Health care becomes flashpoint in Minnesota governor’s race

October 11, 2018

Health care has emerged as the most contentious issue in the Minnesota governors race, as both candidates grapple with the bedeviling details of a system that is both worrying to families and phenomenally expensive to taxpayers.

Republican nominee Jeff Johnson and U.S. Rep. Tim Walz both say that all Minnesotans even those with pre-existing conditions should have access to affordable health care.

Thats where the agreement ends. A fiery exchange at a debate in Willmar on Tuesday drove home the divide, and Johnson also criticized Walz over health care earlier in the day at a news conference.

Johnson, a Hennepin County commissioner, has been hitting Walz for favoring what he calls a single payer health care plan.

We have to understand what single payer means, Johnson said. We all lose our insurance and are forced on to one government plan.

Single payer advocates use Medicare the government insurance program for Americans 65 and older as an example of how socialized insurance can cover all Americans at lower cost than the current private system.

Johnson cites Walzs answer to a questionnaire from a progressive group: We also recognize that expanding Minnesotas public option is just a start, ultimately, we need to enact a single-payer system, and as Governor I will fight to put us on a path toward single-payer health care.

In a recent interview, Walz cited statistics showing Americans spend twice as much for health care as the rest of the industrialized world, often for inferior results. He said he views Medicare access for all Americans as an inevitability, but on a national, not a state level.

Asked if he would make it a priority at the state level, Walz said, This is a difficult one. California tried to do it. Vermont tried to do it. Both gave up on the effort.

For the moment, Walz is proposing a plan that would mimic one offered by DFL Gov. Mark Dayton, which would allow all Minnesotans to buy into the public health insurance program that is currently reserved for the working poor called MinnesotaCare, giving all residents a public insurance option.

Johnson attacked the proposal this week by arguing that because MinnesotaCare pays lower reimbursement rates than private insurance, rural hospitals and health clinic could face financial ruin if thousands of Minnesotans are using the new government insurance option. He cited the Minnesota Hospital Association, which opposed Daytons MinnesotaCare buy-in proposal.

Wendy Burt, vice president of the hospital association, said the group is bipartisan, does not endorse and has made no determination about Walzs plan. Burt said the hospital group has made no claims about whether hospitals would close if more people were enrolled in MinnesotaCare. We dont know that. We havent said that, she said.

(The hospital association comprises 142 institutions, nearly all of them nonprofit. Some are owned by insurance companies which would be in direction competition with the expanded MinnesotaCare.)

While the hospitals oppose the Dayton MinnesotaCare buy-in, they also oppose aspects of Johnsons plan.

Johnson said he wants to give consumers more choices, including buying so-called skinny health insurance plans, which are less expensive but do not offer comprehensive health benefits.

Walz, who voted for the Affordable Care Act and then voted dozens of times against repealing it, pointed out a potential problem with this approach during the Tuesday debate: Lets say Im 28. You decide Im healthy. Im fine. You dont buy into the (insurance) system. The pool shrinks. The pool shrinks. The pool shrinks. Rates go up.

In other words, if younger, healthier customers opt-out of comprehensive health coverage, the remaining older, sicker customers will have to pay significantly more to account for higher risk.

Burt said the hospital association is also opposed to this idea because it could hurt bottom lines: If youre 27 and you get in a motorcycle accident and you dont have (comprehensive) coverage, guess who pays for that health care? The hospitals.

The Affordable Care Act required individuals to have comprehensive coverage, a mandate that Congress repealed in 2017. But the law also forced insurers to take on all customers, even high risk customers with pre-existing conditions.

Johnson said he would like to see Minnesota return to a system in place before the Affordable Care Act, in which people with pre-existing conditions who could not get coverage anywhere else could enroll in a program called the Minnesota Comprehensive Health Association (MCHA). The government-chartered nonprofit provided coverage to those who couldnt get private market coverage. Insurance companies and policyholders funded it, but premiums were higher than market rates. MCHA needed three cash infusions just to stay afloat.

Even with help from the taxpayers, enrollment was steadily declining as premiums increased, and when it closed there were only 20,000 Minnesotans covered.

Johnson and Walz differ on another key state health care issue. A tax on health care providers thats used to pay for health care programs is set to expire at the end of 2019. Walz wants to extend it. Johnson wants it to end on schedule. It currently brings in $700 million per year and is funding insurance for low, middle and even upper-income Minnesotans in the individual market. In 2017-18, for instance, the Legislature spent $543 million to pay off insurance companies most expensive claims, which helped stabilize the market and reduce rates this year.

Much of the health care debate between Walz and Johnson is actually a return to a contentious argument that has roiled American politics for a decade: the Affordable Care Act, also known as Obamacare.

During the debate Tuesday, Walz said that since its passage, the number of Minnesotans in Kandiyohi County without insurance dropped by half. Statewide, the number of Minnesotans without insurance before Obamacare was 8.2 percent. It dropped to 4.1 percent in 2015, but last year jumped back up to 6.3 percent.

Johnson said since Obamacare rolled out, Minnesota has been mired in mediocrity.

We kind of got sucked down to the same level as everybody else and now we dont do it better than everybody else anymore, Johnson said.

Data from the federal government, however, indicates that Minnesota continues to lead the nation in health statistics, including life expectancy and access to health care.

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