Rep. Tina Liebling, chair of the Health Finance and Policy
Committee
BY DIANE J. PETERSON AND JOHN KOLSTAD
Our Minnesota Legislature keeps allowing ever-increasing billions of our tax funds to pay private corporations to manage the health care of people who cannot afford their own medical care. However, most legislators and patients do not comprehend how this government function operates. On Dec. 1, a very long informational hearing was held at the state Capitol on the low-income health care program called Medical Assistance. Six experts testified on various aspects of this state program for five and a half hours. This 19-person committee of the Minnesota House of Representatives heard complex and complicated explanations from six experts describing various aspects of the program.
A health care lobbyist with decades of professional experience said that the complexity and complications of the system are more accurately described as confusing. The confusion baked into the system makes legislators struggle to understand the program. It is designed to be confusing. That is how private corporations acquire huge amounts of taxpayer funding to pay themselves to administer the care for low-income patients dependent on government to get their medical needs met. There are much simpler and directly accountable methods available.
The Dec. 1 marathon hearing was scheduled by the chair of the House Committee on Health Finance and Policy, Rep. Tina Liebling. She controls whether health care bills get heard in the state House of Representatives or get laid aside, unheard. She also has the power to conduct informational hearings on public policy connected to health care outside of the regular session. The members of this committee are Democrats and Republicans representing metro and non-metro areas, a geographic mix of our state’s population. To review the hearing, go to these links: Part 1 at https://www.youtube.com/watch?v=p3NR5INhwn8 and Part 2 at https://www.youtube.com/watch?v=sxkY1xFRnSg.
In the past 20-plus years, health policy groups, including our own, have lobbied and campaigned for the entire Medical Assistance program to be audited using Generally Accepted Accounting Practices (GAAP). State and federal laws have required for many years that any expenditure over $700,000, made to people or businesses outside of government, be audited annually using GAAP standards. Mysteriously, in the 30-plus years since Medicaid was privatized there has never been a single audit using standard practices. This program was required to have an annual study done to determine if the patient care was better, worse or the same. It never has been done. This is a bipartisan problem. These requirements have failed to be met under Democratic and Republican control. About 10 years ago Connecticut went from privatized managed care to the state government directly running the program. They saved millions of tax dollars per year. Minnesota could also save millions of dollars every year. Minnesota citizens should demand that their elected representatives get these required annual audits done (or de-privatize all of Medical Assistance).
In the testimony there was repeated acknowledgment of the lack of transparency and accountability in the Medical Assistance programs. Connecticut no longer outsources its Medical Assistance program to corporations. Connecticut has switched to a transparent system where the state directly pays the health care bills of its low-income residents, saving an estimated $986 million between 2012 and 2018 by eliminating managed care corporations from its Medical Assistance program.
In Minnesota, we have a transparent system which allows Medical Assistant patients classified as disabled to get their medical bills paid directly by the state, but the majority of Medical Assistance patients are required to get care in a prepaid program administered by private managed care corporations. The prepaid program remains nontransparent; its finances are not accountable for how individual patients received or were denied their care.
The committee hearing resulted in no decisions about the information presented. The chair’s stated intent for this hearing was to get the committee’s legislators better informed, and less confused, about the complexities involved in the Medical Assistance program, particularly the part affecting the majority of patients controlled in the private corporations the Legislature calls managed care organizations. Rep. Liebling is an advocate for eliminating managed care organizations from Medical Assistance. She initiated a bill to fix this, but it has not been enacted. The Dec. 1 hearing revealed inadequate government information on the costs involved in the Medical Assistance program. It would be safe to conclude that those inadequacies could be solved by switching, as Connecticut did over a decade ago, to the transparent payment system for all Medical Assistance patients. There would then be clarity, not confusion, on costs.
The authors are longtime members of Health Policy Advocates.
