Minnesota has a long and proud tradition of providing health care coverage, not just for those who can afford it, but for people in need. With the passage of the Affordable Care Act, our state will be able to provide health care coverage to another 120,000 Minnesotans by 2016 through an expansion of Medicaid, with all of the cost picked up by the federal government for the first three years and 90 percent after that.
Many of those newly eligible for Medicaid are already eligible for or receiving MinnesotaCare, a program that costs state taxpayers significantly more money and offers fewer benefits than Medicaid. The bottom line – expanding Medicaid is a greater value for Minnesotans at a lower cost to the state.
It’s a deal few could pass up.
That’s what makes Rep. Sean Nienow’s recent commentary opposing the expansion so puzzling (“Without an audit, Medicaid expansion shouldn’t proceed,” July 2, 2012). Nienow’s assertions that Minnesota’s Medicaid program is somehow not sound enough to build upon are flawed on several fronts.
While it is true that our Medicaid spending is higher than other states, this is for a very sound reason. Minnesota has consistently chosen to cover more people with disabilities and the elderly, beyond what is required by the federal government. It’s part of our culture to take care of the elderly, children and others who are vulnerable. Our legislature has decided that paying for optional Medicaid benefits such as prescription drugs, eyeglasses and inpatient psychiatric care for children is worthwhile. Choosing to spend more on people in need is a policy decision we can debate, but to suggest it is fraud is a faulty conclusion.
Senator Nienow makes two points we can agree on: the need to become smarter purchasers of health care and the constant need for greater transparency and accountability. Minnesota has already started to address both. Governor Mark Dayton has explicitly offered to open the books to anyone who wants to audit the past 10 years of Medicaid spending. Since taking office, the Dayton administration has taken a number of steps to strengthen Minnesota’s Medicaid program:
• We have increased accountability. Republicans and Democrats came together last session to support third-party audits of the state’s health plans, as well as a study of whether the existing managed care program is bringing value to taxpayers. Just as we worked together to require these audits, we expect to work together to address any weaknesses these audits identify. The Department of Human Services also established an Office of Inspector General to detect and go after fraud where it exists.
• We have increased transparency. Governor Dayton, through executive order, also established a public website with a wealth of information about health plans and their finances, contracts and health performance outcomes. DHS is developing a comprehensive managed care report that will be issued annually, beginning later this summer. The report will be in a format easily understandable to the public, including summary analysis of each plan.
• We have introduced competition. For years, Minnesota paid health plans based on their previous costs. This year, DHS required health plans to compete for the state’s business – reaping hundreds of millions of dollars in savings. Competitive bidding began in the Twin Cities, our largest market, and soon will begin in other parts of the state.
Should we expand Medicaid? Consider the perspective of the 84,000 Minnesotans who have gained health care coverage under early expansion, which allowed states to extend coverage to people with incomes up to 75 percent of the poverty line. Or, consider the perspective of just one Minnesotan: the construction worker who was unlucky enough to lose his job and get sick, for example; or the woman who struggles with mental illness but cannot afford to pay for the medication necessary to treat it. From each perspective, the answer is clear: the Medicaid expansion allowed by the ACA is the right path for Minnesota.
Providing health care to Minnesotans improves lives. That’s why Governor Dayton made early Medicaid expansion one of his first acts in office, and why it’s important to take advantage of the opportunities for further expansion of Medicaid under the ACA. We will continue efforts to ensure program integrity in Medicaid, but to delay and deny thousands of Minnesotans the health care they need would allow the politics of obstruction to win the day. This is not the Minnesota tradition; we owe the people better.