April 17, 2019 Community news from the prairie to the lakes  
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  Fix the ACA; don’t repeal, replace it

As the place for Minnesotans who can’t get health insurance through an employer or a public program, MNsure has worked with hundreds of thousands of Minnesotans experiencing a wide variety of health concerns. While doing that work, we have seen time and again that the federal Affordable Care Act, or ACA, while imperfect, has improved the lives of Minnesotans.

As Gov. Tim Walz says, if Washington, D.C., won’t improve the ACA, we need to improve it at the state level. The governor is fighting to maintain the funding source for the proven MinnesotaCare program; to add a targeted subsidy and state-based tax credit to make coverage more affordable for Minnesotans who don’t qualify for federal tax credits; and to give consumers the option of buying into ONEcare, a comprehensive buy-in insurance product similar to MinnesotaCare. These proposals could greatly improve health care access and affordability.

Improving the ACA, as Gov. Walz proposes, makes much more sense than scrapping it altogether. After all, consider all the good the ACA has done for Minnesotans.

The ACA has improved access to affordable, comprehensive coverage and provided important consumer protections that help ensure hardworking families don’t go broke or forgo necessary medical treatment because they are not able to find coverage.

The ACA provides subsidies that help families pay their premiums. Last year, Minnesota households received credits that averaged nearly $7,000 per year. Since 2014, over 630,000 Minnesotans have used MNsure to sign up for private health insurance plans, saving more than $800 million in health care costs.

Because of the ACA, insurance companies can’t deny coverage to anyone with a pre-existing condition, and they can’t raise premiums or cancel coverage if the beneficiary gets sick. Annual or lifetime limits on benefits are illegal, which prevents the mountain of medical bills that bankrupted families before the law was enacted or caused them to stop treatments.

Young adults under age 26 now have the option to stay covered on their parents’ health insurance plans, and all Minnesotans have access to preventative health care services like immunizations, cancer screenings, and testing for chronic diseases without paying out-of-pocket costs.

Before the ACA, there were no essential benefits that health insurers had to cover. As a result, nearly three out of every five people didn’t have maternity care coverage, one in three had no access to substance abuse and prevention services, and one in 10 didn’t have pharmaceutical coverage. Thanks to the ACA, Minnesotans now have the peace of mind that all those things are covered.

Because of these new protections, Americans are significantly more likely to get the health care we need. According to the Commonwealth Fund, between 2010 and 2018, the number of Americans who had trouble paying a medical bill decreased by 17 percent, the number who skipped a medical test or treatment decreased by 24 percent, and the number who didn’t fill a needed prescription decreased by 27 percent. In Minnesota, the uninsured rate has decreased from about 8 percent in 2013 to about 5 percent today, giving Minnesota the third-lowest uninsured rate in the country.

None of this is to say the ACA is perfect. It isn’t. We can, and must, do better.

Fortunately, Gov. Walz’s proposals will go a long way to improve access and price competition. Those kinds of improvements would make an effective ACA law even more effective. They could move Minnesotans forward instead of backward. That’s the direction we need to be headed.


Nate Clark is the chief executive officer of MNsure mnsure.org, Minnesota’s health insurance marketplace under the federal Affordable Care Act.

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April 16, 2019