Health care reform policies and implementation

¶ … health care reform has been a hot button issue across the United States in the form of the Affordable Care Act (ACA) but in the State of Minnesota it has been a hotly contested since the passage of the 2008 Minnesota Health Care Reform Act (Gray) and, most recently, with the extension of the General Assistance Medical Care program (Minnesota Department of Human Services). The fate of the ACA will soon be determined when the U.S. Supreme Court announces its ruling on said Act's constitutionality. The Court's ruling will have a profound effect on the delivery of health care throughout the nation but regardless of how the Court decides health care in the State of Minnesota will be altered.

On the national level, health care has been hotly debated but it has also been a contentious issue within the State of Minnesota as well. The legislature in Minnesota has been aggressively addressing the problems inherent in the delivery of health care services in the state but the changing political climate within the state has altered the playing field and it has caused an aura of uncertainty to exist within the state. In the past several years, new legislation such as the 2008 Health Reform Act and the General Assistance Medical Care has been enacted in an effort to widen the availability of health care within the State of Minnesota. Unfortunately, the executive branch and the legislative branch have not always been in agreement relative to the application of such legislation. As an example, in late 2009 then Governor Tim Pawlenty used his line-item veto authority to fully eliminate the General Assistance Medical Care (GAMC) program and the House of Representatives was unable to override Pawlenty's veto (Berkel). The result of Pawlenty's action was to abolish medical services for over 77,000 low income Minnesotans who had become accustomed to the receipt of the program's services. Pawlenty argued at the time of his veto that nearly all those denied services through the abolishment of the GAMC program would be eligible for alternative Minnesota programs but the premiums in these other programs proved to be too expensive. The result was that a large number of Minnesota residents were suddenly left without healthcare and pressure was again placed on emergency rooms to serve as primary care centers in addition to serving as trauma centers.

Since that time, Pawlenty has left office and the present administration, led my new Governor, Mark Drayton, has established a different approach to the delivery of health care in the State. Drayton signed an Executive Order that established a special Task Force to investigate and recommend strategies to improve the overall delivery of health care in the State of Minnesota. One of the recommendations coming out of this Task Force was the state's participation in a state insurance exchange. The State has been involved in the creation and operation of such an exchange for a number of years and has actually operated a private exchange with some limited success for a number of years but a full scale exchange required extensive funding. In February of 2012, the federal government, as part of the ACA, awarded Minnesota a $26 million grant that will assist the state in creating a full-scale state insurance exchange. The federal grant will enable the state to develop the software needed to allow Minnesota citizens to make educated comparisons between the different health insurance plans that exist throughout the state.

The receipt of the funds, however, does not completely alleviate the situation. Thousands of Minnesota citizens remain without medical care or the means of paying for it. The exchange is offered as a method of assisting state residents in purchasing health insurance but it does not address the actual delivery of health care. The cutbacks in the GAMC program which were initiated by the Pawlenty administration caused a severe shortage in the delivery of health care services for the state's low income citizens. Governor Drayton's administration extended the program and replaced some of the cuts but has met up with opposition from the Republican controlled legislature. This opposition has been extended to the implementation of the insurance exchange program as well.

Despite of the receipt of federal funding to assist in the set-up of an insurance exchange program, the Minnesota legislature is not cooperating with the Governor Drayton's plans to design a program. Instead, in a classic example of partisan politics, the legislature is going forward with its own plans to design an exchange program. In doing so, the legislature is placing the State of Minnesota in a position of possibly losing the grant provided by the federal government. According to the grant provisions, the state must show it can operate an effective exchange program by the end of calendar year 2012 or the federal government under the terms of ACA will impose a one size fits all exchange on the state. Even the state's most conservative political groups oppose this happening and advocate that the state's executive and legislative branches cooperate in formulating an acceptable state exchange program.

The effect of this political wrangling has created a feeling of uncertainty regarding health care in the State of Minnesota. Although the state has been aggressive in its attempts to address health care concerns, the affective result has not been much different than the rest of the nation. In Minnesota, a significant percentage of Minnesotans lack health insurance coverage; a significant number of individuals have no access to medical treatment; and the entire population must face spiraling health care costs. These problems compound each other. As medical care becomes more expensive, obtaining health insurance becomes less affordable. The dilemma is that covering everyone will increase costs for taxpayers and people who already have coverage. Herein, is the problem that confronts the health care situation in Minnesota and elsewhere.

On a daily basis, the present health care situation does not affect most health professionals. Patients still need treatment and for most health care professionals that is their only concern. Unfortunately, the larger picture demands radical change.