this is a gift…

    Whatever you do donn’t point out the fact that double digit increases were a standard feature of health insurance premiums for decades before ACA. Don’t report the fact that increases will affect a small percentage of population, especially those living in states that opted out. And whatever you do don’t point out the fact that despite the increases health care will remain more affordable and available that it was prior to ACA.

    Look, the reason rates are increasing is because insurance companies are actually paying for health care, and health care costs have not been contained. Insurance used to make money by collecting way more than it paid out, they denied coverage, but took the money anyways. ACA addressed that end of the equation in some ways by requiring coverage, but it never had a chance of containing costs because it doesn’t look at the provider side, and it doesn’t offer a public option that would drive down costs. It also didn’t require state participation. So yeah, until a nationwide public option or better yet Medicare for All get implemented, costs and premiums will continue to rise. That doesn’t mean Obamacare is failing and should be completely repealed. Whatever you do don’t cover the actual story. Let’s not have headlines like: “Health Care Industry Continues to Raise Prices”, a headline that actually tells us what happening.

    • Submitted by Jim Million on 11/03/2016 - 10:34 am.

      Untimely Argument Here

      The price increases come from market forces, not greed. How many major companies have pulled out of the program, with more planning to do so?

      Of course the remaining companies are raising premium prices. Premiums are directly driven by claims cost, more than any other expense element. Do you truly believe that suddenly expanding the claims pool to include a greater percentage of unknown claims history would lower premiums?

      The delivery model is neutral in this price argument, whether single-payer or private/public commercial payer. Right now, it’s mostly a matter of more immediate feedback from commercial payers than we would typically get from government sources. There are no immediate or short-term options that would address these early known issues. Anyone preferring a single-payer regime should be thankful for this perhaps interim model of claims/cost/demographic feedback. Please consider the wealth of data coming from this current arrangement, data that should improve design and financial aspects of any broader scheme.

      This is a time for close review and honest analysis of many factors, not for ideological repetition. Embrace the information and appreciate the immediacy of it, regardless of disposition.

      • Submitted by Paul Udstrand on 11/03/2016 - 11:06 am.

        Market forces?

        “The price increases come from market forces, not greed. ”

        It’s always funny when market “experts” show up with comments like this. Anyone who understands the true nature of markets understands that all markets are ostensibly driven by profit motive… which is simply a socially santized form of greed. Our corporate laws actually require that greed take precedence over any other consideration upon penalty of legal action and or termination. Consider the latest reports regarding epi-pen prices etc. Government regulation can mitigate profit driven effects on markets quite reasonably and has done so many times, public utilities are a good example among many others.

        If ever there were a time to set aside these absurd myths about market “efficiency’s” our health care system and it’s attending crises surely point to a clock that needs to be heeded.

  17. Submitted by Paul Udstrand on 11/03/2016 - 12:31 pm.

    Just in case…

    Someone hasn’t already pointed this pointed this out… typical “market” analogies usually fail to explain prices because they ignore the most basic rule of all pricing which is you typically try to charge as much as you can for whatever you sell. Supply and demand mumbo jumbo rarely actually explains anything.

    Market analogies are particularly useless explaining health care costs because they don’t involve truly voluntary commerce, you can’t walk away from a heart attack you don’t want to pay for like you do a car, a TV, or a house.

    The reason health care in the US is so much more expensive than it is elsewhere is actually very simple, but remains mysterious to our dyslexic economists. Providers charge what they do simply because they can. Procedures like colonoscopies for instance cost two or three times in the US as they do in Germany for instance. Part of the cost is basic inefficiency built into an overly complex system of payments, billing, and reimbursements, but mainly they just charge more because they can. We pay more for everything from egg shell mattress’s to surgery. I was recently trying to pay a routine bill for an office visit and the billing department literally could not tell me what I was actually being billed for. I wasn’t challenging the bill, I was just trying to understand it. No one else on the planet could get away with something like that, that’s not a “market”, it’s a racket, and you have no choice but to pay. And you wonder why health care costs have been exceeding inflation for decades?

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