Minnesota Health Care Act

Minnesota State Represetative Shelley Madore talks about her family's financial difficulties with two children with disabilities during a Health Care Town Hall meeting Saturday at Watkins Manor in Winona. (Photo by Andrew Link/Winona Daily News)

By Elena Grimm / Winona Daily News

A few years ago, Rep. Shelley Madore was raising her two teenagers in the Twin Cities suburb of Apple Valley. When an X-ray of her daughter's back revealed a tumor and a diagnosis of spina bifida, Madore faced medical bills topping $60,000.

Her options? To receive state medical assistance, her family had to reduce all cash assets to $3,000. Madore had health insurance. But like many families, she found herself underinsured.

She called the current health care system and what her family faced "a slippery slope of poverty."

"We impoverish (families) to give them the help they need," she said.

Now, Madore, a freshman legislator, is calling on lawmakers to reverse this slope. She is co-authoring a bill with other state legislators to provide health care for Minnesotans in a single-payer system. Called the Minnesota Health Plan, the plan was unveiled Saturday in Winona during the legislators' three-day tour around the state.

Rep. Ken Tschumper (DFL-La Crescent), Rep. David Bly (DFL-Northfield) , Rep. Carolyn Laine (DFL-Columbia Heights) and Sen. John Marty (DFL-Roseville) joined Madore (DFL-Apple Valley) on the statewide tour to explain the plan.

Marty, who is the chief author in the Senate and chairs the Health Committee, outlined the plan. The Minnesota Health Plan includes all Minnesotans, has no deductibles or co-pays and offers premiums based on individuals' and businesses' ability to pay.

The health plan would be administered by a board created by the Legislature, which would collect premiums and pay the bills.

Since it was introduced late last session, more than one-quarter of state legislators have signed on to the bill.

Marty said he feels optimistic, but that it would take time to get it passed into law.

"It's a three to four year process," he said.

Supporters say it will cost less than the current system and cover more health needs.

Costs can be reduced through early intervention and prevention, rather than expensive emergency room visits down the road, Marty said. It also calls for reducing administrative costs and being more efficient.

Laine pointed out how other industrialized countries are already providing care for everyone for less. Bly added that "the United States is the only country that treats health like a business."

However, the plan is not socialized medicine, Laine explained, as patients can still choose private doctors.

While waiting in the hospital during her daughter's surgery, Madore kept thinking to herself, "I'm insured." But then the reality set in.

"In less than two weeks, I had gone from a situation I could handle to a new life," she said.

Madore's story is not unique. While developing the Minnesota Health Plan, lawmakers traveled around the state last year to hear people's stories, many similar to Madore's family.

"The problem is not with the uninsured, but the underinsured, " Marty said.

The plan promises to cover all necessary care, from mental health to medical equipment like wheelchairs.

"We think it really reflects what the public is saying to us," said Tschumper, the chief author in the House.

All four representatives who came to Winona were elected to their first term in 2006, something that they agreed would help ignite health care reform in the state.

"It's a changing climate at the Legislature, " Marty said.

Last week, the governor-appointed Health Care Transformation Taskforce released a report that recommended mandated coverage, which Gov. Tim Pawlenty opposes.

In a statement, Pawlenty said he disagreed with parts of the report but hopes for health care reform that is "market-driven. "

Lawmakers talk to Duluth about plans to fix health care

Duluth News Tribune - 02/08/2008 - Jane Brissett

Should Minnesota reform its current system of health care or throw it out and adopt a government-paid system?

This week, lawmakers have been talking in Duluth about three plans to fix health care in advance of the opening of the legislative session on Tuesday. Numbers already are being disputed and viewpoints are being argued.

Over the past few years, health insurance premium increases and out-of-pocket costs have made the cost of health care increasingly difficult for many Minnesotans, advocates of reform say. Families USA, a nonpartisan health-care advocacy group, says this year more than 1 million Minnesotans will spend at least 10 percent of their income on health care, even though the vast majority of those people have insurance.

Gov. Tim Pawlenty and members of the Legislature appointed separate groups to study ways to cut costs and improve quality. The plans unveiled during the past month by the governor’s Health Care Transformation Task Force and the Legislative Commission on Health Care Access call for changes that Rep. Tom Huntley, DFL-Duluth, says will cut costs and promote better care. But they continue to involve the insurance industry. A third proposal, the Minnesota Health Plan bill, would provide health care for everyone, paid for by state government.

Huntley, who co-chaired the legislative commission and the governor’s task force, said after a Duluth Area Chamber of Commerce forum Tuesday that he is determined to create a health care reform bill during the coming session that Pawlenty, a Republican, will sign.

The governor, for his part, said this week that he is “hopeful that significant health care reform can be achieved this year.” Pawlenty wants a new system that’s “market-driven, patient-centered and it should re-establish the relationship between patients and doctors.” And it has to lower costs.

Huntley said he expects to draft a bill that melds the recommendations of the two groups he led, which are generally similar. He said they should achieve a 20 percent savings — much of which would go to businesses that provide health care insurance for their employees — from what health care would be in 2011 if nothing changed.

The bill, he said, would change the insurance system in several ways:

Insurance companies would have to sell policies to anyone.

They would not be able to base premiums on a patient’s health history.

Policies would be transferrable from job to job.

Furthermore, the state would subsidize premiums for people at up to 400 percent of the federal poverty level, and would expand MinnesotaCare, a state insurance plan for low income people, to people with incomes up to 300 percent of the poverty rate.

During the upcoming session, Huntley, who chairs the Health Care and Human Services Finance Division Committee, said he hopes pay-for-performance, chronic disease management and bidding on patient populations will be enacted as part of the legislation.“I just want to get the waste and inefficiency out of the system,” he said.

But members of a newly formed legislative health-care caucus who were in Duluth on Thursday afternoon said their plan for state payment of all medical bills for everyone was better and cheaper.

Speaking at the YWCA, state Rep. Mike Jaros, DFL-Duluth, equated health care to public education and other essential services provided by government.

“The United States is the only country in the world that treats health care as a business instead of a service,” said Rep. David Bly, DFL-Northfield.

Minnesota Health Plan advocates are taking their concept on a road trip throughout the state for three days ending Saturday. Their plan is to give medical, dental, prescription and mental health care to every man, woman and child in Minnesota, paid for through premiums that fund the health care system based on income. Businesses would be required to pay premiums, too.

Sen. John Marty, DFL-Roseville, said that covering everyone would be cheaper because care would be managed better and people wouldn’t end up going for expensive treatment in the emergency room when they could have gone to their physician earlier at no cost. Administrative expenses would decline significantly as well, he said, citing Medicare’s low costs compared with private insurers.

But he conceded that the single-payer plan will not be enacted while Pawlenty is in office. Rather, it’s a three- to four-year plan and the push is just beginning, he said.

Marty, who was a member of the legislative commission, also said he might support enacting some measures that the governor would sign, as long as they don’t make the system more complicated and costly. “If we can do something to help in the short term, great,” he said.

Local supporters of the single-payer plan, Northland Health Care For All Coalition, will meet from 6 to 7:30 p.m. Feb. 19 at the YWCA.

Health care tour comes to Hibbing

Hibbing Daily Tribune
Last updated: Monday, February 11th, 2008 07:49:35 AM

by Mike Jennings

Editor

HIBBING — Minnesota legislators who back sweeping health care reform brought their arguments in favor of state-sponsored universal coverage to Hibbing last week.

Speaking to a gathering of about 30 people at Hibbing Community College, Rep. Shelley Madore said her family's experience illustrates the gaping flaws in the private health coverage that most Americans depend on.

Madore, DFL-Apple Valley, said she learned about those flaws while trying to meet the medical needs of a son who has autism and a daughter with spina bifida. She said her family was paying $700 a month for medical insurance, yet after her daughter was diagnosed and underwent surgery her insurance company refused to pay a $60,000 balance on her daughter's bill.

To get publicly funded medical care for her daughter, she said, the family had to conform to drastic income and asset restrictions.

“If you're on public (health care) programs, you have no savings,” she said.

Now, she said, her daughter's approaching 18th birthday poses a new concern.

“Now she is an adult with a pre-existing condition,” Madore said. “What are we going to do?”

One option, she said, is for her daughter to live in poverty so she can receive public medical benefits.

“But this brilliant young woman is going to have to live in poverty because she has a medical condition?” she said. “Is that the best we can do in Minnesota? Is that the best we can do in the United States?”

Rep. Carolyn Laine, DFL-Columbia Heights, said Americans' health care costs are the world's highest at more than $6,400 per capita, yet they visit the doctor less often and, on average, have shorter lives than the citizens of many countries where health care costs are less.

She said insurance companies' spending on advertising, lobbying and perks for their executives helps account for the gap between the quality of health coverage and its cost. Underwriting — which Laine described as insurers' way of deciding “who should they refuse to cover — adds another layer of cost, she said.

“This isn't about care,” she said. “This is about the dollar.”

Rep. David Bly, DFL-Northfield, said at the event that families typically spend 10 to 25 percent of their income on health care, and the cost continues to rise.

“It's costing more, and you're getting less,” he said.

With the Minnesota Health Act, backed by 25 state senators and 35 state representatives, “we think we can take the lead in Minnesota and be an example for everywhere else,” Bly said.

According to its sponsors, the legislation would set up a publicly funded system providing full coverage of all necessary health care for all Minnesotans. There would be no deductibles or co-pays and no rejection of coverage because of pre-existing conditions.

The event at the college was part of a “health care reform state tour” conducted by the measure's legislative backers. Sen. John Marty, DFL-Roseville, and Rep. Ken Tschumper, DFL- La Crescent, are also participating in the tour.

Spirited exchange exposes health care challenges at meeting on Senate plan

Bemidji Pioneer - 02/09/2008 - Brad Swenson

After a spirited exchange between a Bemidji insurance agent and several state legislators over health care reform, Dan Strehlo could only shake his head.

“The problem is here,” he said, pointing to the insurance agent, “and here,” pointing to the DFL legislators who were in Bemidji to unveil their health care plan for the 2008 session.

Strehlo of Bemidji said he was diagnosed in 2000 with Parkinson's disease and his wife, Mary, with multiple sclerosis 27 years ago.

“To this day, I have not asked for one dollar, not one dollar, from state or federal programs,” he said. “I'm here to tell you that this program (of the DFL), you haven't sold me on this one.”

Pointing to Derrick Pickett, the insurance agent, Strehlo said, “You haven't sold me on anything.”

Sen. John Marty, DFL-Roseville, led a delegation of freshmen legislators to Bemidji to unveil the Minnesota Health Plan, a bill he introduced late last session and which he hopes will be heard this session.

It would create a single-payer system, meaning the state through a special board set up by the Legislature would collect premiums from all Minnesotans — based on ability to pay — and pay the bills.

The legislators, however, prefer to call it a single-administrator plan as they say it creates savings by centralized billing and by spreading premiums among all Minnesotans. And, they say, it isn't socialized medicine as providers such as doctors are still private.

Pickett, who services Blue Cross/Blue Shield and Medica, said whenever legislators talk about health care reform, they blame the insurance industry rather than the high cost of medical services itself.

After several people told horror stories of not getting treatment paid by their health insurance companies for a number of reasons, such as failure to get pre-approval or non-coverage of a pre-existing condition, Pickett said there are just as many stories of people who were saved by insurance.

“If I did not have health insurance, I would lose my house; I would have lost everything,” he said as he had to deal with treating a son with cancer. “So when we're talking about health care, are we talking about health insurance, because that's all I hear.”

Pickett said when he thinks of car care, he thinks about the mechanic and not car insurance. “When we talk about health care, we talk about insurance companies.”

When thinking about affordable health care, he said, he wouldn't be able to seek treatment in Fargo without insurance and only out of pocket.

When a client complains about coverage not extended to a certain drug, Pickett said he counsels, “Then just buy it — buy it if you need it to live. To live comfortably you have to pay for it.”

And he charged that state health programs seek the cheapest and most restrictive coverage. “We always hear about the bad,” he said. “But I have so many good stories …”

Sen. Mary Olson, DFL-Bemidji, an attorney who has battled health insurance companies over coverage, said that the DFL plan “is not a socialized system where the doctors are working for the government. The doctors are still private doctors.”

People would retain choice over which provider to see, and the state would serve as administrator of the funds, she said.

“One of the problems that our rural hospitals have is that under the current system, unlike what is being proposed here, we have so many different payment rates depending on who's paying,” Olson said. “The government is not paying enough for poor people's health care, which is why it is so hard for them to get access to health care.

“But basically it's not the government paying those bills, it's taxpayers who are paying those bills,” Olson said. “In order to raise those rates, you have to raise taxes to pay for them.”

The simplified Minnesota Health Plan would set one rate, whether insurance paid or state program paid, to create a fairer system, and would seek savings through administration reforms, she said.

The exchange frustrated Strehlo, who said there are programs for the poor, the rich can afford medical care, but it's the middle class that is most likely to see bankruptcy with any catastrophic health problem.

He said he's paying $4,500 a month for his wife in an assisted living facility, adding that “I cannot do that for very long.”

He said he applied to Beltrami County for financial help, but was told he'd have to meet financial guidelines to qualify for public assistance, and since neither he nor his wife were 65, they couldn't enroll in Medicare.

“The state and the county's program, I'll tell you what it is: it's impoverish and incarcerate,” Strehlo. “They want to take all my money, not just my available money, but all my retirement accounts, and when they're all gone, then they'll find a nursing home that will charge the state $5,000 to $7,000 a month.”

And Strehlo, turning to Pickett, said that “he wants the costs as high as he can get them — the insurance companies want the costs … high.” That's because the companies' profit comes from costs, he said.

Turning back to the legislators, “these guys over here, they don't have clue,” he said.

Strehlo said he told the county he'd rather have $2,000 a month to care for his wife himself, and save the county $35,000 a year to spend on other people needing help.

He pointed at both the lawmakers at one side of the room and Pickett at the other, and said, voice quavering, “You guys have got to do something … because I'm being terrorized by you people.”

A visibly emotional Strehlo made his way out while Rep. Shelley Madore, DFL-Apple Valley, said the Bemidji man's plight is what legislators want to fix with their health proposal.

“The No. 1 complaint that I hear with late-onset disorders is that people are forced to leave their jobs in their 40s, any wealth that they have accumulated for their retirement plan get eaten away,” she said. “You don't get into the county plan unless you spend down all of that money. So if you are healthy enough to stay in your home, that's available cash assets.”

Madore citing one health insurer, U Care, whom she said put $33 million of taxpayer dollars into its reserve account last year. “Those people collected all the Medicare dollars that were delivered to those patients who have Medicare with their insurance.”

That's a problem of the current system, Madore said, that people need to “swallow their pride, to lose your dignity to be able to ask for a program. This has got to stop.”

Marty outlined the proposal as:

-- Allowing people to go to the doctor, clinic or hospital of the patient's choice.

-- The plan covers all medical needs including prescriptions, mental health care, dental services, chiropractic.

-- A patient cannot be rejected because of a pre-existing condition.

-- No deductible or co-payments.

-- Premiums on individuals and businesses are based on ability to pay.

-- The plan is administered by a 15-member public board representing the public, not just insurance company executives.

-- The plan focuses on preventive care and early intervention to keep people healthy and save money.

Marty doesn't expect swift action — it may take four or five years to make a full change.

Health insurance “is not something we should be selling,” Marty said. “It's something we should be making sure we all pay into and we all get the service, like we do with police and fire.”

Health care should be a community need that everyone needs, he said.

Y bswenson@bemidjipioneer.com

Pictures and stories from Saturday's Health Care Forum

Submitted by adam.gurno on Sun, 02/10/2008 - 7:55am. Government | People

(Submitted by Jane B. McWilliams)

Four Minnesota Legislators and over 50 citizens gathered Saturday at the Public Library Saturday to talk about health care. ( Click here for the photo gallery , click here for a slideshow .) Representative Bly introduced his colleagues Senator John Marty, Representatives Carolyn Laine and Shelley Madore. Staff member Laura Northfield and advocate Joel Clemmer also participated. Northfield was the seventh community the group has visited this week to talk about the Minnesota Health Care Act, legislation the authors say will provide quality, affordable, comprehensive health care to all Minnesotans through all stages of life.

More inside...

According to Sen.Marty, the draft bills (SF 2324/HF 2522) "treat health care as a community need, something everybody needs and everyone gets - just like police and fire protection." Legislators noted that many middle-income families have insurance but are still only one serious illness away from bankruptcy. Rep. Shelley Madore spoke about how her family underwent just such an experience with the serious illnesses of her son and daughter. A slide presentation spelled out the principles behind the legislation and reported on research documenting the need for and wisdom of the new approach to funding and delivering health care. For additional information check out: mnhealthplan.org .

» adam.gurno's blog

Minnesota Health Care Plan

Broken and dysfunctional… that's how some Minnesota lawmakers are describing the state's health care system.

LaCrescent WXOW

They say the time is now for reform.

A group of Minnesota lawmakers are on a three day, statewide tour to discuss what they call a health care crisis.

Over the past few years, many families in Minnesota have experience double-digits premium increases year after year.

Lawmakers are facing that challenge, and today they held a town hall meeting in Winona.

News 19's Sarah Alain details what's wrong with they health care system, and what lawmakers want to do to solve the burden for Minnesotans.

Walt Bennick says, “The drug plan that we got doubled from last year to this year.”

Walt Bennick, a Winona resident, is concerned about his mounting medical bills.

Over the past few years, health care costs have risen substantially for Minnesotans like Bennick.

State lawmakers want to change that, and are promoting a proposal called the Minnesota Health Act.

John Marty says, “It's a health care reform that will cover every Minnesotan, not 92, or 95 percent, it will cover everyone for their medical needs.”

Senator John Marty, Chair of the Minnesota Health Committee says the mission of the proposal is to make Health care affordable to everybody.

Marty says, “When you cover everyone, for all their needs and do it in an effective manner, it actually costs a lot less than what we are spending right now.”

Senator Marty says universal health care coverage, would not be expensive since people would not put off annual check-ups or other preventive measures.

Marty says, “We think by early detection, by cutting out the insurance middle man, we have something that everyone is much simpler, less paperwork, and it's cheaper.”

And that's music to Bennick's ears.

Walt Bennick says, “It's not a hardship yet, but I can see where it will become a hardship.”

Right now, four hundred thousand Minnesotans are without insurance.

There will be hearing on the Minnesota Health Plan shortly after the legislature plan begins.

In Winona Sarah Alain… News 19.

Minnesota lawmakers say families in the state spend the largest portion of their income on health care.

And health care is the number one bankruptcy in the country.

The three-day statewide tour began on Thursday in Duluth.

It wrapped up today in Northfield, Minnesota.

Updated: 2008-02-11 08:07:57

StarTribune.com

DFLers advance health insurance plan

By PAT DOYLE , Star Tribune February 11, 2008

A bold plan to provide health insurance coverage for all Minnesotans through a government run program was advanced today by DFL legislators, who say they expect to wage a three or four year battle for such a system.

The proposed Minnesota Health Plan was touted as the most effective way to transfer savings resulting from lower insurance overhead and other costs to provide coverage for an estimated 400,000 uninsured Minnesotans. The effort is being led largely by new House members, who say they are responding to numerous complaints about health insurance while campaigning in 2006. "Health care was either number one or number two as a primary concern," said Rep. David Bly, DFL-Northfield.

The single-payer plan will compete with less dramatic proposals for health coverage reform during the upcoming legislative session. Some longtime DFL proponents of insurance overhaul favor universal health insurance that stops short of a single-payer system. Brian McClung, a spokesman for Gov. Tim Pawlenty, said the governor "is opposed to government-run health care" and is working with a bi-partisan task force on other plans. While critics of a single-payer plan say it could reduce patient choice and innovation, supporters of the Minnesota Health Plan say it would allow people to choose their own doctors and hospitals.

Lawmakers seek health-care reform

Scott Wente , Minn. State Capitol Bureau
Published Tuesday, February 12, 2008

Bemidji Pioneer

ST. PAUL – Some Minnesota lawmakers and health-care reform advocates say an ill state budget does not have to delay remedies to a troubled health-care system.

As the 2008 legislative session opens today, top Democratic-Farmer-Labor Party lawmakers and the Pawlenty administration say they believe some improvements to the health care system are possible this year.

Legislators and others who have been involved with dozens of health-care reform meetings in recent months are optimistic that by the time the Legislature's May 19 adjournment deadline arrives, Minnesotans will notice some changes to a costly and problematic health-care system.

In fact, health-care reform could be a rare major issue on which Republican Gov. Tim Pawlenty and DFL lawmakers reach agreement this year, and that may stem from an understanding that a compromise will focus on finding ways to cut costs and promote preventative health care.

Rep. Tom Huntley, the top House Democrat on health-care issues who recently served on two major reform panels, said the overarching goal is to go from “having a sick-care system to having a health-care system.” Lawmakers and Pawlenty face a state budget deficit estimated at $373 million and probably growing, making the case for significant new spending difficult.

“Obviously, the budget has an impact on us,” said Huntley, a Duluth Democrat.

In advance of the session, Pawlenty has quietly met with lawmakers in recent weeks to discuss a variety of legislative issues, including health-care reform. Pawlenty spokesman Brian McClung said compromise is possible in that area.

“I think you're seeing the coalescing of ideas,” he told reporters.

Minnesota House Speaker Margaret Anderson Kelliher, DFL-Minneapolis, also offered an optimistic assessment of health-care reform this legislative session.

“There will be a lot of work done on this and it does not necessarily cost money immediately to get this done,” Kelliher said Monday.

Health-care reform is a contentious issue, however, and Huntley said both a legislative task force and a governor-appointed panel that developed reform recommendations will face opposition.

There are more drastic health-care reform proposals floating around the Capitol. A veteran Democratic senator is teaming up with several freshmen House DFLers in promoting a so-called single-payer system in which a government-appointed board would oversee insurance coverage of all Minnesotans.

Supporters said moving to single-payer, universal coverage would allow patients to pick their doctors and focus on preventative care. But Pawlenty and Republican lawmakers oppose a government-run program.

The single-payer approach, which supporters unveiled Monday and said could take up to four years to implement, got the early support of the Greater Minnesota Health Care Coalition. Vicki Sanville of Duluth, the group's vice president, said patients would be more comfortable with that type of plan.

“People will be able to use the doctors they want to use,” Sanville said.

The issue is on the minds of rural Minnesotans, advocates said. Health care ranks second only to the economy among some farmers, said Bruce Miller of the Minnesota Farmers Union. Miller said health-care reform is critical for Minnesotans who must choose whether to pay for health insurance or other essentials, and must travel long distances to see doctors.

Some elements of the various reform proposals eventually would cost more money, Huntley said. Lawmakers may try to turn to a state health-care account that is running a surplus, but Huntley said that money only can be used once, and Pawlenty has made clear he wants to see cost savings before more dollars are spent.

Pawlenty and DFL lawmakers specializing in health care issues have not always had an amiable relationship. The Republican governor long has criticized the rapid growth rate of state-subsidized health care for low-income Minnesotans and has proposed cutting spending in that area while some Democrats have tried to expand those programs to more citizens.

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Senate Majority Leader Larry Pogemiller , DFL-Minneapolis, said leading Democrats on health care believe Pawlenty is “genuinely interested” in reaching agreement on health care reforms.

“We believe that this could be a pretty dramatic year in terms of moving toward universal health care,” Pogemiller said.

Renewed discussion of health-care reform Monday came as an independent audit concluded Minnesota should do a better job containing costs in three state-paid health care programs for low-income Minnesotans. Those programs are Medical Assistance, MinnesotaCare and General Assistance Medical Care, and together cost $6.5 billion in 2007.

A report by Legislative Auditor Jim Nobles' office found that state officials conducted limited reviews of the administration of those three programs. Among other recommendations, the audit suggested more oversight of the administrative costs for those programs, which in 2006 totaled $200 million.

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Vicki Sanville of Duluth, right, and Charlotte Fisher of St. Cloud discuss the Greater Minnesota Health Care Coalition's support for a single-payer, universal coverage health insurance system in Minnesota during a Monday news conference in St. Paul. Sanville is the group's vice president. They stood near an illustration criticizing the state's current health insurance system.

Health care tour comes to Hibbing

Daily Tribune
Last updated: Monday, February 11th, 2008 07:49:35 AM