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Supporting a State-Based Mandate for Health Insurance – A Bi-Partisan Approach

Supporting a State-Based Mandate for Health Insurance - A Bi-Partisan ApproachEvery now and then, I will read something relating to healthcare policy that makes some sense to me, regardless of the writer’s political perspective. I don’t spend much time writing about healthcare policy issues, primarily because the politics of enacting anything that makes sense is, at best, a crapshoot, and, at worst, a waste of my time – and yours! I’ll leave this discussion to the ‘policy wonks.’ Additionally, the legacy lobbyists are thick in Washington and state houses determined to control the process of what eventually becomes policy – usually for the betterment of their own interests. They also have a stockpile of financial resources to ensure their insulated world does not become too disrupted anytime soon.

There, I said it.

The new tax law ends Obamacare’s requirement that nearly all Americans purchase health insurance coverage or pay a fine. With this, I do expect to see some states search for ways to shore up their individual health insurance markets by passing their own state-level mandates to keep many of their residents insured. In addition to Massachusetts’ mandate dating back to 2006, other states such as California, Washington, Maryland, and the District of Columbia may take measures to pursue their own specific mandates.

In the December 28 ‘Editorial Counterpoint’ found in the StarTribune, Minnesota state senator (and physician), Scott Jensen, a Republican from Chaska, wrote a piece, ‘Why we should start talking about a state mandate.’ Jensen suggests that Minnesota-elected leaders begin discussion on establishing a state mandate for individual healthcare insurance coverage – because it is the right thing to do. Jensen does a wonderful job of reaching across the aisle to do something they were elected to do.

I particularly appreciate the bipartisanship approach Jensen gives to this discussion – which is a great way to begin 2018. Instead of paraphrasing his editorial, I have included the entire article. By the way, for those of us from Iowa, just insert ‘Iowa’ whenever you see ‘Minnesota’ – including references to the Governor. Do I advocate that Iowa embrace all of the specifics as described by this elected MN official? Not necessarily. But I do support his attempt to find common ground on a topic that has become too polarized and unsustainable for most every state.

Scott Jensen’s Editorial

Helping someone at the scene of a recent auto accident sparked in me a resolve to publicly address health care costs and universal critical care coverage. I firmly believe Minnesotans want their elected leaders to stop drawing lines in the sand, stop the partisan quibbling, redouble their efforts to get something done with the health care crisis and do it in the coming 2018 session.

I have been asked if I would support a discussion regarding a state-based mandate for health care (“After lost mandate, what’s next for care?” editorial, Dec. 24). Yes, I would engage such a conversation — why wouldn’t I? Health care is infected with big problems, and easy solutions are not looming on the horizon. Legislators are in no position to close their minds to an idea that has received support from both sides of the aisle over the last 30 years.

In 1989, an individual mandate to purchase health care insurance was championed by the politically conservative Heritage Foundation when Stuart Butler wrote: “If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate, but society feels no obligation to repair his car. But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance.”

An individual mandate resonates with conservative principles of personal responsibility, and comparisons are often made to similar requirements for auto insurance. But it is crucial to realize that an individual mandate requiring insurance companies to include too many “essential” benefits will likely sabotage the affordability and sustainability of such a mandate. Patients are capable of championing their own health care, and they should be allowed to choose what they want to buy. Teetotalers should not be forced to buy inpatient chemical dependency coverage, and seniors may want to invest their dollars on maladies of aging rather than prenatal care. Choice matters!

Public and private entities have both indicated strong support for a health care insurance mandate. Brainstorming and discussion may help create a blueprint for catastrophic coverage for such essentials as hospitalization, access to generic and select trade name medications, emergency room visits for true emergencies and mental health problems. (Please trust my 30 years in the trenches on at least this one point — no one knows when a mental health crisis might occur, so coverage of some sort is indeed essential.)

Let’s not forget that Medicare started in 1965 as a limited part A hospital-only plan and it grew thereafter. We can take a lesson from this initiative. Just because we can’t do everything doesn’t mean we shouldn’t do something. Indeed, we should do it now.
As a starting point, maybe everyone can agree that people should not die on the streets from heart attacks — but also that not every wart, runny nose or incidental hernia needs to be paid for by a third party.

But a mandate for health insurance is just one idea needing to be explored in the coming months, and individual coverage is not the only sector of the insurance marketplace clamoring for attention. Employer-based insurance is experiencing its own escalating affordability crisis. Some earnest soul-searching needs to happen at the Capitol — soon!

The Senate Select Committee on Health Care Consumer Access and Affordability has deliberated on numerous cost-reduction issues, including pharmaceutical prices, narrow networks, transparency of fees, low-value services, end-of-life decisions and protecting patient-doctor relationships.

As elected leaders, we need to roll up our sleeves and get the job done. If we don’t, we will have failed our constituents.

Hospitals all over the state are in trouble financially because too many bills go unpaid and charity care is crippling their ability to respond to community needs.

Parents and patients are being forced to make impossible choices as to whether critical medical care for their children or themselves should be subordinated to paying bills or house payments — a health crisis should not invoke fear of bankruptcy or a second mortgage.

Home health aides work for $12 per hour with no benefits, and the shortage of these compassionate servants intensifies while the sick and infirm pray for help and a bath.

The time has come for statesmanship — and this will require attention to patient choice, unintended consequences, sustainability, representation from both parties, civil tongues, and a passion for what best serves our state, our nation and the common good.

(Maybe now is the time for Gov. Mark Dayton to take the lead and host a breakfast with Senate and House leaders from both sides of the aisle to determine the level of resolve for addressing our health care crises in 2018. I suspect such a meeting would be more fruitful if cellphones, egos and sound bites are checked at the door.)

Final Comment

The best way to help individuals buy health insurance is to find ways to reduce the cost of it, such as disrupting how healthcare is both delivered and paid. This will require consensus from both sides of the aisle and willing stakeholders to disrupt the status quo.

In the meantime, we can periodically learn from our neighbors to the north.

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