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In this interview, incoming Chair of the Health and Human Services Finance and Policy Committee, nailed it when she was asked by the AP reporter if there will be a special session. Sen. Benson replied “I am less hopeful today than I was even a couple of days ago. We’re just not hearing anything from the governor that indicates he’s interested in the bigger picture in health care. There needs to be some understanding from the governor’s office that he wants to change things going forward. If we get that, I think we go a long way to opening the door to a special session.”

I wrote this post to highlight Gov. Dayton’s unseriousness in fixing Minnesota’s health care system. It wasn’t that long ago that Minnesota had the best health care and health insurance systems in the United States. That isn’t true anymore. Rather than fixing the problems are having, Gov. Dayton has chosen to criticize Republicans, saying “We’re running out of time. Quit dilly-dallying and get to work, and decide whether you are going to support my proposal, which is ready to go, and is viable, or you don’t want to do it.”

First, Republicans have agreed that there needs to be a rebate system for this year to help people who don’t qualify for the federal subsidies. That’s the entirety of Gov. Dayton’s plan. Gov. Dayton’s plan doesn’t do anything to fix anything for the long-term. If that isn’t fixed, Minnesotans will be faced with a bigger crisis this time next year. This isn’t a matter of Republicans “dilly-dallying around.” It’s a matter of whether Gov. Dayton will stop pretending the ACA is a solid health care system. It isn’t.

Q: How much can the Legislature really do before the changes from the federal level become clear?
A: We have to put some solid things in place. I think we have to look at a reinsurance program (to help insurers pay for high-cost patients). How do we improve choice of competitiveness? I don’t know if we’ve already gone too far. Can the individual market recover?

Thanks to Minnesota’s reinsurance program, Minnesotans with pre-existing conditions could get health insurance at a reasonable price. It isn’t coincidental that health insurance premiums have skyrocketed since it was eliminated.

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I normally don’t talk about the things posted in the comments sections of articles but I’m making an exception in this instance because the comment uses one of the Democrats’ frequent talking points. The subject of the LTE is a bailout of insurance companies by the Obama administration. The comment, though, starts by saying “Most of the world has affordable health care, but not the USA, the wealthiest nation in the world. … Yes, there are issues with the ACA, but it could be fixed, but I guess these same groups have no souls or compassion…just that evil selfishness that cares nothing for anyone else.”

First, the ACA isn’t affordable. That’s why voters rejected Democrats on Nov. 8. It’s a major reason why Mrs. Clinton was defeated. It’s the biggest reason why Democrats didn’t regain their majority in the US Senate. It’s why Republicans flipped the Minnesota Senate. It’s why people are calling for a special session. Next, while there are a few worthwhile features in the ACA, the fundamental principles that it was built on aren’t sustainable. That’s why the ACA was written to include a bailout for insurance companies. The administration anticipated that the insurance companies would lose money. The insurance companies anticipated that, too. That’s why they insisted on writing that provision into the bill before they’d support it.

Third, the US had the best health care system in the world prior to implementing the ACA. A whopping 85% of people who had insurance were happy with their plan. That’s why people were furious when Obama’s promise of keeping their doctor was broken. Some improvements were needed. Specifically, we needed to make sure people with pre-existing conditions could buy reasonably priced health insurance. Minnesota had a fantastic system with MCHA. Minnesota’s effective insured rate prior to Obamacare was 96.5%.

Fourth and most importantly, prior to the ACA, Minnesotans could actually afford to use their health care. What person can afford $3,300 a month premiums, then pay $13,000 in deductibles before the insurance company spends a penny? That’s the system that Democrats gave us. That isn’t affordable health care. That’s expensive, drive-you-to-bankruptcy health care.

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Gov. Dayton’s last day in office can’t come soon enough. Saying that our governor is a spoiled rich brat with a short fuse is understatement. This time, Gov. Dayton says that he’s running out of patience with the GOP over MNsure. This article quotes Gov. Dayton as saying “I’m running out of patience” after accusing “Republicans of dragging their feet about fixing” MNsure.

After watching Gov. Dayton the past 6 years, I’m not convinced that Gov. Dayton ever had patience. Later in the article, Gov. Dayton is quoted as saying “We’re running out of time. Quit dilly-dallying and get to work, and decide whether you are going to support my proposal, which is ready to go, and is viable, or you don’t want to do it.”

Gov. Dayton, stop pretending like you have a plan to fix all of Minnesota’s health care problems. You’ve got a plan to send out rebate checks to people who make too much money to qualify for federal subsidies.

Gov. Dayton’s ‘plan’ doesn’t do a thing to increase access to health care. It certainly doesn’t make health care affordable for anything more than a year. People living in rural Minnesota don’t have a lengthy list of insurers to pick from, either. Here’s the video of Gov. Dayton coming unhinged:

I published this post to highlight Greg Davids’ plan to fix the multiple problems with Minnesota’s health care system. At the time that I published that post, I made these points:

One part of Chairman Davids’ proposal deals with out-of-network expenses:

Create a tax credit to reduce out of-network-costs that arise from seeking care from a long-time primary care physician. Minnesotans were promised that if they liked their doctor they could keep their doctor, but too many are losing their long-time doctors due to narrow networks. Continuity of care needs to be addressed to ensure that we do not lose sight of the importance of actual health care when we look at the problems with health insurance coverage.

Another part of Chairman Davids’ plan deals with expanding choices:

Allow Minnesotans to purchase non-qualified health plans (QHPs), and seek a federal waiver to waive tax penalties for those who purchase a non-QHP insurance plan. If the federal government will not approve the waiver, Minnesota should provide a rebate to cover the cost of the non-QHP penalty.

Since the time I published that post, it’s likely that the Trump administration will grant states waivers that would permit them to ignore parts of the ACA.

Where’s Gov. Dayton’s comprehensive plan to fix the things that he and the DFL broke when they created MNsure? Gov. Dayton and the DFL certainly sang MNsure’s praises at their signing ceremony. Sen. Lourey said “The people won on this bill.” Rep. Joe Atkins said “This truly is a landmark day in Minnesota. This is the most significant reform of health insurance we’ve seen in Minnesota in 50 years.”

The system that the DFL put in place certainly wasn’t a reform and the people lost when MNsure was implemented. If Gov. Dayton and the DFL want to lose big in 2018, all they have to do is keep doing what they’re doing. Gov. Dayton and the DFL are heading for a trainwreck of historic proportions if they don’t get serious about working with Republicans in fixing the DFL’s crisis.

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It isn’t a secret that Gov. Dayton will resist attempts to improve Minnesota’s health care system. This article includes a quote from Gov. Dayton that indicates he’s still in denial about Obamacare.

First, it’s worth noting that Gov. Dayton said “The average wait time has been measured in seconds. If they’re going to be attacking MNsure and wanting to abolish it, they should at least do it on the basis of the current situation, not [what happened] three years ago.” Though I’m not the GOP spokesman, I think it’s safe to say that Republicans use the term MNsure to talk about Minnesota’s health care system.

Right now, Minnesota’s health insurance system isn’t affordable. Lot’s of people have health insurance but can’t afford health care because of Minnesota’s high health care premiums and high deductibles. One of the things that was talked about at this press availability was the need to return Minnesota to having a high-risk pool:

Leader-Elect Gazelka highlighted MCHA multiple times during his press availability. Specifically, WCCO’s Pat Kessler asked about whether Republicans could maintain Minnesota’s 96% insured rate. The clear inference was that the Republican plan would kick people off of insurance. Had Kessler done his homework, he’d know that the Republicans’ plan was likely to maintain that 96% insured rate. In 2007, Minnesota’s insured rate was 92.8%. Of those that weren’t insured, half were eligible for taxpayer-subsidized health care. That means that the effective insured rate pre-ACA was 96.5%.

Most importantly, Minnesotans’ health insurance was affordable prior to the Anything But Affordable Care Act. Why would Gov. Dayton and the DFL resist returning to a health insurance system that worked and was affordable? I predict that that’s what Gov. Dayton and the DFL will do. With Dayton’s propensity to shut the government down, I think it’s likely that Gov. Dayton will attempt to shut state government down for the third time in his time in office.

Gov. Dayton’s legacy will be ruined if MNsure is discredited. Gov. Dayton and the DFL were bigtime cheerleaders for the ACA and MNsure. It’s possible that the ACA will get gutted before Trump is sworn in. The individual and employer mandates are guaranteed to be repealed. Shouldn’t Gov. Dayton say yes to keeping the exchange intact but then accepted the major overhaul of Minnesota’s health care system?

Shouldn’t Minnesotans have the option of HSAs and catastrophic policies if that’s the best fit for their situation? Why should government tell families what their policies have to include? Democrats say that “a woman’s right to choose” must always be between her, her doctor and her god because it’s a highly personal decision. Shouldn’t providing health care for their family be a highly personal decision, too?

Families, not bureaucrats, know what’s best for their family. That’s why families, consulting with their doctors, should be given their choice. Gov. Dayton and the DFL insist that they know best. Here’s a hint for Gov. Dayton and the DFL: Any politician that doesn’t remember that the tax bill he negotiated has a sales on farm equipment repairs shouldn’t be trusted with making health insurance decisions for families.

Finally, how can Gov. Dayton and the DFL insist on maintaining a system that’s driving health insurance companies out of the individual market? Apparently, they’re that willing to hurt families rather than admit that they made a colossal mistake.

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This Strib article highlights the fast rate that people are signing up for health insurance during this year’s open enrollment period. According to the Strib’s article, “Shoppers have been scrambling because of enrollment caps that regulators granted most insurers as an emergency measure to help them prevent further financial losses.”

This isn’t a success story that the DFL should be touting. It’s verification that capping the number of policies that each of the insurance carriers would be expected to sell would inevitably lead to some getting stuck with Blue Plus health insurance policies. It’s widely known that Blue Plus policies are the most expensive policies with the narrowest networks. Those caps were granted because “as an emergency measure to help them prevent further financial losses.”

The system is deeply flawed. The networks in outstate Minnesota are limited. Insurance options are, too. Altogether too often, people are forced out of using the hospitals, doctors and clinics in their cities while using hospitals and clinics 50+ miles away. That’s immoral. It’s potentially life-threatening, too.

A significant portion of the policies getting sold carry the price tag of a Cadillac plan but the high deductibles of a catastrophic policy. Put differently, people in Minnesota and across the nation are too often paying high prices for little coverage. What’s worse is that the Obama administration is forcing families into this situation with the individual mandate.

The system needs to be scrapped ASAP. There are features that should be part of what replaces the ACA. It’s entirely possible to phase out the onerous parts of the ACA while phasing in the patient-centric parts of whatever replaces the ACA. Here’s hoping that the DFL locally and Democrats in DC don’t stand in the way of getting good health care.

One of the reasons why the ACA is collapsing is because the product is exceptionally expensive. Soon-to-be-former Minnesota State Senator Roger Reinert accidentally highlighted that in this op-ed.

Early in his op-ed, Sen. Reinert wrote “A friend recently shared his story with me. He is a professional in Duluth with a young family. He is self-employed and currently gets insurance through the individual market with no subsidies. His family faces health insurance deductibles and premiums in 2017 of up to $20,000, before they’d see a single dollar of benefit from having coverage. He’s considering going without and just paying the penalty.”

First, Sen. Reinert’s friend should consider himself fortunate. The Buck family, which I wrote about in this post, would consider that insurance policy cheap. Starting on Jan. 1, 2017, the Buck family’s “monthly premiums will jump to $3,300 a month with” a $13,000 deductible. That’s $40,000 in premiums that they’ll pay regardless of whether they use their insurance a single time. Then they’d have to spend another $13,000 in deductibles for a grand total of $53,000. Next, it’s worth noting that Minnesotans never experienced that type of sticker shock until the ACA was created.

What financially intelligent person would spend $20,000-$40,000 in insurance premiums, then have to spend another $12,000-$15,000 in deductibles when they can pay a fine of $2,000-$5,000 and the deductible? HINT: This is the structural flaw with the ACA. This can’t be fixed. The only way to fix the ACA is to start from scratch. Right now, the ‘tinker around the edges party’ is the DFL.

Third, Sen. Reinert was one of the DFL politicians who voted for MNsure. It’s disgusting that he’s saying it’s the Republicans’ “duty to quickly find a solution” to a crisis he created. This paragraph reeks of dishonesty:

I urge current legislative leadership to call a special session in the coming weeks to craft a short-term solution. I also urge newly elected members to the Minnesota House and Senate to set aside their differences and work together to offer an ongoing solution for Minnesotans paying these high health insurance premiums.

The only person who can call a special session is the governor. Sen. Reinert knows that. It isn’t a stretch to think that Sen. Reinert wrote that paragraph to put additional pressure on Republicans now that they’re the majority party in the House and Senate.

Republicans don’t have all of the solutions. No political party does. What Minnesota Republicans have, though, is a penchant for trying to fix things.

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Briana Bierschbach’s article exposes the DFL’s electoral dilemma going forward. She quotes Ken Martin, the DFL State Party Chairman, as saying “Clearly there were a lot of white, non-college-educated, working-class voters who were frustrated and anxious about their future and they wanted change. We have to figure out how to speak to white, working-class voters in a better way.”

Actually, the DFL’s problem isn’t messaging. The DFL’s problems revolve around geography and policies. Specifically, the DFL is dominated by the Twin Cities environmental activists that can’t relate to outstate Minnesota. What’s worse for the DFL is that these environmental activists don’t want to relate to blue collar workers.

This isn’t just a problem for the DFL. The Democratic Party nationally got routed because they ignored these blue collar workers. Democrats nationally and the DFL locally both have sided with environmental activists on issue after issue. Whether it’s on the Keystone XL Pipeline or the Dakota Access Pipeline nationally or the Sandpiper Pipeline here in Minnesota, the environmental activists always win the fight with the Democrats.

If that pattern doesn’t change, the DFL will continue to get hurt electorally. They won’t admit this in public but the truth is that Donald Trump has changed the political landscape. I’m not calling this a permanent realignment. It’s a significant shift, though, because there’s now a new option available to blue collar Democrats.

This past year, Rep. Thissen told us that the DFL would make up ground in outstate Minnesota with broadband and transit. I wrote that those things wouldn’t help them in outstate Minnesota because they weren’t important to outstate voters. The DFL didn’t identify health care accessibility or health insurance premiums as battleground issues.

Think of it this way: outstate voters that normally vote DFL are drifting away from the DFL because of health care and environmental issues. Suburban voters are drifting, too, because health care prices are expensive. The DFL’s messaging won’t change those realities.

If LFR gave out awards for DFL stupidity, Duluth Rep. Jennifer Schultz would definitely have a shot at winning this week’s award. This article is proof of that accusation. First, a little background is required. Blue Cross-Blue Shield Minnesota dropped the Integrity Health Network from BCBS’s network. This is puzzling because their clinics are some of the highest quality clinics and most reasonably priced clinics in Minnesota. But I digress. Let’s look at what Rep. Schultz said that puts her in the running for this week’s award.

According to the article, “state Rep. Jennifer Schultz, DFL-Duluth, who was aware of the situation, said there’s little, if anything, that state government can do. State regulations require the insurer to have adequate coverage in the areas they serve, she said. But as long as Blue Cross Blue Shield meets those requirements, there’s nothing the Legislature can do to prevent them from dropping providers.”

What a dipstick. Of course, there’s nothing government can do to tell a private company that they have to include specific companies in their health networks. That isn’t the same as saying that Republicans are hypocrites, which is essentially what she said in this statement:

“A lot of these folks … complain about too much government regulation,” Schultz said. “And here they’re asking: What can the government do? We can’t. … If you want the private markets to work, this is what happens in private markets.”

What type of dipstick thinks that’s what Republicans are talking about? House Taxes Chair Greg Davids wants to expand Minnesotans’ networks by giving them the ability to afford purchasing health care outside of the insurance companies’ networks. That isn’t regulations. That’s changing tax policies to help Minnesota families. Rewriting Minnesota tax policy to allow for HSAs might help. Other remedies might work, too.

If this is true, BCBS Minnesota isn’t being honest:

“And when you call customer service, Blue Cross Blue Shield representatives are telling their patients that absolutely we’re in network for 2017,” Shelton said. “But what they’re not telling us is that they may only be in network for one month. And at that point, they will not have the opportunity to change their insurance.”

BCBS needs to update their customers if they’re misleading them like this. At this point, it’s just an allegation. If this becomes verified information, BCBS needs to be punished.

When open enrollment first came on the horizon, the DFL instantly said that MNsure “only” directly affected 250,000 people. I’ve frequently challenged that assertion because it doesn’t paint the entire picture. While it’s technically true, it’s only true due to the qualifier “directly.”

The secret to the spin is that qualifier. The PR people don’t want others to know that insurance companies losing money in the individual market bleeds into other markets. For instance, Blue Cross lost $500,000,000 on the individual market last year. (That’s why they’ve announced that they won’t participate in the individual market anymore.)

It isn’t a stretch to think that Blue Cross’s $500,000,000 loss last year caused them to cut expenses elsewhere. Unfortunately, cutting expenses carries a human price with it. One of the people affected by Blue Cross’s decision is Sarah Gill, a Kindergarten teacher in the Sartell-St. Stephen School District. Ms. Gill has 3 children, ages 6,5 and 2. Her youngest child, Aiden, “was diagnosed with a rare birth defect called congenital diaphragmatic hernia at 22 weeks gestation and was given a 50 percent survival rate. I chose Sartell Pediatrics in 2013 after learning about Aiden’s diagnosis and I needed a pediatrician who was willing to answer all my questions, close to my home and work, and easily available for appointments. I want my children to continue to receive their medical care at Sartell Pediatrics because of the exceptional care of the doctors and staff there. The doctors and staff know my family and my children’s medical history, especially Aiden’s. Aiden’s diagnosis and medical care is rare and unique and many doctors have not treated patients with this condition. The doctors and staff at Sartell Pediatrics have gone above and beyond for my family.”

Sartell Pediatrics is part of a network called Integrity Health Network. This afternoon, I spoke with Jill Smith, the administrator at Sartell Pediatrics. She told me that IHN negotiates contracts with the insurance companies, which allows them to focus on improving health care practices. She told me “We’re proud to be part of Integrity Health Network and we would like to continue to have them negotiate our contracts with Blue Cross and other insurance providers. Sartell Pediatrics, among the other Integrity Health Network clinics, are some of the most cost-effective providers in the region. Data released by Minnesota Community Measurement in early October highlights Sartell Pediatrics with the 5th lowest total cost of pediatric care in the state. These are good health care providers and we are concerned about the negative impact on access and costs due to Blue Cross’s decision.”

I’ve confirmed that other provider networks are getting dropped by Blue Cross and that they’re being told it’s for financial reasons. Since Blue Cross isn’t in the individual market anymore, their decisions are affecting people not in the individual market. It isn’t a stretch to think that MNsure is just the tip of the iceberg that’s negatively affecting health care in Minnesota. The information I’ve gathered indicates that the money being lost by health insurance companies in the individual market, aka MNsure, is narrowing the size of networks while driving up premiums.

If Gov. Dayton and the DFL don’t step up and fix all of the problems involved in Minnesota’s health care crisis, voters should vote the DFL out of office in 2018. This crisis isn’t just about too-high premium prices. This crisis is about deductibles being totally unaffordable, accessibility being difficult and network and options being too limited.

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David Montgomery of the Pi-Press has done Minnesotans a great service with this article. Specifically, he dug into some statistics that explain why MNsure is failing. These statistics fit into 3 categories in Montgomery’s article: too many sick people, costs vary widely and the “premium cliff.”

Starting with the category titled too many sick people, I was astonished when Montgomery wrote “In Minnesota, for example, the most expensive 20 percent of the population paid about 83 percent of total costs, a 2014 study by the Minnesota Department of Health found, a typical figure for the U.S. The most expensive 2 percent alone accounted for 24 percent of spending.” That’s just the start of the statistics.

Next, he cited the statistic that “But Minnesota’s individual market takes this into overdrive. Just 2.2 percent of the roughly 267,000 Minnesotans on the individual market in 2015 caused almost 50 percent of health costs, a Department of Commerce study found.” Here’s why that last statistic is important:

This 2.2 percent, about 6,000 people, averaged about $100,000 per person per year — a total of $600 million.

The ratio of healthy people to unhealthy people means that insurance companies are paying out huge payments to hospitals. The bad news for these health insurance providers is that they aren’t getting the revenue they expected from policies sold to healthy people. That imbalance creates a crisis that’s impossible to overcome.

The other thing that’s contributing to the crisis many people are feeling is called the “premium cliff”:

So while a 60-year-old St. Paul resident earning $45,000 a year might pay 9.5 percent of his or her income in premiums, that person could pay almost 20 percent of their income in premiums if they earned $50,000 per year, according to data from the Department of Commerce.

It’s even starker for a Rochester resident, subject to that region’s higher premiums. The Department of Commerce data shows a 60-year-old on the individual market could face premiums nearing 30 percent of their income if they’re just over the poverty line.

Remember that this just takes into account the premiums being paid by these individuals. It isn’t factoring in these people’s deductibles. Their deductibles would put these people one catastrophe away from financial hardship.

This isn’t affordable care. It’s expensive care. Think about this: a healthy person living in Rochester making $50,000 a year would pay $18,300 in premiums before factoring in his deductible. That individual is better off paying the fine and saving the money they’d spend on the premiums. If they stay healthy, they’ve saved more than $15,000 by not buying health insurance.

The individual with health issues can’t afford to not buy health insurance. That individual is likely to purchase a gold plan with a modest co-pay rather than dealing with an expensive deductible. This post isn’t complete without this graphic:

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