Minneapolis Star Tribune, Dec. 30
Minnesota didn’t cave on health-care contracts
A move that Minnesota made three decades ago - privatizing much of its medical-assistance program for the poor - became one of the biggest controversies of 2016 just south of the state border.
Iowa’s longtime Republican Gov. Terry Branstad spent much of the year under fire from patients, providers and Democratic lawmakers for contracting out his state’s Medicaid program to three for-profit private insurers. Branstad claimed that switching from state administration to managed care would result in big savings. But just months into the move, Iowa officials agreed to provide an additional $127 million in state and federal funding to cover insurers’ unexpected costs, setting off angry new questions about the benefits.
Minnesota faced a similar and similarly outrageous demand late this year from a private insurer after big savings were promised for privately administering medical assistance here. Unlike Iowa, Gov. Mark Dayton’s administration admirably pushed back. The move will not be without consequences for enrollees, who will have to switch insurers next spring, but it shows that state officials are serious about wringing savings from outsourcing the taxpayer-funded programs. For too long, these contracts, which pay a monthly sum for each enrollee’s care, have been one of state insurers’ most reliably profitable lines of businesses.
The request for more public dollars came from Minnetonka-based Medica, which claimed in late November that it had lost $150 million managing the program. It sought higher payment rates or other financial protections. A key point to know is that Medica had expanded its public program contracts by bidding aggressively under the state’s new competitive bidding system. The shift to competitive bidding was a positive step forward in response to criticism in 2011 and 2012 about the amount of money insurers made from managing medical assistance and MinnesotaCare. The competitive system started small but was expanded to include the entire state in 2016.
State officials have claimed about $450 million in 2016 savings from the expanded bidding. But UCare, a widely respected insurer specializing in public programs and high-need patients, was virtually shut out.
State Human Services Commissioner Emily Johnson Piper admirably didn’t cave to Medica’s request, responding with hard questions of her own in December. A competitive bid situation shouldn’t allow for lowball bidders to come back once a competitor is weakened and ask for more money. Blaming the state for unsound rates, as Medica has, also isn’t reasonable given that the insurer has its own experts to calculate coverage costs. It also has significant experience dealing with the state’s medical-assistance program enrollees.
The problem resulting from this standoff is that 311,000 Minnesotans served by these programs will have to switch insurers this spring because of Medica’s looming exit. Many of them already had to switch from UCare to Medica or other insurers last spring after the bidding process results were announced.
There are understandable questions about the bidding criteria. Legislators should delve into this. But they should also leverage the opportunity to ask higher-level questions about the state’s long reliance on the managed-care model for medical assistance.
Insurer demands in Minnesota and Iowa raise fair questions about whether promised savings and value for taxpayers and enrollees are being realized. The coming year will be one of significant health care changes with the expected repeal of the Affordable Care Act. This is a good time to evaluate fresher options for efficiently serving enrollees and taxpayers.
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St. Paul Pioneer Press, Dec. 28
Coordinating ideas around Minnesota’s early-childhood work
While research confirms the value of early- childhood advocates’ efforts, a hometown lawmaker observed that their work wasn’t necessarily in sync.
When he arrived at the Minnesota Capitol after his election in 2014, Rep. Dave Pinto - long interested in the issue - expected to find clarity about an agenda and direction, based on growing consensus about the value of public investment in early education.
Instead, there were a number of agendas, the St. Paul Democrat told us.
He found that, with varied groups working on such efforts, “often they’re parallel, often they overlap, sometimes they may conflict.”
That makes it hard for legislators, who might agree in general on the matter, Pinto told us, to “cut through the clutter” and figure out “where do we go, where do we focus our efforts, what do we do?”
In an effort that uses what he describes as a lawmaker’s leverage to “convene,” Pinto helped bring them together via a quarterly Prenatal-to-Three Policy Forum series that began last summer. The next such session will be Jan. 6 at the University of St. Thomas.
Partners in the meetings, which draw about 100 participants, include Elders for Infants, a group of retired early-childhood professionals, and the St. Catherine University-University of St. Thomas School of Social Work.
In preparation for the session next month, Pinto reached across the aisle to Rep. Ron Kresha, who will serve as co-host. The Republican from Little Falls, a leader on such issues, told us his colleague’s invitation “was just a natural way to continue to bridge common interests.”
Objectives for the sessions include sharing plans and building relationships among individuals and organizations, as well as efforts to “establish a common base of knowledge” among the advocates. The agenda from the October forum, for example, featured speakers from the state’s departments of health and education, the University of Minnesota Institute of Child Development and coalition reports and updates from such organizations as MinneMinds, the Minnesota Association for Infant and Early Childhood Mental Health and Minnesota Communities Caring for Children.
The January meeting will focus on early parenting and include presentations from coalitions on their plans for the legislative session. The session is free and open to the public, and information and registration details are here. A live webcast is intended to help involve advocates across the state.
Advocates and others have appreciated “this chance to be in the same space” and learn from each other, Pinto says.
There’s potential to create a unified and growing team of early-childhood advocates, and hope that “it does, in fact, establish a solid, mature base of understanding about this issue,” he said. Eventually, it could result in “a more unified plan - not just sharing plans but collaborating on plans - leading to an agenda that a wide variety of organizations are pushing.”
Pinto saw the approach work well in his day job as a prosecutor in the Ramsey County attorney’s office, where he specializes in gender violence issues. A statewide human trafficking task force meets quarterly to bring together key professionals, and “it’s played a very important role in the response to that issue,” he told us.
“From a process perspective,” Pinto said, “I had the idea of doing something parallel to that work.”
In his work as a prosecutor, Pinto is witness to the impact of disparities that can begin early in life. He believes that other challenges we face “can be met if we can get this one right - if we can unlock the potential in every child growing up.”
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Post Bulletin, Jan. 2
Legislative changes will require effort
The clock starts Tuesday for the Minnesota Legislature. It has a total of 120 days over two years to get its work done.
It may seem like a long time, but history tells us most of the work will be done in the final days of the 2017 and 2018 sessions. History also shows us much of that work could be left undone.
Last year’s legislative session left tax and bonding bills unfinished, and the last time Gov. Mark Dayton worked with a Republican-controlled House and Senate, a government shutdown occurred and three people hammered out a $45 million state budget behind closed doors.
It’s clear that something must be done.
If the legislature fails to reform, it won’t be for the lack of ideas.
Sen. Carla Nelson has repeatedly pitched creating a conference-committee deadline to require compromise a week before session ends, which would allow lawmakers and the public time to review the proposals.
“We have three calendar deadlines, but if you think about it, they are not the important ones,” the Rochester Republican said.
In the House, Rep. Gene Pelowski has offered a wealth of ideas to unclog legislation and help work get done, from limiting the number of bills to creating deadlines for amendments. The Winona DFLer’s suggestions also include simply following established rules.
Unfortunately, most legislative rules are flexible.
“Unless it’s in the Constitution, rules can always be changed,” Rep. Nels Pierson, R-Rochester told the Post Bulletin Editorial Board while discussing his frustrations with the system.
Others have noted delays are often negotiation ploys, since pressure increases as the deadline to end session nears.
“It’s always going to be taken up to the deadline,” Rep. Greg Davids said when we spoke to him prior to the November election. The Preston Republican added: “I’m thankful there is a deadline. Otherwise, we would still be up there.”
Such resignation points to the reform that is truly needed. While new deadlines, limits and rules will offer guidelines, the real needed change is in the culture.
Political and geographical divisions must end, and lawmakers need to focus on the final goal - passing meaningful legislation.
Pelowski points to reforms that ended social interaction among lawmakers as the start of a partisan shift. When legislators could no longer accept meals at large events, the incentive to gather was diminished and a herd mentality began to grow.
The results are seen in partisan votes and an unwillingness to compromise.
While we hope to see new rules and deadlines imposed, they will only work if the culture changes.
In talking with local lawmakers, we see hope for potential change.
“I almost voted with Rep. (Paul) Thissen when he brought forward a proposal to amend the House rules to require the budget resolution to be passed by a certain deadline to ensure we were going to have this all done,” Rep. Steve Drazkowski said, noting he eventually gave into political pressure from his caucus and opposed the change.
“I have regrets about that,” the Mazeppa Republican said of not supporting the Minneapolis DFLer’s proposal.
Such regrets carry added weight when the work is left undone.
Commitment to change must overpower political pressures and make sure the work is completed.
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