In the coming days, Minnesota House Speaker Kurt Daudt, Senate Majority Leader Tom Bakk and Gov. Mark Dayton will make decisions about the future of MinnesotaCare. As they do, we hope they remember the history of why, and how, it was created. Those reasons continue today, as does the success and sustainability of MinnesotaCare. End-of-session negotiations will be contentious as they grapple with how to bridge wildly divergent priorities. But MinnesotaCare must not become a casualty.
The idea that every Minnesotan should have access to affordable, high-quality health care was the central tenet and guiding value of our bipartisan “Gang of 7” back in 1992. This group of (now former) rural and urban lawmakers was formed around a shared goal: to make sure every Minnesotan had affordable health care coverage. The group, along with the Republican governor at the time, were able to bridge considerable differences in ideology on behalf of the greater good. We were, respectively, that governor and one of those seven legislators. And the success, in large part, was due to the fact that everyone was more committed to health care solutions than politics or party loyalty.
Minnesota had a real problem where health care coverage was concerned. Scores of farmers, students, self-employed people and low-wage workers were going without coverage. They made too much to qualify for Medicaid but not enough to pay for private plans. But that did not mean they went without health care; it just meant they did not get it until they were very sick and they couldn’t pay for it. This resulted in suffering for them, uncompensated care costs for providers and a premium increase for everyone else. It was a statewide problem in search of a statewide solution. Thus was born MinnesotaCare, a pooled approach to health care coverage that now covers more than 100,000 low-wage working Minnesotans.
As a result of hard work and focus, the team managed to craft and pass MinnesotaCare despite a $2.3 billion budget deficit that year and a bitter public dispute. To repeal this effective, nationally lauded program 23 years later while the state enjoys a $1.9 billion budget surplus would be foolhardy, to say the least.
Nonetheless, state Rep. Matt Dean, R-Dellwood, has proposed abolishing MinnesotaCare. In its place, he has presented a rather murky plan that would boost costs, lower quality and greatly increase uncertainty for low-income working Minnesotans who are disproportionately concentrated in Greater Minnesota and rely on the program. Ultimately, there is no good purpose to the Dean plan, and his reasons for ending MinnesotaCare are most confusing.
House Republicans claim that MinnesotaCare is “financially unsustainable,” but the facts are otherwise. MinnesotaCare has always been funded, in part, with a 2 percent tax on providers, a more efficient way to pay for care. Funding has also been covered by premium contributions from enrollees themselves and, most recently, by federal funds through the Affordable Care Act. These sources are pooled, along with enrollee premiums, into the Health Care Access Fund, which currently enjoys a surplus.
However, during final budget negotiations in 2011, the Legislature and Gov. Dayton placed a 2019 “sunset” on the provider tax, with no alternative revenue source put in its place. Legislators should renew this funding stream right away, since it is hard to understand why it was discontinued in the first place. Providers who pay the provider tax, such as the Minnesota Hospital Association — ironically one of MinnesotaCare’s most vociferous opponents back in the early 1990s — now publicly support it. Without MinnesotaCare, they might pay less in provider tax, but they would lose more in unpaid bills and delayed care.
Additionally, the promise of “choice” has been bandied about as a reason to end MinnesotaCare. The nonpartisan Minnesota Budget Project has analyzed the Dean plan and concluded that it would “more than double the current maximum MinnesotaCare premium,” would do “nothing to reduce out-of-pocket costs” and would leave 100,000 Minnesotans “choosing between more expensive monthly premiums or riskier low premium plans with high out-of-pocket costs.” In this way, the Dean plan amounts to nothing more than a choice to pay more for less, or to go uninsured. And those are just horrible choices.
Ultimately, the Dean plan aims to “fix” something that isn’t broken. You should not eliminate a program that is recognized as a great success, both nationally and by people across our state. Minnesota has the most comprehensive health care infrastructure in the country, in large part because we have MinnesotaCare, a critical element that most other states miss. Considering all the things that actually need fixing, it is hard to understand why anyone would want to tear down something that actually works.
Arne Carlson was governor of Minnesota from 1991 to 1999. Lee Greenfield, DFL-Minneapolis, was a member of the Minnesota House from 1979 to 2000.