Blue Cross Blue Shield of Minnesota's President and COO Colleen Reitan told a University of Minnesota luncheon crowd that there are six key elements to achieving universal coverage. First, all individuals must be required to have basic health care coverage. If coverage isn't required, Reitan says the plan won't work.
"Our modeling suggests that without this sort of mandate for individuals to have health care coverage, you can't get much closer to coverage than we have gotten to today in Minnesota," according to Reitan. "Our modeling suggests you can get there with an individual mandate, not an employer mandate."
If individuals refuse to purchase health insurance, Reitan says the state could assess tax penalties or have employers garnish their wages. But she says the state must also be willing to offer substantial subsidies for people who can't afford health insurance. The Blue Cross plan recommends helping people who make under 300-percent of the federal poverty guidelines.
Reitan says in order for the plan to work, insurers must be willing to change the way they do business too.
"A third requirement and this is another radical thing for an insurance executive to say, is a requirement that insurers must accept individuals who apply for their products," she said. "That means insurers would no longer be able to reject people who apply who have health conditions. You couple that with a mandate for coverage and you can safely do that in a market reform."
The Blue Cross plan also suggests that employers do more to help their employees find appropriate health insurance. It recommends creating a system to simplify the insurance process. And it encourages the state to do a lot more outreach to the estimated 59 percent of Minnesotans without insurance who are already eligible for public programs.
Insurers must accept individuals who apply for their products. That means insurers would no longer be able to reject people who apply who have health conditions.Colleen Reitan, president of Blue Cross Blue Shield of Minnesota
Reitan says if the state adopts all six of these elements, the price tag for universal coverage would probably run upward of $900 million - mostly in the form of subsidies for lower wage workers.
"Now that number is high," she admits. "But you also have to consider the economic benefits and when you do that it seems much more feasible."
By insuring all Minnesotans, Reitan says the state would save about $560 million a year. She says that's the estimated cost of lost worker productivity, unnecessary sickness and unpaid hospital and doctor bills that get passed along to taxpayers.
The Blue Cross proposal sounded good to Ken Richard. He's a small business owner who was worried he would hear a very different proposal.
"When she mentioned universal I started to sweat. As a small business owner and afraid they were going to talk about employer mandates," he said.
Richard says he supports the idea of making health coverage an individual responsibility, rather than an employer responsibility.
But another small businessman, Dan Schmidt, owner of Mercury Office Supply in St. Paul wasn't as comfortable with the proposal.
"I just see State of Minnesota and government cause, I don't know I just think the state's gonna get too involved in telling people how and where to go and what to do for treatment," Schmidt said.
Aside from business concerns, there were also people in the audience who shared broader economic concerns. University of Minnesota health economist Stephen Parente says it's hard to rely on universal coverage estimates, when the overall cost of health care is steadily rising. He says the universal coverage debate will have to consider limits on health care as well leaving room for those who want more coverage.
"First off," said Parente, "We need to describe what kind of benefit we think all Minnesotans really need to have as a baseline and then we can have these discussions that sort of partition out for those who want health care as a good, because it is something they can afford and it's tied to their income, that that's a possibility too."
Blue Cross Blue Shield of Minnesota released its plan now in the hopes that lawmakers will be ready to tackle the issue during the next legislative session.