If you’ve struggled with finding and affording health coverage, recent U.S. Census numbers probably won’t be much of a surprise.
Nationwide, the number of uninsured increased to a record 47 million, a jump of 2.2 million since 2005. Here in Minnesota, the number of uninsured increased from 7.9 percent in 2005 to 9.2 percent in 2006. That brings the number of uninsured Minnesotans to 465,000.
The concern with these numbers is that Minnesota has historically been better than other states when it comes to access to affordable health care coverage. Since the early 1990s, we’ve ranked at or near the top when it comes to the percentage of our citizens who have health insurance.
That can be attributed to innovative policies of the state and the health care community. We were leaders in the creation and use of HMOs and our MinnesotaCare program was once hailed as the great hope for universal coverage when it was established back in the early 1990s. Unfortunately, universal access to the program was pulled out of the MinnesotaCare legislation in order to ensure that it would pass. Despite MinnesotaCare’s success, it remains limited.
These days, the great challenge of reducing the number of uninsured and achieving the Holy Grail of universal coverage is reducing overall health care costs. Buried in the data of the census report is the grim news that fewer and fewer employers are offering paid health care as benefit.
Of course, this is worse in rural areas of the state. Only 38 percent of employers in Greater Minnesota are able to afford health benefits for their workers, something that is only going to get worse as options for coverage vanish. Individuals in rural areas are also more likely than urban residents to be insured by public programs or have individual insurance (rather than employer-sponsored insurance). In 2004, only 77 percent of rural Minnesota residents had employer-offered insurance, compared to 81 percent in urban counties.
Part of the reason health care costs have increased so much over the past decade is that providers are rewarded for treating catastrophic illnesses rather than keeping patients healthy. That means doctors don’t have an incentive to spend enough time with patients to make sure they’re staying healthy in the first place.
For example, a hospital and heart surgeon are going to make more money by putting stents in a patient than they would preventing that patient from needing stents in the first place.
The silver lining in all this is that if any state can get it right, Minnesota can. We’re in a better position to do it because of our history of innovation in both the private and public health care sectors.
Most of the state’s clinics, health care networks and hospitals are already set up in a way that they can coordinate care for individuals, creating what health care professionals call a “medical home” where patients are linked to specialty care and support services through their primary care physician or clinic.
This means that doctors can focus on prevention, health education and chronic disease management and reduce or eliminate reduce duplication of services (tests, scans, x-rays, etc.), as well as gaps in care.
This is particularly important for people with chronic illness. In a medical home, care comes together and all the patient’s medical needs are met within a single facility. That focus makes sure that patients with manageable diseases like diabetes are exercising, watching their diet and monitoring blood sugar, which in turn prevents unnecessary trips to the emergency room or extended stays in the hospital.
St. Mary’s Duluth Clinic, Park Nicollet in Minneapolis and Rochester’s world-renowned Mayo Clinic all have done ground-breaking work in this area and provide a number of models for our health care system.
Minnesota is also in a good position because of the long-standing public-private partnership when it comes to health care. For all of the assaults on it over the past several years, the state’s MinnesotaCare program remains a model for providing affordable and quality care to working families priced out of the private insurance market.
MinnesotaCare will continue to play a big role in future reforms, in a large part because rural communities are going to need to special focus because of the shortage of providers in rural areas. MinnesotaCare already serves as a link to specialty care and support services for rural patients, much the same way that private clinics do in Minneapolis, Duluth or Rochester.
All that’s missing right now is leadership. Most of the medical community recognizes that reform is needed. The public, in poll after poll, shows a hunger for change.
After a decade of stagnation and satisfaction with the status quo, we have an opportunity to reestablish Minnesota as a leader in health care reform and innovation. We just need to demand it.
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