ST. PAUL LEGAL LEDGER CAPITOL REPORT
Minnesota must forge ahead with its own system for universal coverage; a single payer might make sense
As pundits try to explain the “99 percent” movement, they typically identify driving factors such as student debt, high levels of unemployment, anger at Wall Street greed, and the glaring and growing economic inequality in the United States.
But health care — namely the lack of it and the excessive cost of it — is one of the most important and overlooked motivating forces.
The protest messages, on the plazas and online, tell the story. An analysis of the postings on the “We are the 99 percent” Tumblr website found that fully half of the posts mentioned the soaring cost of health care and policies that favor insurance companies over patients. The signs displayed at an Occupy MN gathering on the Hennepin County Government Center plaza in Minneapolis reflect that, too:
“My mom was diagnosed with breast cancer in 2010. My family was lucky to have insurance, but now owe over $80,000 in medical bills. My 12-year-old twin brothers’ college fund was wiped clean.” (http://wearethe99percent.tumblr.com/)
“Two jobs – No Health Insurance – $150,000 + In Medical Debt – I am the 99%.” (Sign at Occupy MN gathering)
Recent reports are helping to provide a fuller picture of a broken national health care system as both cause and effect of our inequality crisis.
According to the Kaiser Family Foundation/Health Research & Educational Trust, average family health insurance premiums have increased 113 percent in the last decade, and the share of premiums paid by workers has risen a whopping 131 percent in the decade. During that same period, according to the U. S. Census Bureau, median household income has increased 17 percent in nominal dollars (though it has actually dropped by 5 percent when adjusted for inflation).
Despite soaring premiums, more and more policies, especially employer-based plans, are now high-deductible plans. This means that patients are responsible for a larger portion of their medical costs, regardless of their ability to pay. Minnesota leads the nation in the percentage of people enrolled in these high-deductible plans, at 14.9 percent.
The 99 percenters, like their Tea Party counterparts on the right two years ago, may not have produced comprehensive policy papers or detailed prescriptions for addressing their grievances. But when it comes to health care, they are on the mark in fixing part of the blame on big corporations, in this case the giant health insurers. Many insurance companies continue to seek double-digit premium increases despite reporting record profits.
While insurance companies are reaping profits, millions of Americans (including hundreds of thousands of Minnesotans) are forgoing necessary care. According to a new Commonwealth Fund report, one-third of adults in the nation report self-rationing care because of cost. This means skipping tests, treatment or follow-up; not filling prescriptions or skipping doses; or not seeing a doctor when they know they have a medical problem.
Further, the U.S. ranks last among 16 high-income nations studied on “amenable mortality” (deaths that are considered preventable by timely and effective care). The lack of universal coverage and the high cost of care in the United States were pointed to as factors in our nation’s poor showing.
While the federal health reform law (the Affordable Care Act, or ACA) expands coverage and implements some vital consumer protections against rescinding policies and exclusions for pre-existing conditions, it is little wonder that many people are disappointed at the overall impact.
Millions of people will be mandated to buy insurance products from the very companies that have realized record profits and contributed to economic insecurity for individuals, families and small businesses. And if the experience of Massachusetts is any indication (recall that the ACA was based upon that state’s plan), continued price escalation, shrinking benefit packages and restricted provider networks will be the norm, even if the ranks of the uninsured are reduced.
But there is a better way forward, state by state, and Minnesota could be in the vanguard.
Section 1332 of the ACA allows for a “Waiver for State Innovation.” This allows states, beginning in 2017, to apply for waivers to several provisions of the bill if the state develops an alternative plan that meets or exceeds the ACA on access, coverage, benefits and affordability. President Barack Obama has called for moving the waiver date earlier, and several states are heeding the call.
Vermont, Hawaii, Montana and Oregon are pushing ahead with plans for universal coverage or single-payer methods for streamlining the financing of health care, and Minnesota, which has historically been a progressive leader on health and health care, is poised to follow.
Gov. Mark Dayton recently appointed a health care reform task force that is charged with developing an action plan for reforming how we deliver and pay for health care in Minnesota, with a commitment to better care, lower cost and healthier communities. Progress can be followed at a just-launched website on health reform (http://mn.gov/health-reform). This is a big step in the right direction.
We can and must find our way to a model for health care that is “of the people, by the people and for the people” — all 100 percent of them.
A version of this column originally appeared in the St. Paul Legal Ledger Capitol Report on Thursday, December 1, 2011.
Dane Smith is president of Growth & Justice, a policy research organization focused on expanding prosperity in Minnesota. Amy Lange is a registered nurse and certified nurse-midwife who is a policy fellow on health care for Growth & Justice.