Our Minnesota legislators are currently at work in St. Paul. One of the issues they are considering is an expansion of Minnesota Care. Minnesota Care came into being in 1992 to help provide health insurance for those earning too much to be on Medicaid but earning less than 200 percent of the federal poverty guideline. (The federal poverty guideline is currently about $29,160 for an individual and about $49,720 for a family of three.) Taking into account the cost of food, housing, clothing and transportation, there is no money left over for health insurance at that level of income .
The Minnesota Care expansion, also referred to as a “public option”, would expand Minnesota Care to those earning above 200 percent of the federal poverty guideline. Premiums would be based on a sliding scale depending on income.
Expanding the availability of health insurance to more Minnesotans would be good. It is, however, pertinent to note that an expansion of Minnesota Care would not cut the cost of medical care to our society as a whole. It would not do anything to reduce the current excessive administrative costs caused by the crazy quilt of current health insurance (multiple insurance companies with multiple different insurance packages interacting with multiple hospitals, multiple clinics, multiple government programs and complex contracts defining who pays who, how much etc.). It would not eliminate the generation of profits for insurance company shareholders. It would not cut US pharmaceutical costs which are twice that of other prosperous countries.
There is a cost saving possibility in the bill. The bill requires an analysis of a state-run insurance program for Minnesota Care compared to the current insurance company-based situation. Why would that save money? Administrative costs for health insurance companies are quite high. why? The health insurance companies spend lots of money advertising to convince the consumer that their plan W is better than the competitors’ plan X. (When the reality is the furniture is the same — but it has been rearranged.) The commercial insurance companies also need to generate profits for their owners. In the case of the “nonprofit” insurers, they are squirreling money away for a snowy day (otherwise known as building “reserves”) in addition to paying their administrators princely salaries and having enough money left over, they make grants to other “nonprofits” ” (I kid you not.).
As we consider health insurance, it is reasonable to identify what constitutes good health insurance. Everyone should have good health insurance (In general we do not have a choice regarding whether we get sick or stay healthy). The health insurance should preserve an individual’s or family’s financial well-being. Good health insurance should be affordable. Good health insurance should allow one to see the doctor of one’s choice at the hospital or clinic of one’s choice. The insurance company should not have the ability to decide what care a patient can have. That decision should be based on the doctors’ recommendations. Additionally, health insurance should include one’s vision, hearing and teeth as they are as much a part of us as our heart or bones.
Is the overall cost of medical care important? Currently, the United States is paying about twice as much per person per year compared to the other modern prosperous countries in the world. At the same time, our health outcomes are inferior. The CIA (yes the Central Intelligence Agency does track this statistic) notes the United States is 72nd among world nations for life expectancy. Making US health care more effective, less costly and redirecting that money would have a very positive effect by allowing more dollars to improve housing, eliminate hunger and increase wages.
Is expanding Minnesota Care our best option? No. A comprehensive, state wide health insurance plan such as Senator John Marty’s bill for the Minnesota Health Plan would save more money while providing us all with good health insurance. It doesn’t appear that Minnesota voters understand the problem well enough to make that jump. The Minnesota Care expansion is not the silver bullet; but it is a positive step.
Consider a conversation with your state senator and state representative. Make it clear to them you want all Minnesotans to have excellent health insurance at an affordable price.
If you like to read proposed legislation, the pertinent bills for Minnesota Care expansion are HF 96 and SF 49. The legislature/Minnesota government has an excellent website (https://www.leg.mn.gov) which will enable you to read proposed as well as existing legislation word for word. (If you don’t enjoy reading legislation, it can also cure some people’s insomnia.)
Mark Brakke is a retired family practice physician. He cared for patients in Coon Rapids, Minn. for 41 years during which time he was on the boards of directors of two health insurance companies. He is currently on the board of the educational non-profit Health Care for All Minnesota (HCA-MN.org).