Regardless of the Affordable Care Act's fate, Minnesota will press on with changes.
No matter how the black-robed Supreme Court justices rule on federal health reform, the pioneering work done by white-coated Minnesota medical providers to improve care while reducing costs will go on.
At CentraCare clinics in Becker and other midstate communities, staffers will continue their push to keep diabetic patients healthier between checkups. In the Twin Cities, the innovative county-run Hennepin Health initiative will move forward on melding medical care and social services to improve care for some of the state's most vulnerable patients and prevent expensive emergency room visits.
And around Minnesota, a collaboration of 80 hospitals, health plans, health care quality groups and others -- known as the RARE Campaign -- will press forward with the ambitious goal of reducing the state's overall hospital admission rate by 20 percent by the end of this year. The Reducing Avoidable Readmissions Effectively initiative will save an estimated $30 million for patients with commercial insurance and will deliver additional savings for Medicare.
The eyes of the nation are on the Supreme Court, which is expected to rule this week on the constitutionality of the 2010 Affordable Care Act and its controversial components: the individual mandate to buy health insurance and the Medicaid expansion. But it's a mistake to believe that the future of health reform -- the work that must be done to keep medical care affordable without sacrificing quality -- rests solely in the hands of the nine justices.
If it's upheld, the ACA will continue herding the public and private health care sectors in the same direction: toward a system that increases access to care, more fairly distributes coverage costs, and provides incentives for better care, not more care.
Striking down the law, or the mandate, would slow progress toward these goals, but it won't derail it permanently, because the status quo is not an option. Health care is in crisis, with costs that far outstrip the ability of consumers, businesses and taxpayers to foot the bill.
The cost of the nation's total medical care is expected to consume an unhealthy 20 percent of the gross domestic product by the end of the decade, with some estimates predicting it will hit a sobering 25 percent by 2025. In Minnesota, the state's total health care costs rose 82 percent from 2000 to 2009.
If current trends continue, state spending on health care services will increase 8.5 percent a year through 2033, according to research presented to the state in 2008. Revenue was predicted to grow by only 3.9 percent annually, which means that health care spending will steadily erode funds for everything else -- education, public safety, transportation and natural resources.
With or without the ACA, Minnesota must continue its pioneering work building a health care system based on quality and affordability. The state is well-positioned to do so, thanks to its political leadership and an unusually public-spirited health care industry that has collaborated on change instead of fighting it.
A landmark health reform law passed in Minnesota in 2008 gives the state a solid framework on which to go forward. Measures in it empower consumers to rein in costs but also push providers to implement systemic changes that deliver better care for less. Too often, the national debate takes an either-or approach to these strategies.
Results of the groundbreaking state law can be seen in the growing number of clinics certified as "health care homes," which encourages care coordination and preventive health care. All of HealthPartners' primary care clinics, for example, have this designation -- an impressive achievement. The state's trailblazing "Provider Peer Grouping" initiative, which compares providers by name on key benchmarks, will also provide consumers with the information needed to make more-informed medical care choices.
Minnesota's commitment to coverage and quality has translated into other progress. The state's Department of Human Services under Gov. Mark Dayton has done praiseworthy work expanding Medicaid coverage for the poor, and will make maintaining this improvement a priority in the Supreme Court's wake. Providers such as Park Nicollet and Fairview are national leaders in launching Medicare accountable-care organizations to improve care for seniors enrolled in this popular federal program.
The Supreme Court's historic ruling, whatever it is, will exacerbate already bitter divisions over health reform. But the nation can ill afford to put progress on hold while the inevitable anger subsides and an election cycle (or two) goes by. We have to figure this out. Minnesota is already a leader when it comes to putting actual reforms in place. The state's history of collaboration and its can-do spirit should be an example to the nation as the health reform debate is renewed in the contentious days ahead.
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