A bill for an act
relating to health; conducting an analysis of the benefits and costs of a universal
health care system to assist the legislature in comparing it to the current public
and private health care financing system; requiring a report; appropriating money.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
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(a) "Total public and private health care spending" means:
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(1) spending on all medical care including but not limited to dental, vision and hearing,
mental health, chemical dependency treatment, prescription drugs, medical equipment and
supplies, long-term care, and home care, whether paid through premiums, co-pays and
deductibles, other out-of-pocket payments, or other funding from government, employers,
or other sources; and
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(2) also includes the costs associated with administering, delivering, and paying for the
care. The costs of administering, delivering, and paying for the care includes all expenses
by insurers, providers, employers, individuals, and government to select, negotiate, purchase,
and administer insurance and care including but not limited to coverage for health care,
dental, long-term care, prescription drugs, medical expense portions of workers compensation
and automobile insurance, and the cost of administering and paying for all health care
products and services that are not covered by insurance.
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(b) "All necessary care" means the full range of services listed in the proposed Minnesota
Health Plan legislation, including medical, dental, vision and hearing, mental health, chemical
dependency treatment, reproductive and sexual health, prescription drugs, medical equipment
and supplies, long-term care, home care, and coordination of care.
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(a) When calculating administrative savings under the
universal health proposal, the analysts shall recognize that simple, direct payment of medical
services avoids the need for provider networks, eliminates prior authorization requirements,
and eliminates administrative complexity of other payment schemes along with the need
for creating risk adjustment mechanisms, and measuring, tracking, and paying under those
risk adjusted or nonrisk adjusted payment schemes by both providers and payors.
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(b) The analysts shall assume that, while gross provider payments may be reduced to
reflect reduced administrative costs, net provider income would remain similar to the current
system. However, they shall not assume that payment rate negotiations will track current
Medicaid, Medicare, or market payment rates or a combination of those rates, because
provider compensation, after adjusting for reduced administrative costs, would not be
universally raised or lowered but would be negotiated based on market needs, so provider
compensation might be raised in an underserved area such as mental health but lowered in
other areas.
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The commissioner of health shall
contract with one or more independent entities to conduct an analysis of the benefits and
costs of a legislative proposal for a universal health care financing system and a similar
analysis of the current health care financing system to assist the state in comparing the
proposal to the current system. The contract must strive to produce estimates for all elements
in subdivision 3.
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The commissioner of health, with input from the commissioners of
human services and commerce, shall submit to the contractor for analysis the legislative
proposal known as the Minnesota Health Plan ....... that would offer a universal health care
plan designed to meet a set of principles, including:
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(1) ensure all Minnesotans are covered;
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(2) cover all necessary care; and
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(3) allow patients to choose their doctors, hospitals, and other providers.
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(a) The analysis must measure the performance of both the
proposed Minnesota Health Plan and the current public and private health care financing
system over a ten-year period to contrast the impact on:
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(1) coverage: the number of people who are uninsured versus the number of people who
are insured;
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(2) benefit completeness: adequacy of coverage measured by the completeness of the
coverage and the number of people lacking coverage for key necessary care elements such
as dental, long-term care, medical equipment or supplies, vision and hearing, or other health
services that are not covered, if any. The analysis must take into account the vast variety of
benefit designs in the commercial market and report the extent of coverage in each area;
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(3) underinsurance: whether people with coverage can afford the care they need or
whether cost prevents them from accessing care. This includes affordability in terms of
premiums, deductibles, and out-of-pocket expenses;
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(4) system capacity: the timeliness and appropriateness of the care received and whether
people turn to inappropriate care such as emergency rooms because of a lack of proper care
in accordance with clinical guidelines; and
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(5) health care spending: total public and private health care spending in Minnesota
under the current system versus under the Minnesota Health Plan legislative proposal,
including all spending by individuals, businesses, and government. Where relevant, the
analysis shall be broken out by key necessary care areas, such as medical, dental, and mental
health. The analysis of total health care spending shall examine whether there are savings
or additional costs under the legislative proposal compared to the existing system due to:
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(i) changes in cost of insurance, billing, underwriting, marketing, evaluation, and other
administrative functions for all entities involved in the health care system, including savings
from global budgeting for hospitals and institutional care instead of billing for individual
services provided;
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(ii) changed prices on medical services and products, including pharmaceuticals, due to
price negotiations under the proposal;
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(iii) impact on utilization, health outcomes, and workplace absenteeism due to prevention,
early intervention, and health-promoting activities;
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(iv) shortages or excess capacity of medical facilities, equipment, and personnel, including
caregivers and staff, under either the current system or the proposal, including capacity of
clinics, hospitals, and other appropriate care sites versus inappropriate emergency room
usage. The analysis shall break down capacity by geographic differences such as rural versus
metro, and disparate access by population group;
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(v) the impact on state, local, and federal government non-health-care expenditures.
This may include areas such as reduced crime and out-of-home placement costs due to
mental health or chemical dependency coverage. Additional definition may further develop
hypotheses for other impacts that warrant analysis;
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new text begin (vi) job losses or gains