Our current approach to healthcare (and paying for it) has been tried for 40 years and has failed to contain cost. It is time for a new approach that actually increases competition and drives down costs.
The insurers have managed healthcare delivery for four decades and have failed to contain cost. Cost per capita in 1980 was $1,180/year before managed care. It is now over $15,000/year. Healthcare cost doubled under Obamacare. Everything that has been tried is dependent on the management of healthcare delivery and has consequently failed because management is simply too labor intensive to ever be cost-effective. A single-payer system, which the DFL is proposing, will fail to contain cost for the same reason. It is time for a new approach that drives down costs and still takes care of our most vulnerable Minnesotans and those with pre-existing conditions.
DRIVING COSTS DOWN
MORE OPTIONS TO PAY FOR HEALTHCARE
WHY: Competition among health insurers is almost non-existent and competition is necessary to drive costs down. Employers who self-fund provide meaningful competition to the insurance industry.
ACTION: We will promote private-driven plans to finance care as an alternative to the traditional insurance model. To do this, I will propose tax exemption for contributions into healthcare benefit accounts and allowing pre-tax dollars to accumulate in accounts that can feed HSA’s and similar vehicles to pay for care. These alternatives will force insurance providers to compete for health care dollars.
ALLOW GROUPS TO FORM ASSOCIATIONS TO PURCHASE GROUP BENEFITS
WHY: Large corporations are able to distribute risk across large pools of employees and keep premiums lower, but small businesses and individuals are forced to pay according to their individual circumstances and risk being dropped for utilizing their insurance for unforeseen events.
ACTION: I will propose allowing Minnesotans to form associations, maybe by a group of businesses in a small community or as a group of churches or other organizations to have the same buying power and risk distribution that large corporations enjoy. The legislature explored something similar this session by allowing farmers to create a cooperative.
ENTICE MORE INSURERS TO OFFER PLANS IN MINNESOTA
WHY: The cost of health insurance has skyrocketed since the creation of MNSure and Obamacare. In fact, in some counties in Minnesota, there are practically no choices at all for consumers on the exchange.
ACTION: I will lead the effort in creating more competition for insurers and more choices for consumers by forming a compact with our neighboring states to allow Minnesotans to buy across state lines regionally. This will increase the number of insurers competing for Minnesotans’ business, giving consumers more choice while driving premiums downward.
WHY: While providers are transparent with their fee schedules, insurers consider their fee schedules a trade secret. This viewpoint incentivizes abuse through overcharging and not permitting consumers to make informed decisions when considering their healthcare. After all, the true cost of a service or procedure is not what the clinician or hospital charges but the amount that the insurer actually allows for payment.
ACTION: I will push hard for certification of independent third-party administrators whose fee schedules are public to replace the role traditionally held by insurance providers. This will introduce true price transparency to the medical marketplace and lower costs.
CUT MANDATES & MAKE MORE AFFORDABLE PLANS AVAILABLE
WHY: The many coverage mandates in Minnesota create one-size-fits-all plans that don’t always meet individual Minnesotans’ needs while also driving insurance out of the realm of affordability.
ACTION: I will work to allow Minnesotans to purchase limited coverage policies that are affordable for every Minnesotan and cover both basic preventative care and potential catastrophic events. And I will propose to roll back some of the coverage mandates that have accumulated over the past decades.
TAKING CARE OF OUR MOST VULNERABLE
REVIVE MN’S HIGH-RISK POOL FOR PRE-EXISTING CONDITIONS
WHY: The Affordable Care Act mandated insurers to sell policies to everyone, no matter their risk. This lowered the number of uninsured, but it also drove up the cost to the point of unaffordability for many. I think we have moved in the wrong direction and should take a step back toward common sense. Minnesota had the first high risk pool in the nation and we were viewed as a model throughout the country prior to the ACA.
ACTION: I will advocate for reinstating a MCHA-style pool for those with pre-existing conditions, guaranteeing competitively-priced coverage for everyone in Minnesota - even those with pre-existing conditions.
BRING SUBSIDIZED CONSUMERS INTO PRIVATE MARKET
WHY: Currently, those receiving government-funded health insurance have no choice. They either accept what government gives them or go without.
ACTION: I will work to allow those receiving government health insurance to shop their dollars in the marketplace among multiple providers to buy the plan that best fits their individual needs and get the most ‘bang for their buck'.
SERVING OUR SENIORS
WHY: Recent census data shows aging Minnesotans are electing to move away from the metro area. Research shows our seniors are overwhelmingly rejecting nursing homes and senior living facilities and electing to stay in their homes. However, our policies inhibit the growth of aging-in-place services.
ACTION: I will deliver more choices for our seniors when it comes to their healthcare services by making it easier to start and run in-home care businesses, increasing access to care, and promoting tele-health technology and services. This is especially important because we have a duty to provide our seniors with the ability to live independent and healthy lives, whether they live in the metro, or in our rural areas.
WHY: We don't find cheaters because we don't check. The Legislative Auditor, Jim Nobles, found $233 million spent in just six months going to non-qualifying people. Bottom line: MNSure doesn’t even know how much money is owed to MNCare.
ACTION: My Administration will work with counties to create a new eligibility determination system. I believe a county-based system giving authority and money to 87 counties to build a new system with greater accountability than our current system would be a step in the right direction.
ATTACKING THE OPIOID CRISIS HEAD-ON
WHY: There were 64,000 deaths from opiate overdoses in 2016. However, the focus of the media and our government has been misdirected in addressing this crisis. According to the NIH, deaths from prescription opiate pain relievers increased almost twofold from 2002 to 2011. Since 2011, deaths from prescription opiates have been stable at about 17,000 per year. This is still far too many, but prescription opiates are only one part of our crisis. Deaths from heroin overdoses increased over 600% between 2002 and 2015, and deaths from cocaine increased over 150% between 2010 and 2015.
ACTION: The legislature came up with a good start to address this crisis on a bipartisan basis in the 2018 legislative session, but that solution was a victim of Governor Dayton’s veto and the chaotic end of session. I will revive that plan as a starting point in 2019. I will also make certain law enforcement has the tools and funding necessary to fight the flood of illicit opiates, specifically heroin and carfentanil, that are responsible for much of the opiate epidemic.