Minnesota began its own statewide health reform initiative in 2008, and has readily accepted the federal reform laws. The state has done much to improve access to health care services and reduce the amount of uninsured Minnesotans by innovative methods that correlate with the national plan to change the system. Integrating the Affordable Care Act into the state’s efforts to make health care and health insurance more available, Minnesota lawmakers have been working for the past four years to implement various changes.
State Health Reforms in Minnesota
Many laws the state created echo the endeavors of federal health reform, though Minnesota has paved their own path as a leader in transforming the delivery of health care and reducing costs. One successful attempt to provide greater care for a lower cost was the creation of health care homes. Health care homes are clinics that the Minnesota Department of Health has certified to offer primary care, and are similar to the Accountable Care Organization concept created by the ACA, yet not strictly for Medicare beneficiaries. Since 2008, these health care homes have served over 2 million Minnesota residents at more than 170 clinics, with 1,764 clinicians to provide care.
Human Services Commissioner Lucinda Jesson said, “Minnesota is moving full steam ahead when it comes to reforming our health system so that we pay for quality of care and outcomes for our clients, not just the quantity of procedures,” in response to receiving federal approval for the state’s payment reform for Medicaid. The Minnesota DHS made adjustments to the way Medicaid providers are paid in order to increase the quality of care, health care cost, and overall value. With federal support for this move, the state was able to proceed with the changes more freely. The state payment reform also works like the federal law’s plan to reward providers when they have improved health outcomes while reducing costs.
Minnesota’s health insurance exchange, MNsure, was established as a state-based organization, and received a $42.5 million federal grant in September 2012 to continue development. The exchange is connected to the Minnesota Department of Insurance, and the program has been open for enrollment since October 2013. The health insurance marketplace provides health insurance plans for anyone without access to coverage, specifically, individuals without access to group plans, employees who would rather buy their own plan, and small businesses who want to cover their workers.
Find out more about the Minnesota Health Insurance Exchange.
The state also created a voluntary 1% cap on health plan profits in 2011 in order to save taxpayer dollars, resulting in a $73 million return for the year. This agreement was reached between Health Services Commissioner Jesson, and Medica, HealthPartners, Blue Cross and Blue Shield, and UCare, and proved successful as state and federal taxpayers saved a total of over $600 million. The cap applies only to health plans with contracts created before 2012, and going forward the state will implement competitive bidding for public health plan contracts. An estimated $500 million will be saved for taxpayers over the next two years when this bidding is combined with other efforts to reform managed care.
Federal Health Reforms in Minnesota
Naturally, all of the same regulations apply to Minnesota as other states when implementing the federal provisions of Affordable Care Act. The options given on the state level have been welcomed by Minnesota officials, including Medicaid expansion, which has already begun in the state. Since 2011, Minnesota has offered public health insurance to a wider audience, including adults without children. Early Medicaid expansion has already given 84,000 more Minnesotans medical coverage, and brought savings to the state budget. Starting in 2014, eligibility for the Medical Assistance program in Minnesota continued to broaden as Minnesotans under 65 with income up to 133 percent of FPL are now able to obtain coverage. An additional 57,000 adults in Minnesota can be helped by this expansion if they choose to enroll.
Other implementations of the health care law to take place are the well known individual mandate, which requires most people to get coverage or pay a fine, and guaranteeing availability of health plans, or not rejecting anyone who applies. The latter of the two is the more crucial, as Minnesotans with pre-existing conditions will no longer need to enroll in a high-risk pool and have access to any health plan they can afford. Premiums will also be regulated, as rate increases will not be permitted based on anything other than tobacco use and age. Even those using tobacco can get around a higher premium if they participate in a wellness program with the intention of quitting.
Minnesota has also made changes to the preventive services provided by each insurer, including more services for free with insurance coverage. Essential Health Benefits (EHBs) are a requirement, beginning in 2014, across all health plans in the state, many of which already seem to offer coverage that meets these guidelines. Including EHBs helps private insurers comply with the law and help consumers choose a plan that .
Other reforms have also taken place, such as the extension of coverage till a dependent turns 26 under their parent’s policy, and Minnesotans under age 19 with pre-existing conditions gaining the right to coverage through any insurer. Adults who were subject to rejection before 2014 could gain coverage under the Minnesota Comprehensive Health Association, or the 2010 introduction of the federal Pre-Existing Condition Insurance Plan. MCHA is still open to those who prefer to purchase coverage that may cover more specific health needs than another company.
1. Minnesota Health Reform. “Minnesota Passes Health Care Home Milestone.” http://mn.gov/health-reform/columns/index.jsp.
2. 9 August 2012. Drucker. “State gets federal approval for innovative health care payment reform.” Minnesota Department of Human Services.
3. 27 Sept. 2012. Pollard. “State receives $42.5 million federal grant to advance development of Minnesota-made health insurance exchange.” Minnesota Management & Budget.
4. State of Minnesota. “Dayton Healthcare Reform Saves Millions for Taxpayers.” http://mn.gov/governor/newsroom/pressreleasedetail.jsp?id=102-38112.