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Viewpoint: Health care discussion begins at state Capitol

Tony Jurgens

By Tony Jurgens, House District 54B

According to residents I heard from last fall, the top political issue in Minnesota is lowering health care costs. It's likely to be the top political issue at the state Capitol this year as well, as it should be.

I've heard former Gov. Tim Pawlenty use a three-legged stool analogy when describing health care, consisting of quality of care, access to care and cost of care. We have some of the best quality of care in Minnesota and right now, most areas of the state have access to care. The cost of care is the leg that is still out of whack.

The goal for every lawmaker this session is to improve the cost of care without damaging access and quality in the process.

Two weeks into session, I can already see we're going to have some interesting discussions.

For example, a debate has already begun regarding the provider tax. The tax, also referred to as the sick tax, is a 2 percent tax levied on most patient services in Minnesota, such as doctor visits. It was eliminated as part of bipartisan legislation passed by a Republican-controlled Legislature and signed into law by former Gov. Mark Dayton in 2011. On Jan. 1, this tax on patient services will disappear.

Or maybe not. Gov. Tim Walz has already said it's a "nonstarter" to end the tax, and the DFL House Health and Human Services Finance Chair said it was "essential" to restore the tax or replace its revenue, which currently helps fund programs such as MinnesotaCare. If the Legislature revisits this topic, does not allow the tax to sunset and reinstates it, the cost to patients is estimated at more than $600 million a year.

Speaking of MinnesotaCare, which is a state health insurance program available for low-income residents who cannot afford MNsure, legislation has already been introduced to expand this program as a buy-in option for those on the individual market.

Proponents see this as a cure-all to Minnesota's individual market ills. Opponents note the low reimbursement rates associated with the program would make it difficult, if not impossible, for some health care providers and hospitals to stay afloat (which would impact access to care in some parts of the state); would negatively impact the private insurance market; and take another major step towards government-run health care.

The key will be finding a solution that ensures a program remains in place to help those in need.

Finally, there is the issue of reinsurance. From 2014-17, average rates on the individual market increased by double digits every year, including up to 67 percent for 2017. That's why lawmakers approved a reinsurance plan two years ago. It was designed to stabilize premiums by mitigating the impact of high-risk individuals, or those who are the most sick, on the individual health insurance market.

It worked. Last year all five carriers on the individual market lowered premiums for 2019, with average rates dropping between 7.4 percent and 27.7 percent.

Despite this, reinsurance was a hot topic in many House election campaigns — mine included. Under the guidance of now-Minnesota House Speaker Melissa Hortman, reinsurance was labeled as bad news, mischaracterized as giving insurance companies a $500 million blank check "with virtually no strings attached."

Yet at a recent Minnesota Chamber of Commerce dinner, Hortman was asked if reinsurance should be continued. She said "yes."

If you enjoy political drama, the possibility now exists that those who ran against reinsurance on the campaign trail could now end up voting for it. Stay tuned.

Politics and legislation aside, understand that every Republican and Democrat at the Capitol wants to improve your health care and lower your costs. The tough part will be deciding how we go about it while maintaining the quality and access of care. I look forward to seeing how these proposals progress through the committee process, and will keep you updated as session moves forward.