Editorial: Healthy children mean a healthy future

12/24/2006

Note to Legislature: Cover all kids.


Star Tribune Editorial
Published: December 24, 2006


In 1992 a bipartisan group of legislators had the radical notion that Minnesota should emulate the grown-up nations of the world and make health insurance available to everyone. They created MinnesotaCare, which combined state subsidies with patient premiums so the working poor could buy into local health plans.


It worked. Within a decade MinnesotaCare covered more than 150,000 people, helped make Minnesota No. 1 in insurance coverage and gave the state a national reputation for social innovation. And it didn't break the bank: Minnesota came closer than any other state to achieving universal coverage, yet its medical spending, public and private, is only a tad above the national average.


Then came the backsliding. By 1995, lawmakers had backed down from the goal of universal coverage. In 2003, trying to balance the state budget, Gov. Tim Pawlenty borrowed millions of dollars from MinnesotaCare's "health care access fund" and cut thousands of families from the program. Minnesota still has the nation's lowest uninsured rate, but that number is creeping upward. Just since 2001, the number of uninsured children has climbed by more than 11,000 to an estimated 73,000.


This makes no sense. A state that cares about its future cares about its kids. Children without health insurance are less likely to get basic preventive care, less likely to perform well in school and more likely to develop costly, chronic diseases as they grow up. States such as Massachusetts and Illinois have recognized this reality and forged ahead while Minnesota was twiddling its thumbs.


Now, as the 2007 Legislature assembles, Minnesota seems to have reached a wise consensus -- from the governor to the Children's Defense Fund -- that universal coverage for children is both a good idea in itself and a starting point toward coverage for everyone.


The trick will be to offer real insurance -- not a few vouchers for a few families to buy skimpy coverage -- without breaking the state budget. But that's not impossible if legislators remember a few key points:


• Nearly 80 percent of uninsured children already qualify for the state's existing programs, MinnesotaCare and Medical Assistance. Simply dismantling barriers that the Legislature itself erected -- a 24-page application form, absurd waiting periods -- would enable thousands of families to enroll or retain coverage. Lawmakers should also restore outreach funds they cut in 2005, making it easier for families to enroll at church, the supermarket or the local clinic.


• Minnesota has the money. The MinnesotaCare provider tax produces an annual surplus of $50 million to $100 million -- if lawmakers would quit raiding it for other purposes. Combined with federal matching funds, that's probably enough to do the job.


• Any new plan must, nevertheless, include cost-containment measures such as uniform billing and electronic medical record-keeping, or else the costs could become prohibitive.


Fiscal conservatives will object that Minnesota already is too generous. They haven't looked at the numbers. Minnesota has fewer people on public health insurance, as a share of its population, than the national average. It also spends less on subsidized care, as a share of its budget, than the national average.


Social conservatives will object that Americans should buy coverage in the private market. That's a fine philosophy, and it works with cars and TV sets. But decades of experience in every modern nation shows that it doesn't work in medicine. Minnesota figured this out more than a decade ago, and it's time to honor that wisdom.