Implementing Health Care Reform in Minnesota – the Time is Now

Perspective from Michele Kimball Stratis Health Board member

Less than two years after it was passed into law, the Affordable Care Act (ACA) is already having a significant impact on the quality and reliability of care for more than one million Minnesotans over the age of 50. Increased access to free preventive care, improved transparency, pay-for-performance, and decreases in the cost of prescription drugs are all critical areas where the new health reform law is improving the lives of Minnesotans.

In order to continue this momentum and capitalize on all the ACA has to offer, it will be critical to achieve consensus at the State Capitol during the upcoming legislative session. With a hotly contested election on the horizon, politics could hamper everything from the creation of a health care purchasing exchange to implementation of grant programs that improve care and capture more federal resources.

Real benefits are already being realized

The ACA has been in effect for less than two years, but already Minnesota seniors are beginning to benefit in improved coverage, quality, and access under Medicare. The new law improves Medicare in at least three important ways:

• Free preventive care: Beginning this year, all Medicare beneficiaries are able to access free preventive and wellness benefits, such as immunizations and screenings for cancer and diabetes. Additionally, Medicare beneficiaries can now get a free annual health assessment from their doctor.
• Reducing the cost of prescription drugs: Each year approximately 67,000 Minnesotans enrolled in Medicare Part D reach the so-called "donut hole"—a more than $3,000 gap—where they pay 100 percent of all drug costs themselves. In 2010, this "hole" began to shrink, and seniors falling into it each received a $250 rebate. In 2011, the hole shrinks again, but beneficiaries instead receive a 50 percent discount on brand name drugs and a seven percent discount for generics purchased in the hole. The hole continues to shrink until 2019, when it closes permanently.
• Extends the life of Medicare: By reforming how Medicare pays for care and requiring more of private insurers who offer Medicare Advantage plans, the life of the Medicare Trust Fund is extended by 12 years.

Now it is time to focus on those under 65

While things are improving for Medicare beneficiaries, progress may be limited for those under age 65 unless state leaders can agree on key implementation elements.

The biggest impact takes place in 2014 thanks to establishment of a state based health purchasing exchange where the uninsured (and Members of Congress who are now required to participate) can purchase affordable coverage. As a national leader on health care quality and efficiency, Minnesota is uniquely positioned to create an exchange that increases transparency, promotes competition and empowers consumers. Despite the fact that such disparate groups like AARP, the Chamber of Commerce, and the Minnesota Hospital Association support it, state leaders have yet to agree.

The next state legislative session may present the last opportunity for Minnesota to control our own health care destiny. The Governor's recently established task force is a great start, and there is hope that we will be able to demonstrate that we have a plan for an exchange that can be operational by January 2014. If we fail to do so, the U.S. Department of Health and Human Services will do it for us.

The ACA presents Minnesota with a unique opportunity to build upon our own state reforms of 2008, to reward quality over quantity, reduce costs, and improve coverage for everyone, regardless of pre-existing conditions. It is an opportunity we cannot afford to miss.

Michele Kimball is a member of the Stratis Health Board of Directors and is state director for AARP in Minnesota. She currently serves as an advisor to the long-term care chair at the University of Minnesota and is a member of the Minnesota Council on Aging.