Improving Health Care Access
Health Care Reform• Following Our Lead |
Minnesota has some of the highest levels of insurance coverage in the country at around 93 percent. This success can be attributed to strong public programs, extensive employer-sponsored coverage, and a culture that fosters innovation and quality in care delivery.
Yet the state is home to some of the nation’s greatest health disparities, with minority populations experiencing lower coverage rates and worse health than the overall population. Other groups most likely to be uninsured include recent immigrants, young adults, and low- and middle-income families.
“Any health reform aimed at increasing access to health insurance will have an impact on reducing health disparities in Minnesota,” says SPH associate professor Kathleen Call. “While efforts to expand coverage are a step in the right direction, attention to cost and quality will also be needed.”
For the past 14 years, Call has worked with the Minnesota Department of Health to survey Minnesotans on their health insurance coverage. That work has given state leaders a clear picture of coverage and where improvements need to be made.
The survey data has, in part, led to a $9.5 million initiative to reduce health disparities among Minnesota’s populations of color and American Indians by 2010. Florida is the only other state to enact a similar legislation. Launched in 2001, the state-funded Eliminating Health Disparities Initiative demonstrates Minnesota’s “longstanding history of trying to tackle health disparities,” says Call. “We’ve already seen some success.”
Minnesota is one of nine high-coverage states singled out for federal support with the goal of insuring the state’s entire population. First-year funds of $4.6 million—with the potential for $35 million over five years—will provide preventive health care to those who are not eligible for public programs and unable to afford private insurance. “It’s that last push to get to universal coverage,” says SPH associate professor Lynn Blewett, whose team at the State Health Access Data Assistance Center (SHADAC) will help evaluate the program.
At the national level, the outlook for universal coverage is not as promising. The proposals moving through Congress would reduce the nation’s 46 million uninsured anywhere from 17 million to 36 million, depending on the bill. But any proposal is better than none; if no reforms are passed uninsured rates are estimated to hit 54 million by 2019—around 16 percent of the total population.
Plugging Away at Health Care Reform
While achieving universal coverage, introducing a public option, and truly reforming the way care is delivered do not appear to be likely in this round of legislation, some sort of bill will pass. For some experts, just moving forward is promising.
“If we can get a toe hold in the process and get a bill passed, we can work on reforming the system to make it more efficient,” says Blewett. “We can continue to push for at payment reform, cost containment, and access expansion.”
SPH assistant professor Jean Abraham agrees. She recently returned from a year in Washington where she worked on the President's Council of Economic Advisers (see sidebar). “It’s not really about getting health care reform done this year. “It’s about getting it started,” she says.
It has been a long time since health care issues have been so visible, both in Washington and across the country. “We’ve had a good national discussion,” says Blewett. “But people like me will continue to work on health care reform when it no longer makes front-page news.”
Lessons from the West Wing
Over the past year, SPH assistant professor Jean Abraham served in Washington, D.C., as one of ten senior economists on the President's Council of Economic Advisers. Working in a nonpartisan capacity under the Bush and Obama administrations, Abraham was tapped for her expertise in health economics and policy.
She was charged with examining the economic implications of different aspects of health care reform such as a public option and insurance exchange. She also studied ways to pay for health care reform through changes to Medicare and Medicaid and through other revenue streams—an exercise that taught her to round dollar amounts in billions.
Q: What surprised you about your experience in Washington?
A: I learned that politics can trump good economic policy. For example, we had some good ideas on how to change the formula the federal government uses to reimburse states for Medicaid costs as a way to reduce geographic variation and generate savings. But the political insiders rejected the idea, saying that certain senators from higher-cost states would never support it. The discussion just stopped immediately.
Q: Did you gain any insight to the White House’s role in health care reform?
Contrary to media reports, there is a lot of communication between the administration and the Hill. The criticism that President Obama didn’t put up his own plan—that was a strategic decision. But one should not assume that the administration was sitting idle. There are actually dozens of people [in the administration] working on health care reform—on issues of [economic] modeling, budgeting, and idea formulation. Much of that work is communicated to congressional staff members on a daily basis.
Q: What do you say to critics who say we can’t pay for health care reform?
Whether we can pay or not is a subjective answer. It’s all about what you think of the distribution of wealth in the United States. But the issues of cost and coverage are linked. If we expand coverage, we have to recognize that we must deal with cost. Even if we don’t expand coverage, as long as health care costs continue to outpace overall economic growth, we are going to face serious decisions about taxes, other government spending, and budget deficits.
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