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Just in time for our next show this Monday on health care comes a StarTribune story about the exponential rise in the number of Minnesotans on Medicaid – to be sure, double the national rate over the last two years, according to Reporter Warren Wolfe’s June 13th article.

Medicaid – not to be confused with Medicare – is the federal health program for the poor, but is handled differently in just about every state. In Minnesota we call it Medical Assistance. Of Minnesota’s population of 5 million folks, fully 733,000 of them are on Medical Assistance to the tune of $4 billion per year. This represents a big jump of 125,000 over the last two years and increases the percentage of us on Medical Assistance to fully 15% of all Minnesota’s people, but big in part because Gov. Mark Dayton added 80,000 to the rolls, thanks to the Affordable Healthcare Act (ACA).

There’s more to this, but the questions remaining for all of us as the Supreme Court approaches a decision on what those who call the ACA “Obamacare,” is what the states’ responsibilities for providing healthcare coverage and access to their citizens, no matter what that decision may be. After all, even if the court throws out one or more of the ACA’s provisions – or the entire law (unlikely) – the need for health coverage for all of us remains as dire as ever.

As it is, most states and health insurers have already implemented many of the law’s provisions – dropping of precondition exclusions, coverage of children up to age 26 under most circumstances, etc. Most major insurers, including Minnesota-based United Healthcare, have no intention of returning to their old ways and exclusions and states have started designing their mandated health exchanges when patients without employer-supplied health plans need some sort of coverage without resorting to the all-too-expensive option of using emergency rooms for routine care.

We know that the public, perhaps even Republicans, support the ACA’s consumer protections:

• Abolishing annual and lifetime caps on benefits paid.

• Ending rescission (dropping people from insurance when they get sick), except in cases of fraud.

• Ending exclusions for pre-existing conditions.

• Ending price discrimination based on gender and medical history. (Higher premiums can still be charged based on tobacco use, age and geographic region.)

• Allowing children to stay on their parent’s insurance until age 26.

• Phasing out Medicare’s “donut hole” (the gap in prescription drug coverage).

• Establishing a minimum medical loss ratio – the percentage of premium that must be spent on health care rather than on administration or profit. (source: Growth&Justice)

Most physicians and consumers support some sort of single-payer system – where our tax dollars would pay for health care that would remain delivered by private providers (like Aspen, HealthPartners, and Allina). Many are suggesting this model would be a Medicare-for-all option. Current administrative costs through even nonprofit private insurers (BlueCross/Blue Shield, HealthPartners, Medica and UCare) amount to almost 30% of every healthcare dollar, whereas the administration of Medicare amounts by law to no more than 2%. How much more efficient would that revision be when another quarter of the healthcare dollar could actually be spent on caring for people.

A new 38-page report from one of Minnesota’s premier progressive voice on state economic issues, Growth & Justice, Beyond the Affordable Care Act: An Economic Analysis of a Unified System of Health Care for Minnesota makes a strong, well documented case for a state-based single-payer system, ACA or no ACA. G&J recommends a “unified system” that takes in many other benefits.

TTT’s ANDY DRISCOLL and MICHELLE ALIMORADI ask the report’s author and advocates to explain the report’s findings and conclusions, the why of this particular recommendation and what the politics might be toward adoption.


DANE SMITH – President, Growth & Justice Policy Developers

AMY LANGE, RN, MS, CNM – Policy Fellow on Health Care, Growth & Justice; Author, Beyond the Affordable Care Act: An Economic Analysis of a Unified System of Health Care for Minnesota

ELIZABETH FROST, MD – Family Physician; Board member, Physicians for a National Health Plan (PNHP)Minnesota Chapter; Advocate, Health Care for All-Minnesota

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