Minnesota routinely ranks as the state with the highest level of people with insurance, but still, about 400,000 Minnesotans don't have insurance. Forty-six million people don't have health insurance nationwide.
Those numbers are becoming a big concern across Minnesota. In the latest MPR-St. Paul Pioneer Press poll, health care was the second most important issue in this year's Senate race.
Carol Mullen, 75, who lives in Alexandria, is concerned that the rising cost of health insurance is hurting people.
"My health care issues are taken care of," Mullen said. "But I see so many young people and people who are working every day who don't have good health care and I think that's an issue that needs to be taken care of."
Mullen says one of her biggest concerns is the cost of prescription drugs. Democrat Amy Klobuchar has been campaigning on making drugs less expensive. Klobuchar brought coffee and doughnut holes to an Edina assisted-living center last month to talk about the issue.
For many senior citizens, the term "doughnut" has nothing to do with pastries. For them, it refers to a gap in prescription drug coverage in the new Medicare drug program.
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The current Medicare drug benefit requires seniors to pay one-quarter of their drug costs for the first $2,250 they spend. After that, the government doesn't cover anything until drug costs get much more expensive; that's the doughnut hole.
Klobuchar is promising to remove it if she's elected. She'll pay for it by taking away tax breaks drug companies get on their marketing and advertising.
"Drug companies, as you know, have been having these huge advertisements all over," Klobuchar said. "They're on TV all the time. Very slick ads. And if you simply say, 'You can't write those off on your taxes anymore' to the drug companies, that's $16 billion right there." Klobuchar also wants Congress to lift a restriction in the law that forbids the federal government from negotiating prices with drug companies.
Klobuchar's Republican opponent, Mark Kennedy, doesn't support her idea. He voted for the Medicare bill in the House. In terms of the doughnut hole, Kennedy says he would rather see seniors buy supplemental insurance to cover their drug costs than use taxpayer money to pay for it.
Kennedy says the Medicare drug plan isn't perfect, but is better than what seniors would have received if Klobuchar had her way.
What else has (Klobuchar) offered? A bus ticket to Canada and a Web site. Because you can design the perfect plan, but you need to get it passed.
"What else has she offered?" Kennedy asked. "A bus ticket to Canada and a Web site. Because you can design the perfect plan but you need to get it passed. And to get it passed you need to be willing to work in a reasonable fashion, by working across the aisle, working with groups who may not agree with you and get 'er done. We still wouldn't have a plan today if we had that type of approach."
That bus ticket to Canada remark is directed at Klobuchar's support of the reimportation of prescription medicine from Canada. Kennedy says he won't back reimportation unless the Food and Drug Administration proves it can be done safely.
The two candidates are also arguing over the pricetag of the prescription drug benefit, and how much seniors would save if the federal government were allowed to negotiate prices with drug companies.
Klobuchar cites a study to suggest her proposal would save about $90 billion a year. Kennedy points to a different study saying the entire cost of the benefit totals only $60 billion a year -- meaning Klobuchar can't find the money she's looking for.
Roger Feldman, a professor of health insurance and economics from the University of Minnesota, says he doesn't think allowing the federal government to negotiate with drug companies will save that much money. He says Medicare already negotiates prices for hospital drugs and saves just five percent off the average price.
Feldman says a better way to lower drug prices is to allow private companies to negotiate on behalf of Medicare recipients and companies.
"If you're talking about the ability to negotiate drug prices on the basis of volume, the private sector can match Medicare any day in that respect," Feldman said.
Feldman also criticized Klobuchar for a plan she supported a decade ago. Klobuchar lobbied the state Legislature to pass a law requiring 48-hour hospital stays for new mothers and their babies. Other states did the same thing.
Feldman, a longtime critic of mandates, says the requirement adds an extra $1.3 billion a year to the nation's health care costs.
The third major party candidate for Senate, Robert Fitzgerald of the Independence Party, won't say how he would have voted for the Medicare prescription drug benefit. He said in a recent debate that eliminating the doughnut hole is too expensive and he won't support it. He does support allowing the federal government to negotiate with drug companies.
On the issue of health care costs and insuring more people, Fitzgerald says he wants to sever health care coverage from employment. He says workers then won't lose their coverage when they lose their jobs. But Fitzgerald also said on a recent radio show that he doesn't have a silver bullet to fix the system.
"I do know what several options are -- including looking at universal health care and single-payer coverage, which I'm not in favor of because it's a liability going forward," Fitzgerald said. "I also know we can take a look at this situation from a consumer-driven model as well, but I don't know what the answer is to fixing health care in the United States."
Democrat Amy Klobuchar is offering several proposals. She says universal health care should be the goal, but she doesn't think the government can afford it. As a start, Klobuchar says she'll push the federal government to work with the states to insure all children and give them access to basic care.
One of the bigger barriers the uninsured face is that individuals or their employers can't find affordable health insurance.
Klobuchar wants to counter that problem by allowing individuals and small businesses to enroll in the Federal Employees Health Benefits program. She says giving them tax breaks would make it more affordable.
"I've talked to small business owners that are just working as hard as they can to keep a pregnant employee on benefits," Klobuchar said. "This idea would allow them to buy in. And if you look at the cost right now of buying into the plan for them, it's a couple of thousand dollars cheaper than they have right now."
But Mark Kennedy says there are less expensive, private health care options for small businesses. He prefers a plan that would allow them to band together to buy health insurance for their employees.
Kennedy is also suggesting tax credits for people who can't afford insurance, and he wants to make health insurance premiums tax deductible across the board. He says Health Savings Accounts should also be available for everyone. People can use those tax-free accounts to pay for any medical need.
"Health Savings Accounts have allowed people to own their own health insurance, to bring them with them when they move from employer to employer. The average 32-year-old has had nine different employers," Kennedy says. "They also allow them to build a nest egg for the future, so they are more in control of their retirement years of addressing their health costs."
Kennedy also wants to limit the amount of money courts can award in medical malpractice cases.
Jennifer Schultz, a health care expert at the University of Minnesota-Duluth, says Kennedy's plan mirrors proposals by President Bush and Republican leaders in Congress. She says his plan would do little to boost health insurance rates for people with low incomes.
"They have to prioritize their income, and they may have to eat rather than have health coverage for a possible adverse health event," Schultz said.
Others, like Roger Feldman with the U of M, say targeted tax breaks could reduce the number of Americans without health insurance by millions.
The makeup of the Senate may come down to key races like the one in Minnesota. What Congress decides to do about health care could be determined by which party is in charge.