Minnesota 2020 Journal: MNSure is Working!
Minnesotans are purchasing healthcare insurance through MNsure, the state’s health insurance exchange. The first open enrollment period closes this Monday, March 31. Widely reported, over 136,000 Minnesotans signed up, suggesting that conservative predictions of Obamacare’s failure and demise were greatly exaggerated. Lost in this moment is healthcare reform’s alternative and what we’d be experiencing if the Affordable Care Act hadn’t passed.
Conservative policy advocates really hate Obamacare. At least judging by their rhetoric and repeated political and policy actions working to undermine or eliminate the Affordable Care Act, reasonable people would conclude that conservatives really hate Obamacare. But recall that Obamacare, broadly cast, is an updated version of a Republican policy alternative to the 1993 Clinton healthcare reform initiatives.
Former Massachusetts Governor Mitt Romney, well before he ran for President, championed state healthcare reform. His proposal, “An Act Providing Access to Affordable, Quality, Accountable Health Care,” required every Massachusetts citizen to purchase health insurance. By requiring participation, the plan created a very large risk pool allowing for lower premiums due to the pool’s large size. It further facilitated lower costs through the large pool’s increased purchasing and negotiating power. Central to the entire concept is attempting to bring market competition to a highly regulated and, in many cases, decidedly uncompetitive or at least weirdly, counterintuitively uncompetitive healthcare marketplace.
Romney looked like a hero for his Massachusetts plan until he realized that it was a political liability as a conservative presidential aspirant. Then, he took a different, oppositional tack. But, I’m not interested in Gov. Romney’s rationale for changing policy directions. Rather, I view the Romney reversal as a reflection of larger conservative pressures on policy direction. What was viewed as a conventional conservative policy approach—greater reliance on market mechanisms and competitive structure—has, in the past ten years, been replaced by a new, obstinate conservative policy perspective rooted in opposition without regard to need or even outcome.
In that light, it’s useful to consider the alternative to Obamacare, especially at this moment of its implementation. The short version? We’d still be living with the previous forms of healthcare insurance. Costs would be skyrocketing for both public and private insurance plans. Off-kilter financial incentivization would continue driving care and reimbursement practices. A screwed-up system would continue intensifying the very elements that screwed it up in the first place.
I disagree with much of former Minnesota Governor Tim Pawlenty’s public policy advocacy but he was absolutely correct when he observed that the previous healthcare system was financially unsustainable. Cost growth projections, unless changed, would threaten to collapse the entire healthcare system. In that regard, Pawlenty was right. I opposed his alternative healthcare policy direction then and now which is to essentially do less for people with the hope that somehow they’ll be able to do more on their own.
The Affordable Care Act is not the end-all of being. It’s a start. It already requires improvement but it’s better than the alternative which is returning to an unsustainable healthcare funding system. Or worse, moving forward with a new version of the old plan.
People face considerable obstacles to realizing truly affordable healthcare. There’s the massive weight of insurance companies commanding extraordinary purchasing power and phenomenal informational insight into customer and vendor behavior. Earlier laws prohibiting people from organizing themselves into larger insurance purchasing pools, mitigating individual healthcare risks by spreading risk over a large group, is addressed in ACA by essentially creating a large-if-loose group served by the state insurance exchanges. The key is finding paths forward, toppling barriers by turning liabilities into assets.
Remember the biblical story of David and Goliath. Goliath was a skilled, experienced and physically imposing warrior. Philistine leaders were so confident of Goliath’s prowess that they were willing to stake the conflict’s outcome on a single combat result. David, in contrast, was not conventionally skilled, experienced or strong. However, David won because he changed the fight’s rules. David used technology to keep Goliath beyond Goliath’s arm reach while skillfully projecting force over distance. David used his sling, in effect artillery, to concentrate a projectile’s impact.
Sticking with the previous health insurance system would’ve created a poor outcome. Conservative objection to healthcare reform, including its manifestation through the ACA, courts disaster. Loudly insisting that Obamacare is a failure purposefully misleads people.
Despite the attacks and the implementation glitches, 136,000 Minnesotans individually chose to enroll in a health insurance program through MNsure. By day’s end on March 31, that number will be higher. Every enrollee reminds us that moving forward is a necessary and worthy goal and reinforces a core Minnesota value. We make our lives better by working at it every day. The past guides but doesn’t trap us.