MMA Viewpoint
Insurance Reform Made Simple
Insurance reform may be one of the most difficult aspects of health care reform and one of the most important.
Last year, when the MMA introduced its health care reform plan, we said that all Minnesotans should have coverage for essential health care services. But we knew we had to build consensus in order to move forward.
To do that, in March the MMA formed Healthy Minnesota: A Partnership for Reform, which recently formed four work groups, including the Insurance Reform Work Group, co-chaired by Kathleen Brooks, M.D., and Robert Snyder. This group will start their discussions using the MMA’s plan to achieve universal coverage, but it will also look at other ideas to develop specific strategies.
Among the MMA’s recommendations for insurance reform that may be considered are requiring all Minnesotans to have insurance coverage, identifying an essential benefits package, ensuring affordability of those benefits through subsidies and targeted tax incentives, creating a fairer system of spreading risk and sharing cost such as requiring statewide community rating for the essential benefits package, and helping employers make coverage options available.
Other ideas are sure to be discussed as well. Some work group members may advocate for a single-payer option. Although many physicians cite the complexity and confusion in Medicare as reasons why a single-payer health care system is not a workable solution, few could argue about Medicare’s popularity among enrollees. And a streamlined administrative system similar to that used for Medicare may have some appeal.
Others may favor catastrophic coverage for medical costs coupled with a health savings account. This would place greater financial responsibility in the hands of patients and could change the way people use health care services. Under this scenario, it would be critical for patients to have more and better information about the cost and quality of the services they are purchasing. For too long physicians and patients have been cost-blind. That may change as reform goes forward.
If the Insurance Reform Work Group embraces the MMA idea of an essential benefit set, questions about what that benefit set would include and who would make the decisions are bound to generate a great deal of debate. Essential benefits could include preventive services such as immunizations, physical exams, and diagnostic tests that have been proven to be of benefit either by research or consensus statement. Some will argue that treatment of chronic and acute conditions should also be part of the essential benefit set. Others will disagree, maintaining that the state should not have to make decisions about treatments to be covered.
Another topic the Insurance Reform Work Group may discuss is the role of employers in the health care system. Is it reasonable to continue the historical trend of linking health insurance to employment? What about the tax implications associated with employer-funded health insurance benefits? The group may explore the idea of eliminating employers’ ability to deduct the cost of health insurance for their workers, or it may decide that employers have a responsibility to contribute to health insurance coverage.
Although the list of issues that the Insurance Reform Work Group is likely to address seems daunting, it pales in comparison with the idea of 343,000 Minnesotans living without health insurance. For them, insurance reform needs to be simple, and it needs to happen now.