A tidal wave of health-care instability is coming toward Minnesota. The bill to dismantle the Affordable Care Act was pulled in the U.S. House last week, but if the ACA is later repealed or defunded, millions of Americans will likely lose insurance. Those lucky enough to keep their health insurance may be forced to pay thousands of dollars more. Minnesota can buffer these potential impacts and add to its legacy of health care innovation if legislators place patient needs ahead of special interest groups.

Dr. Michael Aylward

Even now, as physicians, we see how health care costs affect patients every day. We all have patients who are forced to decide whether to delay treatment, take less effective medications because of cost, or forgo treatment altogether. They often make too much to qualify for medical assistance (Minnesota’s Medicaid program), but cannot afford private health insurance on MNsure.

This legislative session there is a solution for these Minnesotans.

MinnesotaCare Buy-In

Dr. Briar Duffy

MinnesotaCare is a nationally recognized health plan created in 1992 under a Republican governor and insures more than 100,000 Minnesotans. It provides access to doctors across Minnesota and costs a fraction of the typical private insurance plan. Gov. Mark Dayton wants to give every Minnesotan the opportunity to buy into this low-cost option. As members of Minnesota Doctors for Health Equity, a grassroots physician organization, we believe patients should be put before profits and support the MinnesotaCare Buy-In.

Dr. Nathan Chomilo

MinnesotaCare, with overhead costs of 3 percent, is more efficient than private health insurance companies, which typically have overhead costs around 12 percent. The MinnesotaCare Buy-In would allow all Minnesotans, especially those with limited insurance options, to purchase affordable, high quality health insurance. While private insurers offer fewer benefits at higher costs, the MinnesotaCare Buy-In is comprehensive and includes dental coverage.

Dr. Tyler Winkelman

Opponents of the proposal, particularly other physician groups, cite lower reimbursement rates from MinnesotaCare as a major concern and argue the MinnesotaCare Buy-In will lead to cost shifting, meaning health care providers will charge privately insured patients more to make up costs. The evidence does not support these contentions.

Research results

First, according to research done at Northwestern University, hospitals end up paying more of the cost of care when patients are uninsured, and “uncompensated” care goes down when more patients are insured. Second, according to a study by the Center for Studying Health System Change, cost shifting has not occurred in similar situations and is unlikely to happen in Minnesota.

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Additionally, as Minnesota prepares for potential repeal of the Affordable Care Act, state legislators can blunt the effects by making sure the state’s Health Care Access Fund doesn’t dry up. This reserve helps the state cover low-income individuals, including children and parents, and it will be the sole source of MinnesotaCare funding if the ACA is repealed. The Health Care Access Fund is supported by a 2 percent tax on physician services, which is scheduled to end in 2019. Currently, there is no alternate funding source to continue the Health Care Access Fund.

Renew the provider tax

If the provider tax is not renewed, health insurance options for low-income families would be eliminated for the 100,000 Minnesotans who rely on MinnesotaCare. We’ve witnessed the devastating impact losing health insurance can have on our patients and are unwilling to allow our patients’ health insurance be jeopardized. We ask the Legislature to renew the tax on our services.

The choices are clear. If Minnesota is to remain a leader in health care, legislators should pass the MinnesotaCare Buy-In and keep the provider tax on physicians. Gov. Dayton will soon be faced with a choice between putting patients first or subsidizing insurance companies through reinsurance legislation. We call on him to require the MinnesotaCare buy-in be a part of any insurance legislation that gets signed into law.

Michael Aylward, M.D.; Briar Duffy, M.D.; Nathan Chomilo, M.D.; Tyler Winkelman, M.D.; and Malini DeSilva, M.D., who also contributed to this commentary, are part of a grassroots physician organization called Minnesota Doctors for Health Equity.

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