Solutions are Needed to Assure Access to Health Care for all Minnesotans.
Minnesota is recognized nationally and internationally for its excellent public and private health care system. The system in Minnesota includes three medical schools, numerous excellent teaching and acute care hospitals, large and small physician group practices located throughout the state. In addition, we have various approaches to providing health care coverage for our citizens. The ability to diagnosis and to treat diseases within the state exceeds the capabilities of the health care systems of most nations. Medical research and manufacturing have produced dramatic achievements in medical technology which have greatly enhanced the ability of physicians to improve the outcomes for most patients.
Despite the advances in technology, such as magnetic resonance imaging, and the innovations in payments systems such as HMOs, we still have 176,000 Minnesotans who are uninsured for part of the year, and 194,000 who are uninsured the entire year according to the Health Care Access Commission. The Minnesota Medical Association (MMA) finds this unacceptable. The MMA supports universal access to health care for all Minnesotans. We are fortunate that the number of uninsured individuals in Minnesota is the second lowest in the nation. If you are one of the uninsured, however, this fact provides little consolation when you need health care.
One of the reasons Minnesota has fewer uninsured persons is the State’s commitment to programs that provide health care to the most needy. Examples of these programs are Medical Assistance (Medicaid), the Children’s Health Plan, and the high risk pool, the Minnesota Comprehensive Health Association (MCHA). Because these programs provide the foundation for providing health care to the most needy, they must be adequately funded to assure continued access to health care. A resolution to the uninsured problem must include adequate funding for existing programs or we simply will contribute to creating additional problems.
Current information out of Washington, D.C., indicates that funding of Medical Assistance programs is at a crossroads. At the present time, the Health Care Financing Administration in Washington is attempting to eliminate the ability of the states to enhance federal matching funds for Medicaid in order to increase provider reimbursements. Hopefully, Congress will be able to stall HCFA’s plan until substitute funding can be developed. Lacking adequate Medicaid funding, the 200 vacancies currently existing for rural primary care physicians will not only continue to go unfilled, but will also undoubtedly increase causing additional access problems.
Because there will always be individuals unable to purchase health insurance who are also ineligible for Medicaid, the State must assure that coverage is available to those individuals. Eligibility guidelines could include persons who are above Medical Assistance levels but below 200% of federal poverty guidelines. This coverage should only be available to persons who have no access to other health coverage. Emphasis in the benefits portion of this plan must be placed on preventive basic care.
The MMA also supports reforms to the insurance market that will improve access to health care. Employee benefit programs provided by employers are the source of health care coverage for the majority of Minnesotans. Access to coverage must be improved through reforms to the insurance system. The movement of businesses to become self-insured under the federal ERISA provisions must receive a thorough evaluation to prevent continued elimination through underwriting of high risk individuals by self-insured plans. In addition, small employers must be able to afford health care plans for their employees as they currently make up the majority of the uninsured. The use of pre-existing condition clauses must be limited as well. Insurers must be encouraged to move toward a community rating system for their various health plans. A reinsurance pool will be necessary to spread the risk. Finally, coverage for dependents should be required of all health plans.
The MMA recommends that the state coordinate the collection of health care date for the sole purpose of educating both patients and providers. Findings resulting from such a system should be disseminated by the state. In this manner, cost-effective appropriate care can be identified and practice parameters developed. It is critical that the data be thoroughly analyzed and evaluated by qualified physicians who have the necessary skills to provide meaningful interpretations that will result in appropriate practice parameters and outcomes assessments.
One of the stumbling blocks to providing health care coverage for the uninsured is how to fund such a program. The MMA supports the use of a broad-based tax such as the income tax or the sales tax. Because the use of tobacco and alcohol contributes greatly to the health care costs for the citizens of Minnesota, the MMA also supports increasing tobacco and alcohol taxes for the purpose of providing health insurance coverage to the uninsured. Proposals that establish taxes on health care services should not be enacted because the provision of health care is a necessity.
The Minnesota Medical Association is committed to vigorously seeking a solution to providing health care coverage to the uninsured. Legislative proposals to provide that coverage should include sufficient benefits to provide for preventive and acute care; insurance reforms to increase the availability of health insurance for small employers and to restrict inadvisable underwriting practices; adequate funding for existing programs such as Medical Assistance; and other measures that will assure that health care is affordable and that care is accessible to every citizen of the state of Minnesota.
Roger K. Johnson is director of Economics and Government Relations for the Minnesota Medical Association
