Health Care Column: comments welcome!

Here's a column I wrote to the community newspapers on health care. I hope that you will share your comments on health care with me at rep.paul.gardner@house.mn.

HEALTH CARE MUST BE MORE AFFORDABLE AND ACCESSIBLE

The 2008 session of the state legislature will include a hefty discussion about health care access and costs.

Health insurance costs continue to rise dramatically. In the months before the next session, my colleagues in the House and Senate are discussing several reforms that could reverse some troubling trends. I hope that constituents will share their ideas and opinions with me before the session starts on February 12th.

The trends will not surprise you. Minnesota currently has the highest percentage of people uninsured since 1998, including over 100,000 children. And these are not just people making minimum wage. The share of Minnesotans with employment-based health insurance was just 65.7% in 2006, a new all-time low. Since 2000, private health insurance premiums have risen by an average of 10% per year, outpacing yearly income increases by over three times. This inflation reduces the ability of employers to hire more people, and when employers do not provide health coverage, workers are left trying to find coverage on their own.

Cost containment needs to be a priority. The state legislature made positive strides this year and is continuing to look for practical solutions that will help limit health care costs, while maintaining the high quality of care.

Along with insuring over 30,000 Minnesota kids who were previously not covered, we enacted legislation creating a more cost-effective health care system. In December, a new health care payment reform plan will be initiated that rewards cost-effective primary and preventive care and discourages overuse of expensive and many times unnecessary procedures. Minnesota also became only the 2^nd state in the country to adopt uniform billing practices. Combined with electronic medical records (which need to have necessary data protections), this will lower administrative costs.

In June, a bipartisan coalition of legislators began studying Minnesota's health care system, focusing on cost-containment and affordability. This Health Care Access Commission, comprised of both Republican and Democratic State Representatives and Senators, will release their policy recommendations this January. The commission plans to offer proposals that correct redundancy and inefficiencies in health care payments, creating a lower-cost reimbursement structure. Their recommendations will also focus on the need to reduce expensive health care services through preventative measures and early treatment for chronic conditions like obesity and diabetes.

Challenges will still remain. Many uninsured Minnesotans can pay for health coverage but insurance companies may choose not cover them. Reimbursement rates for Minnesota Care, like Medicare, are usually lower than normal market rates so doctors and clinics may limit the number of patients accepted under these programs if we expand them on a much larger scale.

I very much would like to hear your opinions, questions, and concerns about how health care costs and access issues are affecting you, and what ideas you have. Please e-mail me at Rep.Paul.Gardner@house.mn, write me at the Capitol, or call my office at 651-296-2907. Also check out my blog at http://www.paulgardner53a.blogspot.com for more information on my other legislative activities.

Week of November 25, 2007

Schedule: At church on Sunday, the speaker was Tom Gillaspy, the state demographer. He spoke about how our population is aging. That will have massive fiscal repercussions for us as the baby boomers retire. On Tuesday, November 27th, I toured Century College in White Bear Lake/Mahtomedi with the chair of the House Higher Education Committee, Rep. Tom Rukavina (DFL-Virginia), and Rep. Carol McFarlane (R-White Bear Lake). Several hundred of my constituents attend Century so I wanted to tag along for the tour, since I haven't been there before. (The number of students from 53A at local MnSCU campuses is listed in a previous post.
Here are a couple of interesting items that I heard at Century:
* The state is not going to have enough dentists in the near future. Century is training hygienists and other dental technicians.
* The state has a nursing shortage, and Century's nursing program now has the state's first paramedic-to-RN accelerated program. (My neighbor is participating in this program.)
* Century has one of just seven orthotics and prosthetic labs in the U.S. The campus is cranking out graduates who then--among other things--are producing artificial limbs for returning veterans. In fact, some Iraq vets are in the program.
* The student body comes from 100+ nationalities. Their digital language lab (DLL) assists many students in their English proficiency.
* Minnesota imports engineers from other states and countries. To meet future labor needs, Century has a fabrication lab (the "Fab Lab") where students learn applied engineering. They get an associate of applied science degree and many complete a four-year degree at the University of Minnesota.

We also met with some faculty and members of the student Senate. More than 200 veterans are students. I met three of them in a meeting with the student senate.

Some other interesting factoids:
* For each additional $6 million annually from the state, the Minnesota State Colleges & Universities System (MnSCU) can reduce tuition by 1% for a year. Tuition at Century went up by only 4% this year after much larger increases in past years.
* Seven percent of full-time equivalent course loads at Century are taken on-line
* There is a dispute between the legislature and the MnSCU board of trustees as to how much the MnSCU office should be spending on technology versus tuition reduction.

In the afternoon of November 27th, I attended a meeting of the Eastern Transportation Alliance (ETA), a group of city and county governments that are promoting transit expansion in the greater St. Paul metro area and areas from Chisago County in the north to Olmsted County in the south. The group is asking the Governor and the Legislature for $140 million in bonding money in 2008 to complete the Central Corridor light rail line along University Avenue. The idea is that this line, along with a refurbished Union Depot in St. Paul, will allow suburbs in the northeast and southeast metro to tap into a larger transit network. Our district is kind in the middle of transit proposals to the east (like the Rush Line) and to the west (Northstar Corridor and a proposed passenger rail line from Duluth to Minneapolis via Cambridge). You can get a better idea of what is proposed in the Central Corridor and the Union Depot at the Ramsey County Regional Rail Authority website.

I would like to spend my time relating to transit on bus service and park-and-ride lots for the moment. Speaking of park-and-ride lots, I received a letter from Metro Transit responding to an inquiry regarding lots in Lino Lakes. Metro Transit is trying to build a parking structure at 95th Avenue and 35W (in Blaine) where there is an existing (and full) parking lot of 1,000 spaces. The construction would be from September 2008 to September 2009. A temporary park-and-ride for 200 spaces would be required during construction, and that location could be at the proposed Lino Lakes library site at Highway 23 and 35W in Lino Lakes. Metro Transit also wrote that a park-and-ride for 200 spaces could be possible at the northwest corner of 35E and Highway 14 in Lino Lakes as plans for that intersection develop in early 2008.

On Wednesday, November 28th, I attended a Local Government Officials Meeting for Anoka County in Ham Lake. Anoka County staff presented a draft legislative package. (The 2007 version is on-line and it is very similar.) The most interesting presentation was given by Commissioner Rhonda Sivarajah, who spoke on Anoka County Human Services. The presentation gave the facts about what we might otherwise call "welfare" and the myths that are out there about it. Here are some factoids I picked up:

* A breakdown of benefits issued by the county in 2006 for public assistance included 89% ($268,818,008) for health care (especially nursing homes, Medicare), five percent for food assistance ($13,805,648) , and six percent ($17,888,007) for cash assistance. These are state and federal dollars and the county only pays for staff to administer the benefits.
* The average costs for nursing home care are about $3,500 to $6,500 per month.
* 70% of people on MFIP (Minnesota Family Investment Program, a cash program for families with children) in Anoka County have only been on public assistance for less than two years. The cash benefit is $532 per month and $378 for food stamps per month.
* 69% of MFIP recipients are children.
* The average monthly caseload for the County for MFIP is 1,798.

After viewing the Star Tribune's web site on the 35W bridge collapse, I found that there were three of my constituents on that bridge, including one who was killed. I was pleased that the Governor announced some temporary relief for survivors but I was distressed that it took so long for him to take action. The temporary assistance comes from an existing tort claims fund. It looks like Senator Ron Latz (DFL-St. Louis Park) and Rep. Dennis Ozment (R-Rosemount) worked with the Governor after the 9/11 fund special master spoke on this issue a few weeks ago.

Visitors: On November 27th I met with a House researcher, MPCA staffers, and another House member on some recycling initiatives.

Constituent contacts: district resident about my bill on scrap metal theft because his company provides alarm systems for construction sites, which have been targets for thieves (the company is RSI Alarm, based in White Bear Lake, and it sells globally); Circle Pines resident about property tax assessments; Shoreview resident about special education and transportation policy; Shoreview resident about MN Board of Medical Practice issue; Circle Pines resident about MnDOT rules about audible pedestian signals for blind pedestrians; Lino Lakes resident about environmental issues; Shoreview resident about health care premium increases and the precariousness of coverage and supporting transit; Shoreview resident supporting fewer mandates and increased competition in health care

Week of November 18, 2007

Schedule: On Monday, November 19th, I met with another House member and a House researcher on a recycling issue. On Tuesday, November 20th, I met with a KSTP reporter about the bill I authored to combat metal theft.

Visitors: Shoreview residents about possible 2008 legislative agenda on health care, transportation, and education

Constituent contacts: Shoreview resident asking "when are you representatives going to protect honest citizens instead of illegal's, criminals and your corrupt buddies" (I'm wondering if news about the Secretary of State's recent admission about using official data for fundraising is the source of this contact); Lino Lakes resident promoting tax cuts for economic growth

New Law Working! KSTP-TV did a story on November 20th on how the new law that I wrote to combat metal theft is working. Hooray! A link to the story is at http://kstp.com/article/stories/S263403.shtml. Burglaries in the 4th precinct in North Minneapolis (mostly copper wire and pipe theft) have dropped by 75 percent! Authorities in Hugo now tell me that they are making some progress with a scrap metal dealer who was buying a lot of stolen metal in that community. The new law also include tougher penalties if someone tampers with electrical transmission equipment, like copper wire. Three men were arrested recently for cutting through Xcel Energy electrical cable underground, and they may be charged with felonies instead of misdemeanors. (This is not a good idea--several thieves in the Midwest have electrocuted themselves this way.)

Another New Law Working! Another bill I spent a lot of time on was on electronic waste. Under the new law, manufacturers of electronics are responsible for the cost of recycling old computers, TVS, and other devices. (The cost eventually is incorporated into the cost of a new device for consumers.) One electronics recycler held a collection event at the Mall of America last week and collected 1 million pounds of electronics that filled 86 trailers! The major barrier to collecting this material in the past has been the high cost of recycling this potentially toxic material. You can find out about e-waste recycling in our area at http://www.greenguardian.com/.

Week of November 11, 2007

Schedule: On Tuesday, November 13th, I spoke to a class of seniors at Centennial High School. They asked a lot of good questions! Several members of the class want to boost recycling at the school, so since that's what I used to do I might meet with them later. In the evening, my family attended a Veterans Day concert at Mounds View High School given by fourth and fifth graders from my children's school. What a great job. There was even a WWII vet there from the Merchant Marine! I didn't know that they have their own song. My kids go to this site for the lyrics and music for the service anthems. On Wednesday, November 14th, I met with the director of Friends of Ramsey County Suburban Libraries about the organization's activities and capital campaign efforts. The Roseville Library, the busiest in the state, will undergo expansion next year if plans go ahead. On Thursday, November 15th, I attended part of a hearing for Rep. Ryan Winkler's proposal for disaster victim compensation. Later than morning, I attended a meeting of the Metropolitan Council's Water Supply Planning Committee, where there were several interesting presentations. After that, I made some remarks at an America Recycles Day event at the Children's Museum in St. Paul put on my by old employer, the Recycling Association of Minnesota. In the afternoon, I will have met with the House Capitol Investment Committee in Coon Rapids about the proposed bike trail for the Rice Creek/Chain of Lakes preserve in Lino Lakes. On Friday, November 16th, I attended a book signing for the new history of Shoreview entitled Shoreview Reflections. There is a one-hour DVD that goes with the history, and you can view a trailer or the whole video on-line.

Visitors: None

Constituent contacts: Shoreview resident against Canadian-style health care system in the U.S.; Blaine resident pleased with new legislation for manufactured home (aka trailer) park residents that would help them with relocation costs if the park owners sell the property

Week of November 4, 2007

Schedule: On Wednesday, November 7th, I attended a meeting of the House Environmental Finance Committee on MPCA issues, including wastewater treatment, deformed frogs, ballast water on Lake Superior, and a few other things. On Thursday, November 8th, I chaired the first meeting of the Drinking Water Source Protection Subcommittee in Apple Valley (more below), and visited a compost site in Empire Township (Dakota County) and an industrial landfill in Rosemount as Vice-Chair of the Solid Waste, Recycling & Resource Conservation Working Group. On Friday, November 9th, I attended part of a meeting of the Legislative Coordinating Committee's Subcommittee on Claims as it will discuss possible claims against the state for the 35W bridge collapse. (More below.)

Visitors: On Monday, November 5th, I met with a house researcher and staff from the Department of Health on drinking water issues.

Constituent contacts: North Oaks resident about freezing a credit report; Shoreview? resident about the labor force used for 35W bridge reconstruction; Lino Lakes resident supporting recent energy legislation and the legislature's on-time finish and asking about measures to constrain spending; North Oaks resident concerned about new reporting requirements for water management organizations; Shoreview resident upset about Taxpayers' League President's comments about education; Shoreview resident with shingle recycling question; Shoreview resident asking about tax deductions for education expenses

Interesting You Tube Video: A constituent e-mailed me a link to this You Tube video. It's called "Do You Know 2.0?" It lays out some of the global demographic and information technology trends that will face us in the next few decades, and asks viewers and elected officials to consider how they will take this information into account when supporting education. Especially thought provoking is the idea that we don't actually know what skills students will need 20 years from now, because the world is changing constantly.

Levy results: The White Bear Lake School District is the only school district in 53A that had a levy question up for consideration on election night. Its levy passed and the district will now be able for now to avoid closing several schools and letting go about 100 teachers. Congratulations to the levy advocates.

Smoking Ban Update: Tuesday's Shoreview Press has an article on how the smoking ban is working in the north metro, and I've got some quotes there. (A few of them aren't quite right, but what are you gonna do.)

35W Bridge Replacement Funding: I'm a little confused by the testimony of MnDOT officials and the words to the media by the MnDOT Commissioner. In the Legislative Action Committee that is meeting monthly to monitor funding needs for the new 35W bridge, MnDOT officials say that they have the money they need in order to do both the bridge and other scheduled road and bridge projects. After the committee meeting, the MnDOT Commissioner said that MnDOT will have to delay some road and bridge projects if the committee doesn't approve additional funding. Which is it?

Drinking Water Hearing: The first meeting of my Drinking Water Source Protection Committee was Thursday this week in Apple Valley. The first presentation was on Dakota County's Ambient Groundwater Quality (AGQS) study. Dakota County is the only county to have systematically test private wells, and boy is there a lot of stuff in them. A majority of private wells tested (mostly in the agricultural areas of Dakota County) have nitrates in them from fertilizers as well as the most common pesticides for corn and soybeans. The second presentation was on the Met Council's drinking water supply planning. While the Twin Cities should not end up like Atlanta or the desert Southwest, there is a lot of long-term planning that needs to go on about the sustainability of our water supply. Finally, we had a report from the Environmental Quality Board on sustainability of our drinking water.

35W Bridge Collapse: The Friday hearing on possible claims against the state from the 35W bridge collapse was instructive. Ken Feinberg, who served as special master for The September 11th Victim Compensation Fund, testified about his experience with the 9/11 fund as well as other tragedies. He said that there were several lessons he learned that would be helpful here in Minnesota.

* "Timeliness is critical" and there is "no reason to hold victims hostage" waiting for a cause to be determined in the bridge collapse. The 9/11 fund was distributing funds to victims within 100 days of 9/11. He indicated that if the state decided to compensate the victims of the bridge collapse, there is nothing stopping the state from requesting reimbursement of some or all of the compensation if someone other than the state has liability discovered through the investigation and then is penalized through the court system. So in the meantime, he suggested, the legislature could compensate victims before a cause is determined to deal with health costs, lost work, etc.
* "Simplicity is a virtue." The 9/11 fund dealt with the families of thousands of people who died, and the bridge collapse is dealing with perhaps 100-150 people. Therefore, it might not be necessary to create a special office with staff and other resources to handle compensation here in Minnesota, and an existing state office could handle the process.
* It is up to the legislature as the representative of the people to determine whether the bridge collapse warrants special treatment over other tragedies where victims were not compensated.

Among the options discussed Friday for the bridge collapse were:
1. Raising the tort liability cap currently in statute ($1,000,000, which would be split among 100-150 people) to a higher number just for the bridge collapse.
2. Set up a special compensation fund, then determine what the right amount is for compensation for each victim or survivor and pay accordingly
3. Do #2, but deduct from the state's share the amount of private insurance or any other compensation received for that victim or survivor ("collateral offsets")
4. Do #2, but then ask for reimbursement from victims or survivors if an entity other than the state is found liable

Other legislative blogs: The National Conference of State Legislators (NCSL) has a blog index at "The Thicket." You can find a link to The Thicket in the links section on the right.