HF 1843

as introduced - 93rd Legislature (2023 - 2024) Posted on 04/19/2023 11:36pm

A bill for an act
relating to health; conducting an analysis of the benefits and costs of a universal
health care system to assist the legislature in comparing it to the current public
and private health care financing system; requiring a report; appropriating money.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1. new text begin ANALYSIS OF BENEFITS AND COSTS OF A UNIVERSAL HEALTH
CARE SYSTEM.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) "Total public and private health care spending" means:
new text end

new text begin (1) spending on all medical care including but not limited to dental, vision and hearing,
mental health, chemical dependency treatment, prescription drugs, medical equipment and
supplies, long-term care, and home care, whether paid through premiums, co-pays and
deductibles, other out-of-pocket payments, or other funding from government, employers,
or other sources; and
new text end

new text begin (2) also includes the costs associated with administering, delivering, and paying for the
care. The costs of administering, delivering, and paying for the care includes all expenses
by insurers, providers, employers, individuals, and government to select, negotiate, purchase,
and administer insurance and care including but not limited to coverage for health care,
dental, long-term care, prescription drugs, medical expense portions of workers compensation
and automobile insurance, and the cost of administering and paying for all health care
products and services that are not covered by insurance.
new text end

new text begin (b) "All necessary care" means the full range of services listed in the proposed Minnesota
Health Plan legislation, including medical, dental, vision and hearing, mental health, chemical
dependency treatment, reproductive and sexual health, prescription drugs, medical equipment
and supplies, long-term care, home care, and coordination of care.
new text end

new text begin Subd. 2. new text end

new text begin Initial assumptions. new text end

new text begin (a) When calculating administrative savings under the
universal health proposal, the analysts shall recognize that simple, direct payment of medical
services avoids the need for provider networks, eliminates prior authorization requirements,
and eliminates administrative complexity of other payment schemes along with the need
for creating risk adjustment mechanisms, and measuring, tracking, and paying under those
risk adjusted or nonrisk adjusted payment schemes by both providers and payors.
new text end

new text begin (b) The analysts shall assume that, while gross provider payments may be reduced to
reflect reduced administrative costs, net provider income would remain similar to the current
system. However, they shall not assume that payment rate negotiations will track current
Medicaid, Medicare, or market payment rates or a combination of those rates, because
provider compensation, after adjusting for reduced administrative costs, would not be
universally raised or lowered but would be negotiated based on market needs, so provider
compensation might be raised in an underserved area such as mental health but lowered in
other areas.
new text end

Sec. 2. new text begin BENEFIT AND COST ANALYSIS OF A UNIVERSAL HEALTH REFORM
PROPOSAL.
new text end

new text begin Subdivision 1. new text end

new text begin Contract for analysis of proposal. new text end

new text begin The commissioner of health shall
contract with one or more independent entities to conduct an analysis of the benefits and
costs of a legislative proposal for a universal health care financing system and a similar
analysis of the current health care financing system to assist the state in comparing the
proposal to the current system. The contract must strive to produce estimates for all elements
in subdivision 3.
new text end

new text begin Subd. 2. new text end

new text begin Proposal. new text end

new text begin The commissioner of health, with input from the commissioners of
human services and commerce, shall submit to the contractor for analysis the legislative
proposal known as the Minnesota Health Plan ....... that would offer a universal health care
plan designed to meet a set of principles, including:
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new text begin (1) ensure all Minnesotans are covered;
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new text begin (2) cover all necessary care; and
new text end

new text begin (3) allow patients to choose their doctors, hospitals, and other providers.
new text end

new text begin Subd. 3. new text end

new text begin Proposal analysis. new text end

new text begin (a) The analysis must measure the performance of both the
proposed Minnesota Health Plan and the current public and private health care financing
system over a ten-year period to contrast the impact on:
new text end

new text begin (1) coverage: the number of people who are uninsured versus the number of people who
are insured;
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new text begin (2) benefit completeness: adequacy of coverage measured by the completeness of the
coverage and the number of people lacking coverage for key necessary care elements such
as dental, long-term care, medical equipment or supplies, vision and hearing, or other health
services that are not covered, if any. The analysis must take into account the vast variety of
benefit designs in the commercial market and report the extent of coverage in each area;
new text end

new text begin (3) underinsurance: whether people with coverage can afford the care they need or
whether cost prevents them from accessing care. This includes affordability in terms of
premiums, deductibles, and out-of-pocket expenses;
new text end

new text begin (4) system capacity: the timeliness and appropriateness of the care received and whether
people turn to inappropriate care such as emergency rooms because of a lack of proper care
in accordance with clinical guidelines; and
new text end

new text begin (5) health care spending: total public and private health care spending in Minnesota
under the current system versus under the Minnesota Health Plan legislative proposal,
including all spending by individuals, businesses, and government. Where relevant, the
analysis shall be broken out by key necessary care areas, such as medical, dental, and mental
health. The analysis of total health care spending shall examine whether there are savings
or additional costs under the legislative proposal compared to the existing system due to:
new text end

new text begin (i) changes in cost of insurance, billing, underwriting, marketing, evaluation, and other
administrative functions for all entities involved in the health care system, including savings
from global budgeting for hospitals and institutional care instead of billing for individual
services provided;
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new text begin (ii) changed prices on medical services and products, including pharmaceuticals, due to
price negotiations under the proposal;
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new text begin (iii) impact on utilization, health outcomes, and workplace absenteeism due to prevention,
early intervention, and health-promoting activities;
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new text begin (iv) shortages or excess capacity of medical facilities, equipment, and personnel, including
caregivers and staff, under either the current system or the proposal, including capacity of
clinics, hospitals, and other appropriate care sites versus inappropriate emergency room
usage. The analysis shall break down capacity by geographic differences such as rural versus
metro, and disparate access by population group;
new text end

new text begin (v) the impact on state, local, and federal government non-health-care expenditures.
This may include areas such as reduced crime and out-of-home placement costs due to
mental health or chemical dependency coverage. Additional definition may further develop
hypotheses for other impacts that warrant analysis;
new text end

new text begin (vi) job losses or gains within the health care system; specifically, in health care delivery,
health billing, and insurance administration;
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new text begin (vii) job losses or gains elsewhere in the economy under the proposal due to
implementation of the resulting reduction of insurance and administrative burdens on
businesses; and
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new text begin (viii) impact on disparities in health care access and outcomes.
new text end

new text begin (b) The contractor or contractors shall propose an iterative process for designing and
conducting the analysis. Steps shall be reviewed with and approved by the commissioner
of health and lead house and senate authors of the legislative proposal, and shall include
but not be limited to:
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new text begin (1) clarification of the specifics of the proposal. The analysis shall assume that the
provisions in the proposal are not preempted by federal law or that the federal government
gives a waiver to the preemptions;
new text end

new text begin (2) additional data elements needed to accomplish goals of the analysis;
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new text begin (3) assumptions analysts are using in their analysis and the quality of the evidence behind
those assumptions;
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new text begin (4) timing of each stage of the project with agreed upon decision points;
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new text begin (5) approaches to address any services currently provided in the existing health care
system that may not be provided for within the Minnesota Health Plan as proposed; and
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new text begin (6) optional scenarios provided by contractor or contractors with minor alterations in
the proposed plan related to services covered or cost-sharing if those scenarios might be
helpful to the legislature.
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new text begin (c) The commissioner shall issue a final report by January 15, 2025, and may provide
interim reports and status updates to the governor and the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance aligned with the iterative process defined above.
new text end

new text begin (d) The contractor may offer a modeling tool as deliverable with a line-item cost provided.
new text end

Sec. 3. new text begin APPROPRIATION.
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new text begin $....... in fiscal year 2024 is appropriated from the general fund to the commissioner of
health to contract with the contractor or contractors to conduct an economic analysis of
benefits and costs of the health care system proposal specified in section 1.
new text end

Sec. 4. new text begin EFFECTIVE DATE.
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new text begin Sections 1 to 3 are effective the day following final enactment.
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