Is the time ripe for universal coverage? Some health care leaders say yes

Universal health insurance coverage is a far from new idea. It's been debated countless times in the state Legislature and in Congress. But in April, the debate became reality for Massachusetts, when state lawmakers there passed a universal coverage law requiring all residents to have health insurance or face penalties.

Massachusetts' decision re-invigorated discussions in many states, including Minnesota. It also made Mary Brainerd more determined to make her case for universal coverage here.

"We think we're closer to having better answers to make it work in Minnesota because we've got some really good market conditions to start with," says Brainerd, President and CEO of HealthPartners, the state's third largest health plan.

Brainerd says many Minnesota employers, even small ones, still offer health insurance. That's kept the percentage of uninsured people in the state relatively low, at around 7.4-percent.

Brainerd says many of those uninsured people could simply be added to the state-subsidized MinnesotaCare program for low-income residents. That move would cost the state an additional $663 million a year, according to a recent estimate from the Minnesota Department of Health.

Brainerd admits that's a lot of money. She also admits that HealthPartners, which is a health plan that also owns clinics and a hospital, would benefit from insuring these people.

"Would we cover more people? Yeah, and I'd be happy to have more people carrying HealthPartners' ID card and I think that's fine," she says. "But I also think for an organization like us, we see what happens when people show up in our emergency room because they haven't gotten care or treatment elsewhere. And there's simply every bit of evidence that you have longer life, lower health care costs in the long haul and better health if you have health coverage."

The cost is only one hurdle. Another major hurdle is making sure that everyone is covered. Brainerd says universal coverage won't work unless it's mandatory. She acknowledges that requiring coverage won't be popular, especially among Minnesotans who have enough money to buy health insurance, but choose not to.

"I think the most challenging part of it is the mandate, in that most people don't like mandated anything. But you could very clearly tie it to the process of paying taxes and make sure that we, at the time when you submit taxes, you also submit proof of coverage," she says.

...you could very clearly tie (mandatory coverage) to the process of paying taxes and make sure that, at the time when you submit taxes, you also submit proof of coverage.

Brainerd's idea relies on private health plans like HealthPartners to provide coverage. Blue Cross Blue Shield of Minnesota, the state's largest health plan, also supports that approach. Blue Cross has been studying the Massachusetts plan and will release a white paper next month showing ways Minnesota could get to universal coverage.

President and COO Colleen Reitan says the goal is to find a sustainable approach.

"Because you could reform the insurance market and you could get universal coverage, but the question is, is it sustainable? Because ultimately you have to have affordable access to health care over a longer period of time and that's what's going to be sustainable," she says.

In other words, if soaring health care prices aren't reigned in, universal health care coverage won't be affordable in the long-term.

That argument resonates with former U.S. Senator Dave Durenberger.

Durenberger is now the Chair of the National Institute of Health Policy at the University of St. Thomas. Durenberger says people are always looking for the magic bullet that will solve the health care crisis and lately universal coverage has gotten a lot of buzz. But he thinks the idea will be a wasted effort if no one tackles the underlying problems that drive up health care costs in this country.

"We now know that quality varies all over the place. So does the issue of safety inside the system. So do the issues of efficiency and productivity. So universal coverage doesn't get at those kind of things," he says.

In fact some critics believe universal coverage will actually worsen health care quality and efficiency.

"I think it will be bad for Minnesota. I think it will be bad for the nation. But I think the odds are we'll see something like it," says V.V. Chari a professor of economics at the University of Minnesota and an advisor to the Federal Reserve Bank of Minneapolis.

Chari says if more Minnesotans have health insurance, they'll use health care that they don't need and that will overwhelm the system.

"Over the long-term, once you provide universal health insurance, then the demand for health insurance will skyrocket. Then the prices will skyrocket as well, at which point there will be a very substantial, huge demand from the public for some sort of rationing scheme, at which point you will have to have necessarily extensive government involvement," he says.

Chari says in such a scenario the only way for the government to get a handle on rising costs would be to take over and create a single-payer system, which he does not support.

That's not something Mary Brainerd or Colleen Reitan wants to see happen either. A single payer system could threaten their business.

But it's clear that regardless of how most Minnesotans feel about universal coverage, they will likely hear a lot more about it in the months ahead.

HealthPartner's Mary Brainerd says it's no coincidence that she launched her universal coverage campaign with just a few months to go until the election.

"It was a good opportunity to stimulate discussion at a time when people are making decisions about what are their policy priorities and to push that agenda forward. We want this to be an important issue for all of the candidates to address," she says.

Some candidates didn't need the prodding.

In the governor's race, DFLer Becky Lourey and Independence Party candidate Peter Hutchinson have proposed universal coverage plans. DFL endorsee Mike Hatch says he wants to get to universal coverage eventually, but he would rather find savings in the health care system first. Green Party candidate Ken Pentel says he thinks favors a single-payer system. Republican Gov. Tim Pawlenty is worried that universal coverage will be too expensive. He says the best way to make health care more affordable is to reward providers who provide high quality, effective care.

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