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Progressive Politics in Minnesota, the Nation, and the World

Support The MN Senate Health Care Proposal - It Is Excellent

Category: Health Care
Posted: 10/15/16 14:39

by Dave Mindeman

I want to go back into healthcare today. There is a lot of simplifying going on for some much more complex issues. And Republicans are only into using the issue without any intention to fix it.

The Democratic Senate put out an excellent fix for the individual market problem. For those of you who did not see it, the parts that are most relevant are:

1. Creating a compatible high risk pool.
2. Minnesota Care expansion to add people up to a certain income.
3. Full Minnesota Care option.
4. Ability to opt out of a more expensive employer based plan.
5. Insurance tax credit for taxpayers that don't fit Federal subsidies.
6. Canadian pharmacies drug import program.
7. Reducing geographic rating areas to increase rural options.

These are solid fixes. Real fixes. It would enhance the Minnesota Care program which has always been considered a national model.

But let's talk about a few more specifics.

On the risk pool. You will hear Republicans talk about going back to the Minnesota Comprehensive Health - high risk pool which Minnesota had used before the ACA. It was the program that so many people said they were not going to be able to keep when the ACA went into effect.

And there are reasons why it had to go away. It didn't cover much in the way of prescription drugs. It had a service cap - if you had a very serious illness, you could easily hit your lifetime limit quickly. It had very high deductibles. Essentially, it was catastrophic health insurance with a premium set by the state.

Many of its provisions would never meet the ACA mandated benefits. So it had to be dismantled. But what is proposed now is a new plan that would meet the ACA requirements....which would also require a much different premium and service benefit. Republicans only talk of the "old" MCHA plan. That plan gives more leverage to the insurance carriers.

Minnesota Care expansion and use as a public option are the real keys to making this work. MNSure has had a very difficult time coordinating with Minnesota Care. MNSure is supposed to find the people eligible for MNCare and then transition them over to that part of Health and Human Services. The technical glitches early on made that very frustrating. That was MNSure's fault, not MNCare's. People identified by MNSure for eligiblity should be moved out of their system and directly into Minnesota Care. Minnesota Care's administration is much better and allows for less bureaucratic snafus.

This Republican idea of dropping MNSure and going to the Federal exchange is also shortsighted. Minnesota Care can only be used as a Minnesota public option - and if the Federal Exchange is used that possibility is negated.

Check out the Minnesota Senate remedies here. They are good ones and allow us to keep our health care options local....and we have had a very good system by all accounts in the past.

The Republicans are offering old solutions. They want us to go back to the pre-ACA days. They were not good days. Not in the least. If anything, the ACA has latched on to too many of those old programs via insistence from the insurance industry.

Support the Senate plan. It is an actual fix - not a political talking point.
comments (3) permalink

ACA: It Is Not A Failure - It Just Needs A Fix

Category: Health Care
Posted: 10/13/16 17:55, Edited: 10/13/16 17:56

by Dave Mindeman

Recently Governor Dayton stated this....

"The reality is the Affordable Care Act is no longer affordable to increasing numbers of people."

Dayton has been a defender of the ACA in the past - is he losing faith? Has he turned against Obamacare?

I don't think he has given up, but he is frustrated with how insurance companies have worked on the exchange.

But let's look at the broader picture. The Minnesota number of uninsured is at a all time low. Back in February, it was noted that the number of uninsured was listed at 4.3% of the population. That is a phenomenal change from the 11% plus Minnesota had at the implementation of the MNSure exchange.

And this isn't a problem caused by MNSure. MNSure has some technical issues, even today, but they are not responsible for rates. That is something the market decides.

Let's digress a minute and look at the role that insurers have played in this. When the ACA was first implemented in Minnesota, the rates were among the lowest in the nation. I don't know if that was an overly optimistic assessment by the state's insurers, but it seemed to be an attempt to increase business by increasing the number of insured. And yes, there was a bigger pool, but it was also a pool with a number of people who could not get insurance before because of pre-existing conditions. Those people could no longer be kicked off the roles and I think the insurance companies did not make enough of an allowance for the increase in chronic illness coverages.

Another culprit in this process was the Republican removal of a risk pool compensation fund that was supposed to be a resource to get companies through this transition period with sicker patients to cover. With that unavailable, insurers had no transition funding to get them through the period of adjustment to higher risk pools. Insurers are feeling the full brunt of a mismanaged assessment of the marketplace.

But let's remember what we are talking about. We are discussing only the people who buy health insurance that do not qualify for subsidies and are not covered by their employer. This constitutes about 200,000 people in Minnesota. Everybody else, people who qualify for the exchange and employer health care, is seeing modest increases in expenses. And remember, that the people in this group always had difficulties in getting low cost insurance. Either they were in a small business that could not obtain a group policy or they were part of that high risk pool.

So, although this is a definite problem, to say that Obamacare is a "failure" is a big stretch. But this problem is also fixable. Since it is not a large group of clients, there are special provisions that could be used. However, it would require legislation. And as we all are aware by now, the Republicans will do nothing to fix their main source of attack ads.

The ACA was a major change in health care. We have had others in the past. Medicare and the Part D Prescription plan - both needed tweaks in the early years. And both have fixes that are still needed. Medicare needs an adjustment to keep it solvent. and the Part D program needs to allow negotiating with pharmaceutical companies.

Republicans are open to those changes. They have accepted that the American public demands nothing less. But with the ACA, they refuse. They want it to fail. That want to leave those 20 million people who have finally gotten health care back out in the cold.

Back to the premium issue. In 2015, despite significant increases that year as well, Minnesota ranked 18th best in average premium cost. 2016 has some substantial increases as well, but we are still in the middle of the pack as far as average premium for individual policies.

Yes, Dayton is right..... for a minority of Minnesotans, the Affordable Care Act has become unaffordable. And that needs to be addressed. Not with an attitude of repealing it, but with a bipartisan effort to fix it.

This is not a "disaster". It is not a "failure". It is not MNSure's fault. It is a situation that needs to be tweaked. That's it.

We don't need insurance companies dictating how we handle this. This program is meant to bring back our own control of health care. If our Republican friends would work for the benefit of all the new people that have received health care via the ACA, instead of working to obstruct needed fixes, we might put health care issues in the rear view mirror.

I know that is a lot to ask.
comments (5) permalink

For GOP: MNSure Is The Target - Solutions Are Not Wanted

Category: Health Care
Posted: 09/02/16 14:51

by Dave Mindeman

We are going to get another round of gleeful criticism of MNSure from the legislative Republicans.

But it is kind of ironic - they don't seem to understand the system well enough to focus on the actual problems.

Let's try to get this right. MNSure is not the reason that insurance premiums are increasing. Got that? MNSure itself has nothing to do with it.

All MNSure does is provide the marketplace for the insurance companies to allow the public to compare what they have decided to charge.

MNSure does have issues. It still has difficulty with technical problems. It has difficulty coordinating with Minnesota Care. It has long wait times to answer questions.

Those things are fixable over time. But insurance premium increases? That is a problem that is still rampant within the insurance system itself.

What did we want the ACA to do? What was its original purpose? It was to reduce the number of people that did not have access to health insurance. To relieve the burden on hospitals to deal with costs of helping those who did not have insurance. To provide government help with affordability.

The ACA is doing those things. I realize affordability has become a bigger issue, but the ACA still provides the subsidies that help the working poor get to affordable options. The ACA is doing its job - the original intent.

But blaming the ACA for having to deal with an insurance based health care system out of control is foolishness.

The biggest change in health care that is causing the current rash of crazy premium increases is the inclusion of people with pre-existing conditions. In the past, the major insurance companies have always developed ways to push them out - to force a government solution to chronic illness. Prior to the ACA, those people went largely uninsured or were thrown into inadequate catastrophic plans that still left them with unaffordable out of pocket expenses.

When the ACA became law, everyone was put on notice that denial of coverage would now be a thing of the past. The insurance companies had plenty of time to prepare and adjust for that coming issue.

But, as usual, they mismanaged it. Some of the companies set up unrealisticly low premiums hoping to capture a bigger share of the market and worry about the cost adjustments later. Some of the companies just completely misinterpreted the new risk pool. Most had the number of new entrants too low - forgetting how many people they had refused to accept.

At the very beginning of creating the new health care law, the ACA made concessions to the insurance companies in exchange for their participation. It was the only way to get such a broad and detailed piece of legislation through Congress.

But the insurance carriers have not held up their part. They refused to let the government negotiate drug prices. They blocked the addition of a public option. They demanded that the government make up the shortfalls.

And now, as everything kicks in, the insurance companies want more concessions.

If the insurance carriers are not going to make a competitive market, then we might as well have the government use a public option to take on what the insurance companies are reluctant to do.

That was the original plan and I suspect that if Democrats win control of the Senate and the Presidency that this will be on the agenda.

But let's get back to MNSure for a minute. The Minnesota Republicans are blaming all the foibles of the insurance market on MNSure. And if we are realistic, that is a stretch. MNSure is not the ACA - it only implements the requirements of the ACA. MNSure does not control the pricing structure - the insurance companies control that. MNSure does not write the policies - they only act as a go between for comparison.

Don't get me wrong - there are plenty of things about MNSure that need fixing, but the MN GOP is not talking about any of those. No, they are pretending that MNSure is to blame for all of our current health care problems - and that is simply not true.

Minnesota started this exchange because we wanted Minnesota to have some control over how Minnesotans would get access. The MNSure system had immediate flaws on technical grounds, but access is improving - although much too slowly.

However, eliminating MNSure would not solve the premium increases and the way the policies themselves are structured. That is outside of MNSure's jurisdiction.

But as far as Republicans are concerned it is a simple easy target. And if they can add confusion and complexity, hey why not.

The GOP is not going to help fix anything.

And quite frankly, that is the main problem here.
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