Ensuring access to affordable health care is one of the most complex but critical challenges that Minnesota policymakers face. So they should seize the opportunity to act when a rare, straightforward solution comes along.
One of these "low-hanging fruit" moments may be at hand — getting uninsured Minnesotans enrolled in public medical programs they're already eligible for — in the aftermath of a recent Department of Health report on the state's uninsured. From 2015 to 2017, the percentage of Minnesotans without health coverage rose from 4.3 percent to 6.3 percent, according to the department's biennial survey.
The report called it one of the state's "largest one-time increases in its uninsurance rate." While this important measurement is still an improvement over rates seen in most years since 2001, the trend is disturbing and threatens to roll back the historic coverage gains made after the full rollout of the Affordable Care Act in 2014.
Broad disagreements remain over health care and, specifically, former President Barack Obama's signature health care law. But there should be common ground that the goal is to move forward and get the uninsured rate as close to zero as possible.
The report ought to be required reading for Minnesota legislators. It points out the reasons why more people are without coverage — among them, the cost of monthly premiums and the move toward a "freelance economy" where more people do not have access to employer-provided coverage.
At the same time, a stunning data point in the report points clearly toward a reasonable state-level fix. "A majority of uninsured Minnesotans, 51 percent, were potentially eligible for coverage through state programs, Medical Assistance and MinnesotaCare.'' Medical Assistance is the state's name for Medicaid — the joint state-federal program that provides coverage for the poor, disabled and elderly. MinnesotaCare is the state-run program that helps those who earn too much to qualify for Medical Assistance but still struggle to afford private insurance.
It's long been true that many uninsured Minnesotans are eligible for these public programs. Why the 51 percent unenrolled-but-eligible group — about 178,000 Minnesotans — have not signed up is unclear.
Intriguing data from MNsure, the state's health care marketplace, offers insights. MNsure advertises core services: helping consumers comparison shop and qualify for financial assistance to buy private coverage. During marketing pushes in the 2016-17 open enrollment period, the average number of enrollments rose between 48 and 62 percent daily.
While counties, tribes and other organizations do heroic community outreach to inform Minnesotans about public programs, the state Department of Human Services does not have an advertising budget for MinnesotaCare or Medical Assistance. Perhaps it should, given the stunning number of Minnesotans who are unaware of this path to coverage.
Concerns that should be aired include the cost of adding enrollees to these programs and the dollars required for a marketing campaign. Enrolling everyone in the 51 percent group would increase the two programs' total enrollment by roughly 15 percent. While the federal government shoulders the majority of the cost of these two programs, the state also shares responsibility. It is difficult to know what the cost would be without knowing which program enrollees would be eligible for.
It's important to note, however, that the programs' existence already answers the question about whether the programs should serve the 51 percent group. And going without coverage carries serious risk for families. Nor do uncompensated care costs that they incur magically disappear.
Insurance plays a critical role in providing preventive, usually less expensive medical care. Coverage helps kids grow into productive adults. It's time to seriously consider the return-on-investment from stronger marketing of Minnesota's two main public health programs.
