Star Tribune

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The fate of a popular health care reform — one with a 70 percent approval rating in a late 2018 Minnesota Poll — was sadly predictable.

In a state with the only politically divided legislature, a proposal to allow consumers to buy into the publicly run MinnesotaCare program in lieu of private health insurance faced an uphill battle. DFL Gov. Tim Walz made this a marquis campaign issue, while Republicans saw it as expanding government’s role in health care.

Now add in the bandwidth sucked up during the recent session by another vital health measure — continuing the state’s provider tax, a critical funding source for medical assistance. The time and focus simply wasn’t available to fully vet a transformative change like the buy-in and create the necessary political momentum.

This week, Walz’s administration told an editorial writer that the work on the buy-in and other initiatives will continue and that it remains a key strategy to ensure that Minnesotans have affordable medical and drug coverage. The reassurance is especially welcome with so many other states embracing ambitious reforms.

Maintaining the provider tax, and extending another program called “reinsurance,” merely kept the status quo in Minnesota. The state needs to pick up the pace if it is to remain a leader in health care innovation.

The action in other states this year is noteworthy, according to United States of Care, a Minnesota-based organization that monitors health initiatives and provides expertise to policymakers.

Consumer advocates, lawmakers, patients and governors have a growing appetite to solve problems on their own, said Joanna Dornfeld, the organization’s senior director of state affairs. They’re striking out on their own as gridlock stymies Congress and the Trump administration seeks to undermine, even eradicate, the Affordable Care Act.

A recent editorial in these pages highlighted a Colorado measure to cap out-of-pocket costs for insulin, a vital medication for diabetics, at $100 a month. But Colorado and a number of other states have also made a buy-in to public medical programs, or variations on it, a focus.

Twelve states, including Minnesota, weighed buy-in legislation in 2019, according to United States of Care. One of these measures recently passed in Washington state. On May 17, Colorado’s governor signed a law requiring health care officials there to develop a detailed proposal that “leverages state infrastructure” to offer a state health plan to consumers.

Connecticut policymakers also vigorously debated a public-private insurance option this year with the goal of saving consumers and small businesses 20% on insurance premiums. That effort met fierce resistance from an insurer with headquarters in the state, and policymakers ran out of time to hammer out a compromise.

The spotlight on a buy-in strategy is merited. Enrollees in publicly run medical programs, which currently restrict participation to those with low incomes, generally give good reviews to their coverage, according to United States of Care. Benefits are robust and costs per enrollee are lower than private coverage, potentially making it more affordable for buy-in customers.

Buying into these existing programs may also offer broader medical provider choices beyond the networks that private insurers have.

In health care, there are always trade-offs. A key question about a buy-in option centers on adequate reimbursement for hospitals and doctors. The main reason the public program costs are controlled is that they typically reimburse at a lower level than commercial insurance plans. Providers are concerned about their financial bottom lines if more people’s care is reimbursed at these lower rates.

Are there ways a buy-in option could strike a balance offering an affordable option for consumers while adequately reimbursing providers? That’s a key question yet to be answered. The debate over this reform should continue, and Minnesota should be the first to get it right.