2018

Health Care
The National Outlook

Thanks to battles in Washington, health care has been in the news more How are People Insured in the US?
than ever over the past few years. Whatever side of the political spectrum
we fall on, it’s clear that this is a key issue for voters and families in Marketplace
November. It’s critical for candidates to understand the motivations behind 7%
that growing energy, and the options available at the state and federal level
to respond to constituents’ concerns.
Uninsured
9%
Employer
Overwhelming majorities of voters of both parties Medicaid
20% 50%

cite affordability as a top concern

Lowering Out-of-Pocket Costs Top Health Care Priorities Among Partisans,
Medicare
Other Priorities Vary by Party 14%

Percent who say each of the following things should be a “top priority”
for Donald Trump and the next Congress when it comes to health care:

Democrats Independents Republicans When Americans talk

Lowering the amount
individuals pay for
about high health care
health care 64% 65% 70%
costs, what do they mean?
Lowering the cost of 55% 61% 67%
prescription drugs Premiums: Monthly payments for
health insurance. These costs can be
Dealing with the
prescription painkiller 39% 46% 51%
particularly significant for individuals
addiction epidemic and families who don’t receive insurance
Repealing the 2010 through their employer, but make too
21% 32% 63%
health care law much money (over $100,000 for a
Decreasing the role of
family of four) to qualify for subsidies to
the federal government in 26% 34% 50% purchase insurance
health care

Decreasing how much the Cost sharing: Fee paid when someone
federal government spends 31% 35% 43%
sees a doctor, pays for a prescription,
on health care over time
or receives another medical service
including copayments and coinsurance
Americans receive health care coverage from many
different sources The direct costs of care: If a consumer
is uninsured or has low-quality insurance,
they will have no protection from the
About 1/3 of the population is covered through Medicare and Medicaid—
“sticker price” of the health care they use
programs that offer insurance to seniors, people with disabilities and
health care work better for everyone, we
certain medical conditions, and families and individuals who qualify have to understand and harness public
because of their income. demands to drive policy changes.

While most of the recent health care debate has focused on the Affordable
Care Act, only 7% of people purchase insurance through the Marketplaces
created by the law- a number that’s dwarfed by the almost 50% of
Americans covered by insurance offered through their employer.
 2018
Health Care
The National Outlook

Cost is a concern at the state and national level, as well as for individuals and families.
America continues to pay more for health care and gets worse results than similarly
affluent countries

Health Care System Performance Compared to Spending Poor health outcomes

impact individuals and
Higher AUS UK
families negatively, and
health system
performance
NETH they’re also a drag on our
NZ NOR
GER SWIZ economy. This disconnect
Eleven-country average
SWE between spending and
CAN results can be attributed to
FRA several factors:
US
 Fragmentation and lack of
Lower coordination
health system
performance
 Misaligned incentives
Lower health care spending Higher health care spending
 Monopolies and lack of
competition

Note: Health care spending as a percent of GDP.  Inequality in both access to care
Source: Spending data are from OECD for the year 2014, and exclude spending on capital formation of health and other social services that
care providers. impact health

 Inadequate resources for mental

E.C. Schneider, D.O. Sarnak, D. Squires, A. Shah, and M. M. Doty, Mirror, Mirror: How the U.S. Health Care health
System Compares Internationally at a Time of Radical Change, The Commonwealth Fund, July 2017.

Federal and state policymakers both have a role in solutions

At the federal level, some policies require action though
At the state level, elected officials can:
legislation or approval from the executive branch:

 Regulate their insurance marketplace  Certain changes to the Medicaid program or the private
insurance marketplace require a waiver from federal
 Address drug prices rules which must be approved by the Centers for
Medicare & Medicaid Services (CMS)
 Propose some changes to Medicaid—including who it covers
(consistent with federal law) and how it is administered  ERISA laws that govern most
employer sponsored health
 Use a variety of policy levers to incentivize higher value and plans
more coordinated care
 Changes to Medicare
2018 and Beyond
The Minnesota
Health Care Landscape
What makes
How are People in the US and Minnesota insured?
Minnesota unique
US MN
Minnesota has been a longtime
national leader in expanding coverage
and access to health care and, as a 49% 55%
result, boasts one of the highest rates
of insurance coverage in the nation.
14% 15% 19% 14%
Minnesota was the first state to 7% 8% 9% 6%

expand Medicaid under the Affordable EMPLOYER MEDICARE MEDICAID NON-GROUP UNINSURED
Care Act, building on the success of
the state’s historic MinnesotaCare
program, which was enacted in 1992 to
MinnesotaCare, and other public to stabilize Minnesota’s individual
provide a coverage option for low and
assistance programs. In 2020, the 2% insurance market.
moderate income workers who did not
provider tax that fuels HCAF is set to
otherwise qualify for insurance. 94% Early engagement on these
expire, leaving a $241 million hole in the
of Minnesotans have health insurance, issues will be critical to building a
Medical Assistance budget.
which is higher than the national consensus approach.
average of 91%. Minnesotans, on Without the tax, HCAF will not be able
average, are also healthier than those to continue operating at its current
in other states. According to a Kaiser capacity. Minnesota’s elected officials MINNESOTA HEALTH CARE
Family Foundation report, 12.7% of TO DO LIST:
will need to make difficult decisions to
people in Minnesota report having fair decide how to fill this funding gap.
or poor health, which is lower than the  Address immediate issue
national average of 17.8%. Reinsurance: In 2017, the Minnesota  Approaching
legislature enacted a $542 million, two- funding cliff
Minnesota’s year reinsurance program which will
 2019 health care priorities
Health Care Agenda expire in 2019. The program provides
funding to issuers to cover extremely  Modernize access
expensive claims, helping to reduce to patient information
Minnesota has a long history of premiums for enrollees.
bipartisan cooperation to improve  Drug Pricing
the state’s health care system. Those For 2018: Premiums decreased as  Future of Medical
elected to public office will confront an much as 15%, while comparable plans Assistance
immediate challenge next year, along around the country rose by up to a third
with several other short-term and  Long term priorities
long-term challenges and opportunities. For 2019: Based on initial rate filings,  Substance Abuse
Successful solutions will require premiums for the individual market next and Mental Health
continued collaboration and creativity. year will be between 7%-12% lower  Access to care in
than 2018. Rural Areas
Address Immediate Issue:
The Approaching Funding Cliff With the looming expiration of  Health Equity
reinsurance, legislators will need to take
Health Care Access Fund: Care Access action and find additional funding if
Fund (HCAF) is responsible for funding they want to continue the reinsurance
Medical Assistance (MA-Medicaid), program in 2020, or pursue other tools
2018 and Beyond
The Minnesota
Health Care Landscape
2019 Health Care Minnesota’s elected officials can to Medicaid enrollees who are not
Priorities learn from successful legislative currently working or who are looking for
efforts in many other states. Many better jobs.
Modernizing Access to of these proposals may reemerge on
the agenda in 2019.  22,000 Montanans have enrolled
Patient Information
and received employment services
Minnesota is one of two states that
Future of Medical Assistance in the program’s first three years.
requires patients to give individual
The Minnesota state legislature debated
consent to each medical provider to
share their information with other
and rejected legislation to create a work Long Term Priorities
reporting requirement for those receiving
medical providers; other states rely on
Medical Assistance (Medicaid). Other Substance Abuse and Mental Health
the federal Health Insurance Portability
states are contemplating similar policies, Along with the rest of the country,
and Accountability Act (HIPAA).
and this issue could reemerge on the Minnesota is struggling with the rising
 According to a report by the legislature’s agenda in 2019. There incidence of opioid related overdoses
Minnesota Department of Health, are some important considerations for and deaths and deaths from suicide.
the extra step of obtaining this elected officials as they consider this
patient approval makes it more policy, including the administrative costs  In 2016, 395 people died from an
challenging for health care providers that implementation can require. opioid overdose, an 18% increase
in Minnesota to coordinate care, from the year before. 2,074
 Enforcing this type of requirement experienced a non-fatal overdose
and providers sometimes repeat
can require a state to update their
unnecessary tests.
data systems and hire additional  Drug, alcohol, and suicide related
 The legislature previously administrative staff deaths are projected to rise by 37%
considered legislation to align the in the next 10 years in Minnesota
 The Center on Budget and Policy
Minnesota Health Records Act with
Priorities estimates that Minnesota  On average, it costs $22,178 to care
HIPAA, but it was not enacted.
counties (which determine Medicaid for a person with a drug, alcohol,
This issues could reemerge on eligibility) would have to spend or suicide related diagnosis in MN,
the agenda next year as a way to $121 million in 2020 and $163 while the per person cost of health
help health care providers better million in 2021 to implement work care for an average Minnesotan is
coordinate Minnesotans’ health care. requirements $8,871 (Source: Pain in the Nation)

Drug pricing Counties estimate that it will take on

 Many Minnesotans report skipping average 53 minutes to process each
or skimping on their doses because exemption, 22 minutes to refer a client to
the costs of their medications are so employment and training services, and
high 84 minutes to verify non-compliance and
suspend Medicaid benefits
 In the 2018 legislative session, 8
bills to address prescription drug Successful alternative
prices were introduced, including approaches may suggest a path
proposals on price transparency, forward. Montana has implemented
pharmacy benefit managers, rate a work promotion alternative which
setting, and price gouging. None of offers employment services, like
the proposals were enacted. career counseling, on-the-job training
programs, and subsidized employment
2018 and Beyond
The Minnesota
Health Care Landscape

Access to Care in Rural Areas

Minnesota residents living in rural areas A Health Care Agenda for Minnesota
face unique challenges, even though the
state as a whole ranks highly in health- When faced with the task of formulating solutions to address Minnesota’s
related statistics health care needs, we encourage policy makers to consider three questions:

 Those in greater Minnesota are less  Will the agenda help Americans gain or maintain access to an
likely to visit a doctor each year than affordable, regular source of care?
those in urban communities due to
transportation, uninsurance, and  Will the agenda create financially sound policies that will allow
provider network gap issues people to receive necessary care without fear of financial
devastation?
 12% of rural Minnesotans rely on
free or sliding-fee scale public clinics.  Is the agenda politically and economically sustainable?
We expect that cuts to safety net
providers would be especially harmful Building a health care agenda requires tough decisions. As political leaders
to rural parts of the state create their visions for state health care policies, we urge them to challenge
themselves and those they work with to build policies that answer "Yes" to
 1 in 4 rural Minnesotans are
all of these questions, ultimately creating an insured America.
covered by Medical Assistance or
MinnesotaCare. This growing number
is a reflection of many factors,
The map shows how Minnesota’s counties rank in health
including higher rates of poverty, self- outcomes. Measures are based on length and quality of
employment and small employers in life. Lighter shades of green and white represent a better
rural communities Nearly a quarter of performance in the in the measurement and ranking
rural Minnesotans are still struggling Between 2014
with paying medical bills and 2016, the
 1 in 5 rural Minnesotans are not Minnesota
getting needed health services Department
because of cost
of Health gave
$10.3 million
Health Equity
Minnesota as a whole ranks high in in grants to
measures of coverage and health projects devoted
compared to other states but dramatic
disparities still exist within the state. to addressing
While health care access is important, health inequities
medical care accounts for only 10-20%
of outcomes. The other 80-90% is
driven by non-medical determinants
of health such as the availability of
transportation and affordable housing
and access to healthy foods.