The Free Press, Mankato, MN

December 16, 2012

Our View: MinnesotaCare option is broken

The Free Press

— A plan to shift 4,200 low-income Minnesotans covered by MinnesotaCare to a voucher system — and enabling people to move off the government rolls while continuing to receive adequate health coverage -— sounded good in theory but it isn’t working. And the state needs to own up to that.

When the GOP took control in 2011, the Healthy Minnesota Contribution Program was one of its priorities. Initially, it wanted nearly everyone using MinnesotaCare to go to a voucher system. Sen. David Hann, R-Eden Prairie, led the initiative to switch saying the growth of the government sector in health is unsustainable. “I’m not persuaded … that that’s been very effective (nor) financially doable.” The GOP felt the private sector could do the job better.

There was resistance by state Democrats and from Gov. Mark Dayton until the budget impasse and the subsequent government shutdown in 2011. As part of the agreement reached by Dayton and GOP leaders to break the stalemate, the switch to vouchers would affect only 4,200 enrollees and theoretically save taxpayers $36 million over three years.

However, according to a report we published by Minnesota Public Radio, only 1,200 are receiving the subsidy leaving two thirds of these enrollees out in the cold. Examples cited included one person who was making $19,000 a year with her part-time job and received Social Security benefits. That income level allowed her to receive a state voucher of $395 monthly to buy health insurance on the private market.

However, the options presented to her included a $10,000 deductible before the insurance kicked in and that coverage had many exclusions. While another option came with a $5,000 deductible with a higher premium that nearly took all of the voucher, she determined the deductible was too expensive to afford and now she is going without health insurance.

“We are seeing fewer people who were previously enrolled in MinnesotaCare who are purchasing coverage through the Healthy Minnesota Coverage Program,” Minnesota Human Services Assistant Commissioner Scott Leitz said.

“As people transition from programs, there’s a possibility that you’ll see fewer people taking up a newer program then as they transition out of an older one,” Leitz said. “For some individuals, it may be that the up-front cost sharing is something they aren’t interested in.”

Sen. Hann, who also sits on the board for the Minnesota Association of Health Underwriters, said the problem is communication. State privacy laws don’t allow the Department of Human Services to share personal information about clients so insurance firms are saying “allow us to know who those people are who are eligible so we can go and invite them or reach out to them and say, ‘here’s some things you can look at,’ “ Hann said.

This is not an adequate solution; it only gives insurance firms a prospect list and does not give lawmakers assurance that firms have packages that provide adequate coverage at equitable costs to users. Without that knowledge, no determination of “equitable coverage and costs” can be made.

Regardless of the findings, if the state returned to MinnesotaCare as it stood before, it would prove costly just as the state is facing a $1.1 billion budget deficit. And any short term fix, as MPR pointed out, may not be worth it since the federal health care law will dramatically change whatever occurs on the insurance landscape.

Any remedy needs to be part of the discussion surrounding establishment of the state’s insurance exchange program being set up in response to the federal Affordable Care Act or Obamacare. It does little good to push people into coverage they cannot afford even with the exchange. The push really will be into the emergency rooms of area hospitals where we expect savings due to lower government disbursements to hospitals.

While we design a cost effective method of health care coverage, we need to heed all of our citizens’ needs and remember Minnesota’s culture of looking out for our neighbors. Not at all costs, but at a shared and reasonable cost that offers some compassion to those who cannot afford it.