In 2015, 4.3% on Minnesotans were without health insurance. In 2017, it had risen to 6.3% leaving about 349,000 Minnesotans without health insurance. This rate still remains lower than it was prior to the adoption of the Affordable Care Act in 2010. This increase in the number of uninsured corresponds with 2 other data points. In 2015, 55.9% of Minnesotans had coverage offered by employers versus only 52.9% in 2017. Also in 2015, 6.2% of Minnesotans were enrolled in the individual market versus only 4.4% in 2017.
53% of people who no longer had coverage in 2017 said they could no longer afford to maintain the coverage they had or purchase new coverage. Other factors included losing a job or losing eligibility to coverage. The uninsured are more likely to be aged 18 to 34, in a lower income bracket, have lower levels of educational attainment, and/or b people of color or American Indians.
Minnesota Health Commissioner, Jan Malcolm, noted, “People without health insurance report poorer health, especially mental health, and are more likely to experience barriers to getting health care. 2017 was a disappointing year in which higher costs, undercutting of the Affordable Care Act at the federal level and declining coverage by employers moved us away from our public health goal of achieving universal access to health care.”
Our elected leaders, both in the legislature and in the governor’s office, have a direct impact on these matters as can be seen below. They are the ones that create and sign the bills that impact who has coverage, the quality of that coverage, and the affordability of that coverage. They have done much in the state of Minnesota to keep our uninsured rates low, primarily through the establishment of MNSure, the expansion of Medicaid through the Affordable Care Act, and the expansion of MinnesotaCare.
MNSure
MNSure is Minnesota’s online health insurance marketplace where individuals, families, and small businesses can shop for health insurance. Here, insurance can be purchased at a federally subsidized rate. Health insurance exchanges such as this were established as a part of 2010’s Affordable Care Act (Obamacare). In 2012, Democrats took control of both the House and Senate in Minnesota. Therefore, Minnesota’s marketplace was established in 2013 when the legislature passed the Minnesota Insurance Marketplace Act. Minnesota’s uninsured rate was 8.2% prior to this.
In 2017, premium hikes for Minnesotans who buy their own insurance, both through MNSure and outside the exchange, were some of the largest in the nation. Therefore, at the end of January 2017, Governor Dayton signed S.F. 1 which provided 25% premium rebates for the affected Minnesotans. Minnesota was the first state to take an active role in alleviating premium-increases through a state-funded subsidy.
In 2018, average premiums in MNSure decreased slightly. This was a direct result of action from the governor and the legislature. They submitted a federal 1332 waiver proposal to Secretary of the Treasury, Steve Mnuchin, and Secretary of Health and Human Services, Tom Price, through the Centers for Medicare and Medicaid Services (CMS). 1332 refers to a section of the Affordable Care Act that allows states to waive certain provisions in order to seek innovative ways for the states to pursue high quality, affordable access to health care. It was a necessary part of House Bill H.F. 5 which created the Minnesota Premium Security Plan which created a state-based reinsurance plan and covers a portion of the claims that insurers face, resulting in lower total claims costs, resulting in lower premiums.
Medicaid and MinnesotaCare
In addition to the development of MNSure, another benefit of the Affordable Care Act was the expansion of Medicaid, which the state calls Medical Assistance. The bill expanded access to Minnesotans who made up to 138% of the federal poverty line. From before the expansion to June 2016, Minnesota saw an 18% increase in enrollment.
Minnesota also established a Basic Health Program (BHP) which is known as MinnesotaCare and covers Minnesotans that are not eligible for Medicaid but make between 138% and 200% of the federal poverty line. There was a bill in the House to expand this to 275%, but it didn’t make it out of committee this year. Minnesota is one of only 2 states to have a BHP, the other being New York.
Single Payer Health Care
The United States currently has a multi-payer healthcare system, meaning that individuals or employers pay for and receive health insurance via multiple private (insurance companies) and public (government programs) sources. A single-payer system is financed solely by taxes and all are covered by one public system (the government).
Senator John Marty has proposed the Minnesota Health Plan for Minnesota. It would be a single, statewide plan that would cover all Minnesotans and their medical needs. He says, “There are currently over 260,000 Minnesotans without any health insurance, and at least a million more who have insurance, but still cannot afford to pay their medical bills due to co-payments, deductibles, and care not covered by their insurance, on top of their premiums!’
He says that under his plan, patients would be able to see the medical provider of their choice and their coverage wouldn’t end when they leave their job or switch to a new employer. There would be no worrying about if a provider was “in network”, if a treatment was covered, or how one would pay for a drug. It would be fully funded by Minnesotans, based on their ability to pay, cover all health care costs, and replace premiums, co-payments, and deductibles.
Here is where the candidates stand on health care in Minnesota:
Jeff Johnson (R): Candidate Johnson says, “I will work to return the power over health care to patients and citizens, and take advantage of federal waivers allowing Minnesota to abandon the provisions of Obamacare that have limited choice and increased costs. I will also start negotiating with other Midwestern states to increase competition by creating an interstate compact to sell and buy insurance across state lines.”
Erin Murphy (D): Candidate Murphy was a nurse in a rural hospital and then on a transplant team. She was the Executive Director of the Minnesota Nurses Association and she was a legislative leader on health and human services. Healthcare seems to be her top issue and she says she knows it from every angle. “And from every angle, I see that corporate profits have been prioritized over patients and workers.” She supports a single payer health plan and was a co-author of Senator John Marty’s Minnesota Health Plan. She acknowledges that a full single-payer solution isn’t possible without a federal plan, but says “we can build the infrastructure here in Minnesota and lead the nation.” She wants to start the process by opening MinnesotaCare up to anyone who wants it. In 2014, she passed legislation that expanded a public option for public school employees and claims that they are seeing lower costs and higher-quality care. She wants to contract with nurses, doctors, and hospitals and invest in our healthcare workforce with training programs that target nurses and home healthcare workers which she says will revitalize local economies across the state.
Tim Pawlenty (R): Candidate Pawlenty says that “skyrocketing health care premiums are crushing too many Minnesotans.” He says he will deliver solutions to bring down the costs while still providing high quality care. He says that one key ingredient of that is to provide transparency about prices so that consumers know about the price and quality of care they will receive. He says, “With that type of information more easily in hand, consumers will be able to make more informed decisions about the health care they receive.”
Tim Walz (D): Candidate Walz will provide a strong public health care option for Minnesotans who want it. He says the Minnesotans don’t have to wait for the federal government to act because we have MinnestoaCare which he says “delivers high quality care at a price Minnesotans can afford.” He will build a One Minnesota coalition that will bring together the best health care minds and Minnesota families facing health care challenges which will focus on reducing costs and increasing access. He says that access to affordable mental health care is a right and will tackle barriers to mental health care. He will make additional investments to medical research in Minnesota. He says, “Minnesota is poised to make huge steps forward on the prevention side of health care, which experts agree will bring down costs. With Minnesota’s great public institutions, our medical device industry, and our premier medical facilities, Tim and Peggy think that Minnesota is where we can find the solutions that will change the game when it comes to bringing health care costs down.”
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