Rebecca's RenewMN Vision, Part II

The Healthy Minnesota Plan

A clean energy plan that creates thousands of jobs A universal health plan that puts the provider-patient relationship at the center and saves costs An economic plan that meets the workforce needs of this century as it lifts Minnesota from a low-wage to a high-wage economy

Rebecca Otto's unique plan for universal, single payer, publicly financed, privately delivered, high quality health care.

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Health care should be about relationships, not billing

Rebecca Otto's Healthy Minnesota plan puts the patient-provider relationship back at the center of health care

The Affordable Care Act made some important strides in extending coverage, but it didn't solve the biggest challenge in health care -- rising costs. Everywhere Rebecca went on her statewide listening tour, she heard from Democrats and Republicans alike who told her that we need to move to some form of single-payer health care.

But "single-payer" is a term that means different things to different people, and it doesn't necessarily address the cost issue. The question is what kind of single-payer, and how will we make it work?

Rebecca sought input from individuals, health care providers, and employers about what is going well and what needs to be changed, then she enlisted the help of economists and health care experts to explore realistic ways to tackle the problem. Rebecca Otto's Healthy Minnesota Plan emerged from these many conversations. It provides freedom from fear.

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A roadmap to health and security

Rebecca Otto's Healthy Minnesota Plan

The Topline: Rebecca's Healthy Minnesota Plan can provide care to all and save money while doing so

Health and health care should be personal and based on decisions made by individuals and families in close partnership with their provider. This relationship needs to be maintained over time, so Rebecca places it at the center of her thinking. Based on research and conversations around the state, Rebecca has developed a health care plan that provides for universal, guaranteed, comprehensive, portable health care coverage, offers consumer choice, relies on private sector health care providers and delivery systems, is publicly financed, and has effective cost controls and dispute resolution. Her plan:

  1. Covers every Minnesotan. You will be covered regardless of pre-existing conditions, employment status, age, or any other factor. You will be covered. Period.
  2. Protects the relationship between you and your care provider. Minnesota has been so far ahead in innovation in part because we’ve tried to honor the patient-provider relationship without disruption from third-party payers - but we can do more.
  3. Eliminates insurance premiums and deductibles. The Healthy Minnesota Plan funds health care fairly - half from redirected public dollars, and half from a package of fair and progressive taxes to be developed with bipartisan input, eliminating costly insurance premiums and deductibles, saving Minnesotans money overall.
  4. Eliminates provider burnout. Health care providers are leaving the profession. Fifty-four percent say they are burned out, "fueled in part by growing clerical demands that have doctors spending 2 hours on the computer for every 1 hour they spend seeing patients." The Healthy Minnesota Plan eliminates this costly burden, freeing health care providers to focus back on what they love - caring for patients.
  5. Controls health care costs. The Healthy Minnesota Plan controls health care costs by attacking the cost drivers:
    • It vastly reduces administrative costs at all levels.
    • It incentivizes providers to become partners in keeping you healthy.
    • It turns the current complex and wasteful payment system on its head.
    • It significantly reduces duplicative services; inefficiently delivered services; missed prevention opportunities; and fraud.
    • It eliminates burdensome eligibility testing for government health programs, saving taxpayers money.
    • It standardizes how we pay for health care. Much of health care is already being paid through large single payers like the Military, the VA, Medicaid and Medicare. Standardizing the financing even more will be a win-win-win for individuals, their health care providers, and employers by reducing waste and confusion.
    • It makes pharmaceutical companies and pharmaceutical benefit managers more accountable if and when they attempt to raise the costs of drugs.
    • It improves the environmental, social, dietary, and structural factors that can keep you healthier longer.

The Healthy Minnesota Plan is simple yet sophisticated, protecting Minnesotans from the catastrophic financial impacts of unexpected health care costs and unaffordable health insurance premiums, relieving businesses of an unpredictable cost that holds back innovation, and letting health care providers get back to caring for patients. To learn how, read on.

Press the plus sign or category heading of each section to open it and see the details.

Rebecca's Plan in Brief


Seven things to know about Rebecca's Healthy Minnesota Plan:

Family on a sofa

Rebecca's Healthy Minnesota Plan is different from other approaches.

  1. It guarantees coverage, provides high quality coordinated care, and allows for choice. It includes a standard, comprehensive benefit package that is portable (it goes with you instead of staying with your employer) and publicly financed, with health care services delivered by private sector health care providers.
  2. It encourages more robust economic activity by removing health care considerations from business decisions, so entrepreneurs can start or expand a business without health care worries. This also reduces labor-management conflict.
  3. It aligns your health care provider's goals with yours - to keep you healthy - and it has effective cost controls and a reasonable process for dispute resolution.
  4. It works to build communities – families, schools, businesses, faith-based organizations, and civic and non-profit organizations – that develop and sustain systems of support for better health, what many refer to as the social determinants of health.
  5. Fosters research and innovation in health care, allowing providers to provide high quality, efficient, patient-centered care. This includes public health efforts that are fully integrated with the health care and community systems to promote health and healthy living and to prevent and manage disease outbreaks.
  6. It includes food and agricultural policies that support the health, well-being and livelihoods of food producers, and the health of all Minnesotans.
  7. It incorporates energy and environmental policies that support human and environmental health.

Meeting The Health Care Challenge of Our Generation


Health care spending in Minnesota is projected to double between 2014 and 2023. No matter how we measure it, American health care costs, rate of inflation, and outcomes are alarming in comparison with other developed nations. Here's why it's happening and how the Healthy Minnesota Plan will tackle the problem.

Why it's happening

US v 10 other countries

Health care costs will double in ten years

Health care spending in Minnesota will double between 2014 and 2023. The U.S. spends more for health care per capita than any other country, and annual Minnesota health spending is expected to grow from $55.1 billion in 2017 to $85 billion in 2023. If unaddressed, this spending growth will cut into all other things that our families and we as Minnesotans care about – including quality education and protecting the environment, and will stifle business growth and innovation.

About half of U.S. health care spending is already publicly funded including Medicare, Medicaid, military Tri-Care and the VA system, health insurance for federal, state and local employees, workers compensation, and a variety of other payments. In 2013, the number was 48.2 percent. Under the ACA this share increased. When we include government payments for employee insurance, as well as tax subsidies and credits, the number increases to 67 percent.

What drives the growth in health care spending? Increased prices for outpatient and inpatient care were responsible for 50 percent of the cost increase in Minnesota from 2011 to 2013. A not-insignificant portion of this caused by duplicative administrative costs at and for the various insurance plans. Another 12.5 percent was caused by prescription drug price increases.

What is the biggest factor in rising health care costs? While inefficiency in our health care system and health care price increases are large drivers of the crisis, the greatest challenge we face in controlling health care costs is the rise in chronic conditions and the expensive treatments and pharmaceuticals available to treat them. Compounding this challenge is the aging of our population. As we age we are more likely to develop a chronic health condition.

Improving equality of opportunity reduces health care costs. In 2012, the Minnesota Department of Health found that Minnesota residents who have a chronic health condition accounted for 83.1 percent of all health care spending. The average annual spending per person was $12,800, compared to just $1,600 for Minnesotans without a chronic condition. The study also found that the incidence of chronic conditions varied greatly across geographic areas and income and ethnic groups, pointing to the strong role played by economic and social inequality. Exercise, quality of food, education, employment, and access to health care all have a role.

Cost vs Outcomes. The extra cost of health care in the U.S. might be worth it if we achieved better outcomes than countries that spend much less. But that is not the case. The research shows that the U.S. health care system does not deliver value. Minnesotans deserve to receive better health outcomes for the dollars they spend.

US v 10 other countries

Health care costs in eleven developed nations

How the Healthy Minnesota Plan will tackle the problem

Minnesota can chart its own path. It would be best to solve the problem at the federal level. Because we cannot count on this, we need to keep working with the federal level while moving ahead with a Minnesota model. After conversations with stakeholders and experts Rebecca's Healthy Minnesota Plan began to emerge. Rebecca believes that drawing on lessons learned from U.S. analyses of alternative options for health care systems, from pilot programs underway in other states, from health systems in other countries, and from the many efforts underway in Minnesota to reform payment systems, improve outcomes, and engage the entire community in promoting health and healthy living, Minnesota can chart its own path to a healthy, affordable future.

Studies of federal and state-level plans show what works. Since the early 1990s, several studies have evaluated the short- and long-term cost of switching to a universal, publicly-financed (single-payer), comprehensive coverage, private provider health care system, either at the federal or state level. The studies show that on the whole such systems sometimes cost slightly more in the first few years because they have a more comprehensive benefit set and extend health care to the entire population, but they cost less over time and are expected to improve outcomes.

The studies that compared single-payer plans to 1)mandate/exchange plans like the Affordable Care Act; and 2)managed competition systems with private, for profit insurers; found that the single-payer systems were the most effective at controlling costs while providing universal coverage.

Technologies and ideas developed elsewhere can be re-engineered to solve problems here. Several countries provide all residents with a standard, comprehensive benefit package and achieve better outcomes than we currently do in the U.S., at much lower per-person cost. A Commonwealth Fund study identified the top three performers:

  • The U.K.’s National Health Service, where health care is paid for through general tax revenue and most of the hospitals and providers are government employees.
  • Australia’s single-payer insurance program that operates much like Medicare in the U.S., with everyone covered by public insurance but most of the health care delivery system is private.
  • The Netherlands' system, which allows for competing private insurers but the financing passes through the central government and then back out to insurers based on the risk profile of their enrollees.

Despite differences, nations with universal health care systems that are more successful and affordable than the U.S. share certain common features that inform Rebecca's approach:

  1. Their systems are financed for the most part through general tax revenues.
  2. Their focus is on primary care and population health.
  3. They operate on a global budget. How much is spent on health care and everyone’s contribution to it is very transparent. If voters think more should be spent on health care, they vote to raise their taxes.
  4. Health care is provided through non-profit provider networks and organizations. Insurers, if they exist, are nonprofit and highly regulated.
  5. Prices for services, pharmaceuticals and medical equipment are set or negotiated by the government or, in cases where non-profit health insurers and plans are part of the system, the plans negotiate prices as a block.
  6. A standard, comprehensive benefit set is guaranteed, but people can often buy supplemental insurance for anything not covered through the standard set.
  7. Health coverage is fully portable. Even when payroll taxes are used to finance all or part of the system, coverage is not linked to employment.
  8. Health care systems (organized groups of providers) compete for patients. Patients choose provider health systems.

Rebecca believes we can learn from and improve upon these various strategies to create a universal, comprehensive health care system that serves the needs of all Minnesotans to create better health outcomes at a lower cost, and narrow the gap in health care access and outcomes across geographic areas and ethnic groups.

How The Healthy Minnesota Plan Works

We can, and must, do better than "medicare for all"

Rebecca's Healthy Minnesota Plan has significant advantages over traditional single-payer and Medicare-style plans, as well as mandate/exchange plans like the Affordable Care Act. The Healthy Minnesota Plan puts the patient-provider relationship back at the center of our health care system. It moves us from treating sickness to maintaining whole person health, and has built-in cost control measures. Here's how it works.

Three generations

We must rise to the great challenges of our generation

As Governor, Rebecca will work with advocacy groups, stakeholders and the legislature to develop and pass a plan with the following features.

A standard, comprehensive benefit package for all Minnesota residents. The package will include preventative care, office visits, hospitalization, screening tests, prescription drugs, physical and occupational therapies, mental and behavioral health and addiction treatment, and basic dental and vision care. The benefit package will be equivalent to quality comprehensive plans currently available through large employers.

Payments are per-patient instead of fees per-service. Our current system and proposed "medicare for all" plans both pay per procedure or service instead of per person. This puts the emphasis on procedures and billing instead of on patients and optimal health. It leaves the payer at the center of health care, telling both patients and providers what they can and cannot do. Under the Healthy Minnesota Plan, health care systems are paid to manage the health care of the whole person for a flat payment set through negotiation. The focus shifts from treating conditions to treating people. Providers profit not from doing procedures, but from partnering with patients to attain and maintain optimal health. This will vastly simplify administration and incentivize overall health.

Universal and guaranteed. All Minnesota residents will be covered and enrollment will be guaranteed. If you are a Minnesota resident, you cannot be denied. All of the different components of the market – private insurance, Medicare, Medicaid, Workers Comp, and public employees will be folded into one. The simplification and economies of scale this produces will realize substantial savings.

No insurance premiums or deductibles. You won't be charged any health insurance premiums or deductibles. The Healthy Minnesota Plan is publicly financed. About half the cost of the Healthy Minnesota Plan is paid for by redirecting funds from public health programs to a transparent, dedicated trust-fund. The rest is paid for by eliminating private health insurance premiums and redirecting the savings into the trust-fund via a combination of replacement payroll, general use, sales, and/or income taxes, as determined by the legislative process. Ultimately, these funds are constitutionally dedicated only for health care so the legislature cannot raid them for other purposes.

Health care systems will provide care. Health care systems (organized groups of health care providers) and county-based health plans and nonprofits who wish to care for Minnesotans will agree to provide the standard comprehensive benefit package of total health care for the negotiated per-person flat reimbursement. They will need to meet requirements for the adequacy of the range of their providers, and the size of their system and/or network in order to guarantee timely and high quality health care. No other plan they offer will be allowed to provide these standard, guaranteed benefits in Minnesota.

Health care systems will be paid a quarterly up front reimbursement based on the number of people they enroll, with a risk adjustment based on the mix of people they enroll and the corresponding severity of their health conditions, subject to later reconciliation. Making the payment standard and predictable, and paying it up front quarterly, will allow health care providers to plan and to develop innovations and sustainable services and programs to assure optimal health of those they serve. Consider the following example:

  • A patient has chronic lung disease that gets worse on muggy days but they cannot afford an air conditioner.
  • In the current fee-for-service world, the only way their health care system makes money is to admit them to the hospital repeatedly during the summer - costing up to $30,000 per hospitalization, and prompting the payers ultimately to cut that and pay much less.
  • But the real problem is not being addressed, because it doesn't fit into the payer's list of things they will pay for.
  • What if, as in the Healthy Minnesota Plan, there was an upfront amount that was paid to the health system for this individual to keep them healthy and not just to treat them when ill?
  • The Healthy Minnesota approach would immediately free the provider to use their medical training and best judgment to get to the root of the issue for this patient and install an air conditioner and air purifier/air exchanger in the patient's house - out of their up front payment - thus solving the real problem for a fraction of the cost, instead of repeatedly treating its effects.
  • The provider wins by sharing in the gains from reducing the cost of care and avoiding unnecessary care; the patient wins by getting the right care at the right place - a healthier environment in their own home; their employer wins by having a healthier employee who shows up on a more predictable basis; and Minnesota wins, because we've lowered the overall cost of care while improving our overall health.
  • There are numerous such examples of innovations - such as paying for transportation that currently is not reimbursed, or doing telemedicine for a disabled patient who doesn't have a car and cannot come in during winter months, which again are currently not fully reimbursed.
  • All these are delivery innovations that providers are dying to do but are not getting paid for - because the current system pays for sick care after the fact instead of for optimizing health up front.

How the Healthy Minnesota Plan will be paid for. The Healthy Minnesota Plan will not increase net costs - it will reduce them by (conservatively) 15%.

We cannot say exactly how much revenue is involved because it will depend on the level and type of benefits the legislature decides upon, but we can speak in terms of percents.

The Plan will be paid for by redirecting all public health care funds and funds from employer, employee, and individual premiums and deductibles to a broad based revenue mechanism going to a health care trust. This mechanism could be a tax or a fee or some other mechanism developed by the legislature. If it turns out to be a tax, it is a tax shift, not a tax increase. Premiums (another word for taxes to pay for health care) go to zero, and total out of pocket costs go down.

By some measures, as much as 64 percent of health care spending is already public under Medicare, Medicaid, workers comp, the VA, local, state, and federal government employee plans, and military Tri-care.

Here is a chart from a 2013 MN Dept of Health report that shows another view of the approximate mix of dollars in the health care system:

The health care spending mis

The numbers have changed slightly since then, but essentially, the Healthy Minnesota Plan takes this $40.9 billion in spending and redirects it like this:

  • Redirects already public dollars (Medicare, Medical Assistance, Other) of 46.7%
  • Redirects all private premium dollars (including those paid by public employers) of 40.8%
  • That means that 87.5% of health care will be paid for by redirecting existing public dollars and private premiums into the trust fund.
  • That leaves roughly 12.5% that is currently being paid out of pocket.
  • The Healthy Minnesota Plan will eliminate these out of pocket costs and redirect this 12.5% via some form of revenue, determined by the legislature, into the trust fund. It could be a fee or a tax or some other mechanism.
So 100% of the money we are paying for health care now is directed into a constitutionally dedicated trust fund to fund the Healthy Minnesota Plan. By using this approach, we can vastly simplify the system, cut large amounts of administrative waste and duplicative efforts, and incentivize health care systems to prioritize keeping you at optimal health instead of just performing services for fees. The end result is overall costs go down by (conservatively) 15 percent, costs will grow at slower rate in the future, overall health goes up, and coverage is extended to every Minnesotan.

Estimated savings of 15 percent. There has been no modeling done of this unique approach anywhere in the nation, however we can glean some clues from modeling of other health care plans to make an informed guess as to the estimated savings. Modeling done for the proposed California single payer plan shows projected savings of 18 percent through their fee-for-service approach, 10 percent of which will be used up by expanding coverage to all California residents, yielding a net savings of 8 percent. The California results are supported by other economic analyses and studies from other states, including one modeling traditional single-payer for Minnesota in 2012 by Growth and Justice. The wholistic, value-driven approach taken by the Healthy Minnesota Plan, in which providers are paid per-patient to treat the whole person and attain optimal health, should yield additional savings above those expected from California's fee-for-service approach. Additionally, Minnesota has a smaller uninsured population than California, of around 4 percent. We therefore estimate net savings of 15 percent, however a modeling study will have to be done to make more solid projections as the plan is taken up in the legislative process.

A public option. If provider- and county-based health systems fail to offer plans for the standard, comprehensive benefit package that meet the needs of every region and/or sub-population of the state, the state will offer a public plan option to fill the gap.

Nonprofit insurers can offer supplemental plans that cover benefits not included in the standard benefit package. Unions, employers, and individuals will be free to purchase these supplemental plans. In some circumstances, non-profit insurers may be hired to administer aspects of the Healthy Minnesota Plan. For example, smaller health care systems may choose to utilize nonprofit health insurers to administer their systems, or in the case of a public option, the Plan may contract out administration.

Transparency and accountability are built in. Health systems providing the standard, comprehensive health benefit package will submit cost and quality data to an oversight board on a regular basis.

High-quality coordinated care. This approach makes health care systems accountable for quality with a streamlined quality measurement system. The payment mechanism -- a system-wide state payment for the standard, comprehensive benefit set -- incentivizes providers to reduce medical errors, decrease hospital acquired infections, use cost effective treatments, and provide coordinated care that better manages chronic conditions and improves health outcomes.

Effective cost controls. Rebecca's Plan will have mechanisms for quality improvement and cost control in the short term and over time:

In the short term:

  • Reducing insurance underwriting, sales and marketing.
  • Reducing administrative, billing, and collection costs.
  • Eliminating means testing to determine eligibility and subsidies for government programs.
  • Providing incentives for health systems to deliver care efficiently by giving a fixed payment for the standard benefits.

In the longer term:

  • Dedicated funding sources such as a voter-approved payroll tax and federal health care funds will limit what can be spent each year on health care.
  • Competition between health systems and/or provider groups will restrain costs.
  • Consumers who buy additional services with after-tax money will be cost-conscious.
  • Systematic technology assessments will shift R&D by drug and medical device companies toward more cost-effective interventions.
  • The guaranteed payment system will eliminate a vast amount of unnecessary paperwork and administrative snarls that cost provider networks millions of dollars, freeing resources to maximize patient care. Paying health systems up front on a quarterly basis, subject to reconciliation, will turn the existing payment system on its head, freeing up resources for patient care. For example, up front reimbursement can allow a provider to help arrange for transportation to allow a patient to be seen in clinic and thus receive timely care, reducing overall cost.

Sustainable, negotiated per-person reimbursement for health care services. The per-person annual reimbursement will be negotiated between the Plan and health care systems with sustainability for our providers as a core objective.

Negotiated prices for pharmaceuticals and medical equipment. Administratively set or negotiated prices for pharmaceuticals and medical equipment will further control health care inflation using state-wide group buying power.

A system for technology and outcome assessment. Reliance on a state, regional and/or national system for comparative effectiveness, cost effectiveness and new technology evaluation to eliminate tests and treatments that the evidence shows have little or no value.

A reasonable system for dispute resolution. A state or regional system for patient safety and dispute resolution to evaluate, resolve, and, as appropriate, compensate individuals in disputes arising from the provision of health care services. Lawsuits can still be filed as a last resort. Providers will save money by having to carry less malpractice insurance, one of the primary drivers of unnecessary tests, helping to reduce costs overall.

A mechanism that allows for out-of-system referrals. The plan will contain a reimbursement mechanism for travel, emergencies, and specialized care when certain health systems have greater strength or expertise than others, or when a patient is referred to a specialist out of the state.

A return to research. The Healthy Minnesota Plan will re-prioritize medical research at the University of Minnesota, Mayo, and other research facilities to find new ways to continue our nation-leading tradition of discovering new cures and treatments through these scientists and engineers, and though our innovative medical device and treatment community.

With the Healthy Minnesota Plan, the vast majority of Minnesotans will pay less than they currently pay for health care through premiums and out-of-pocket expenses.

What this means for You and Your Family

Finally, Health Care freedom is possible

Imagine a world in which you and your family are guaranteed health care and there are no unexpected health care costs. In which the vast majority of Minnesotans pay less for health care, and it's not tied to their employment. In which small businesses can be started and thrive without health care being an impediment. That world is now within our grasp. Here's how.

Family at sunset

The Healthy Minnesota Plan gives you health care freedom

health care freedom

Under The Healthy Minnesota Plan, you and your family will be guaranteed health care and there will be no unexpected health care costs. The Plan will provide health care to all Minnesota residents regardless of their age, employment status or pre-existing conditions. Unexpected health care costs will no longer put you or your family at risk of bankruptcy. You will be covered when you travel, and you will be covered if you need a referral out of state. You will be covered, period.

You will be guaranteed a comprehensive package of benefits. The Plan will guarantee you and your family a comprehensive, generous, publicly financed standard benefit package similar to major corporate packages, delivered by existing private health care systems and provider networks. There will be no premiums or deductibles. Individuals, families, unions, and employers will be able to purchase supplemental insurance benefits if they choose.

You and your family will be able to stay with your choice of primary care provider, who will partner with you over time to optimize your health, and that insurance coverage changes or employment changes do not disrupt that very important relationship. Rebecca understands that optimal health comes from quality care provided with consistency by a knowledgeable provider over time. The Healthy Minnesota Plan will prioritize and protect your long-term relationship with your provider.

The Healthy Minnesota Plan includes mental and behavioral health care and addiction treatment. Every family in Minnesota has a member who is facing or has faced a mental or behavioral health challenge or an addiction. The Plan includes mental and behavioral health care and addiction treatment as part of its standard benefit set.

The Healthy Minnesota Plan will tackle the opioid crisis. Large pharmaceutical companies developed synthetic opioids and marketed pain management heavily to physicians, but there were few if any prescription guidelines. Opioids can cause addiction after just one week. The Healthy Minnesota Plan will work with health care systems to develop clear guidelines on opioid use, so that physicians are educated, and are not pressured to overprescribe. The Plan will replicate successful opioid addiction treatment and prevention models like the multidisciplinary care team model pioneered by CHI St. Gabriel’s Health in Morrison County.

With The Healthy Minnesota Plan, Minnesotans as a whole will pay less for health care. A 2017 Commonwealth Fund study examined health care performance in 11 countries. The U.S. ranked last in overall performance and first in spending. The Healthy Minnesota Plan re-engineers features of universal, publicly financed health care systems in other countries that have proven successful at providing health care for much lower per person costs with better outcomes, and applies them to our situation in Minnesota.

The Healthy Minnesota Plan puts you in charge of your health care coverage, not your employer. Under The Healthy Minnesota Plan, your health care coverage is attached to you and your family, not your employment. The Plan gives you the flexibility to do what is best for your family in terms of where you work or whether you choose to leave the workforce to care for others or start your own business.

Imagine living in a world that supported you and your family's efforts to achieve and maintain good health and the economic stability that comes with it. The Healthy Minnesota Plan calls for greater investment in community-based healthy living and public health initiatives, and greater recognition and encouragement of private efforts aimed at improving health.

There are numerous examples of successful efforts to get people moving, eat healthy, and stop smoking. Rebecca wants to see these efforts built upon in communities throughout our state. Such efforts are essential to combat obesity and chronic disease, and keep health care costs down for all of us.

What this means for Health Care Providers

Health Care providers are freed to provide the best health care

The Healthy Minnesota Plan honors the relationship between the individual and the health care provider, without disruption from third-party payers. Providers won't have to spend a large portion of their time doing paperwork and collections, and are freed to do what they got into health care for, which is helping patients. We can achieve that world. Here's how.

Health Care Provider

The Healthy Minnesota Plan gives providers health care freedom

health care freedom

How health care will be paid for

The Healthy Minnesota Plan frees health care providers, too. Providers tell Rebecca they spend a large portion of their time dealing with paperwork for the various health plans, instead of caring for patients. Each plan they deal with is different, with a different payment system, different rules, different procedures, and different people. Then when providers bill, they often wait several months for reimbursement. They have to get third-party payer approval. They have to change treatment plans if approval is denied. They have to write off portions or sometimes all of their fees. All of this inefficiency adds to the cost of delivered health care. Meanwhile, Minnesota hospitals operate on a one to two percent margin. It makes for a frustrating, duplicative, inefficient, and costly system.

The Healthy Minnesota Plan pays annual care reimbursements per-enrollee, up front on a quarterly basis, directly to health care systems (organized groups of providers), eliminating all these costly inefficiencies. This will turn the current payment system upside down, cutting vast amounts of paperwork and putting providers back in the position of being providers, allowing them to get back to their relationships with their patients. It will allow innovation by making cash flow more predictable.

This is a large improvement over "Medicare for All" proposals or traditional single-payer proposals that adopt a fee-for-service payment system. The Healthy Minnesota Plan drives value by putting the provider-patient relationship indivisibly at the center of health care. They share the same goal: optimize overall patient health.

Accountability will be managed through reconciliation on a regular basis. The Healthy Minnesota Plan will eliminate redundant and burdensome measurement and will measure only what adds value to the patient. Through purchasing power, it will make large for-profit monopolies like electronic medical record vendors add value to your care, not just burden, allowing your doctor to face you and not the computer screen.

Fostering stable, long-term patient-provider relationships.It is critical that the population of individuals that receive care from a provider remain stable year after year, so that the patient-provider relationship can be maintained -which has everything to do with health. Currently individuals have to switch from one insurance plan to another due to various reasons such as affordability or employment changes, thus forcing them to switch their providers - which is not good for anyone. It adds directly to waste, with repeat tests, loss of continuity, and loss of trust. By stabilizing payments and benefits, the long-term patient-provider relationship can be maintained, and placed back at the center of health care.

Our current system is focusing more on coding and billing to payers than these higher goals. The Healthy Minnesota Plan will cut out the waste and make the health care system be more about health.

How health care will be delivered

Health care systems will only have to deal with one standard benefit set. In addition to standardizing and simplifying payments, the Healthy Minnesota Plan standardizes and simplifies benefits. In exchange for the annual care reimbursement, a health system will agree to provide the full standard benefit set to the enrollee. This shifts the incentives from performing and billing for services and procedures to maximizing optimal patient health. Providers will be able to concentrate on providing top quality health care, and make decisions that are in the best long-term interest of the patient, who is placed back at the center of the health care system.

Providers will be supported to continue innovation that Minnesota is nationally recognized for. This will help providers serve everyone in their communities, however diverse, through both medical and social interventions. Working with providers, the Healthy Minnesota Plan will create a sensible population-based health care model that is dictated by what the patients, families and communities need and not what the insurers demand.

The healthy Minnesota Plan will contain a system for patient safety and dispute resolution to evaluate, resolve, and, as appropriate, compensate individuals in disputes arising from the provision of health care services. Lawsuits can still be filed as a last resort. Providers will save on costs by having to carry less malpractice insurance, helping reduce costs overall.

What this means for Employers and Innovators

Compete without worrying about health care

Imagine a world in which you are free to hire and expand without worrying about health insurance costs. In which you are free to leave a dead-end job and start a business without fear of losing your health care. In which workers comp rates are reduced because health care is already covered. In which you have a competitive advantage over businesses in other states. Here's how we can do it.

Small business start-up owner

The Healthy Minnesota Plan frees small businesses to innovate

health care freedom

Small businesses are engines of innovation and job creation, but they are being held back by unpredictable and expensive health care costs.

Individuals often have to make decisions not based on what they'd like to be doing, but on what their health insurance needs force them to do. By lifting the burden of expensive health insurance off of individuals and small businesses and replacing it with quality, affordable universal health care under the Healthy Minnesota Plan, Minnesota will unleash a new era of prosperity, innovation, and job creation. Minnesota will become a destination state for entrepreneurs and innovators.

Under The Healthy Minnesota Plan, you are not limited. Your employees will be covered, but if you are an employer or union wish to offer supplemental "gold" or "platinum" insurance benefits, you can.

Larger employers with self-insured plans will be able to limit or eliminate this cost center as Minnesota resident employees will be eligible for the Healthy Minnesota Plan.

Imagine a world in which businesses don't have to make decisions based on health insurance coverage, or devote resources to health care administration and cost controls. The Healthy Minnesota Plan takes businesses out of the business of health care and lets them focus on their primary mission. And The Healthy Minnesota Plan will save businesses money because the standard set of benefits is publicly financed and costs less than providing health insurance for their employees.

It's the competitive thing to do.

What Rebecca will do to set the Healthy Minnesota Plan up for success

Making the transition

There are many things we need to do to successfully transition to a health plan that works for all Minnesotans. Here are a few things Rebecca will also be working on at the same time.

Doctor and plan administrators

The Federal Role

The financing of Minnesota health care is heavily reliant on federal funds, and its organization is constrained by federal law. About $19.4 billion, or 46.7 percent, of Minnesota health care spending in 2013 was public dollars, and 74 percent of those public dollars came from the federal government.

As Governor Rebecca will address the federal role on three levels.

  1. She will work with other governors and our federal delegation to make sure the feds do no harm.
  2. She will advocate for a federally-financed but state-administered system of universal, comprehensive health care.
  3. If continuing dysfunction at the federal level fails to move us toward universal, comprehensive coverage and effective cost and quality controls, Rebecca will lead the state in adopting its own reforms.

Rebecca will push Congress to provide on-going support for reinsurance until more permanent reforms are implemented.

Rebecca also supports continued federal funding of MinnesotaCare (our state’s basic health plan) and of the Medicaid expansion.

Rebecca will strongly support federal regulatory reform to rules that block coordinated care or emerging best practices and put what is best for payers ahead of what is best for patients. For example, a rule that Medicare won’t pay for a patient to see more than one specialist in a day. To achieve best practices in coordinated care and to inconvenience a patient the least, it is sometimes more efficient and effective to see all the various provider members of your health team over a day or two. This coordinated care approach is something the Healthy Minnesota Plan will embrace.

Rebecca will push for national solutions to runaway pharmaceutical pricing. The feds should harness the negotiating and buying power of Medicare and Medicaid to counter the power of the pharmaceutical industry.

The State Role


Because Congress and the President continue to fail to pass universal, guaranteed coverage, Minnesota must lead the way by adopting its own reforms, and seeking federal waivers re-directing dollars connected to existing public programs wherever possible to finance such coverage.

  • Rebecca will lead efforts to obtain such waivers, and she will draw on Minnesota’s history of innovation in health care delivery, outcomes measurement and payment reforms to create a system of public financing and private delivery of health care that not only lowers administrative costs but creates incentives to be dynamically efficient at controlling costs and delivering quality over the long run.
  • Rebecca will seek changes to federal law so that the state or a consortium of provider and/or nonprofit insurer-based plans can negotiate prices for prescription drugs and medical equipment.

The extent of federal involvement in health care funding at the state level makes it very difficult for states to go it alone. Vermont offers a cautionary tale. Vermont passed a proposal for a publicly financed, single-payer, comprehensive health plan in 2011. The first few years after the law passed were to be devoted to studying alternative models, choosing among them, and then working out the many details. These issues included benefits, tax base, directing federal money to the new plan, and dealing with the operations of corporations self-insuring under the federal ERISA law. The final version, with the generous negotiated benefits, and the carve-outs for Medicare and large corporations, led to the state tax increases being much higher than anticipated. The plan failed to move forward. We must learn from the Vermont's experience, and innovate to surmount the decisions and obstacles that were the undoing of the Vermont effort.

Working with our health providers and health systems, and drawing on the wealth of resources Minnesota uniquely has related to evaluating the performance of health systems, Rebecca will promote innovation in delivering maximum value.

Minnesota Does Better When We All Do Better


We have to take a holistic approach to achieve and maintain good health, and it takes all of us.

Mixed group doing back exercises

Everyone has their part to do in maintaining their health

While access to quality health care is essential, it contributes only about 20 percent to health outcomes. A larger role - 30 percent - is determined by health behaviors: tobacco use, diet and exercise, alcohol use, and unsafe sex. Another 10 percent is determined by environmental quality and features of the built environment.

The largest portion, 40 percent, is determined by social and economic factors like education, employment, income, community safety, and family and social support.

Rebecca recognizes that our health, and thus our health care expenditures, are linked to and affected by our behaviors, our mental health, our environmental exposures, the built environment, and our socio-economic circumstances. Health must be viewed in the context of its connections to all these aspects of our lives.

Rebecca’s Healthy Minnesota Plan recognizes these connections and will direct leadership and funds to every component: health care coverage, health system incentives, community initiatives that support healthy choices by individuals and families, and clean air and water. The University of Minnesota, public health entities, the Minnesota Department of Health, counties, schools and social service agencies will all be encouraged to work with medical providers in order to bring about this proven, effective, holistic model in communities across Minnesota.


What people are saying

National Health Care Expert Ezekiel Emanuel Endorses the Healthy Minnesota Plan

"The Healthy Minnesota plan is simultaneously progressive, prudent, and responsible."

Health Care expert Ezekiel Emanuel

Ezekiel Emanuel, chair of the Department of Medical Ethics and Health Policy at the Perelman School of Medicine and The Wharton School, University of Pennsylvania, and a leading expert on U.S. health care policy

"The Healthy Minnesota plan is simultaneously progressive, prudent, and responsible. Rebecca Otto's proposal eliminates coverage gaps, allowing all Minnesotans to choose a job that’s right for them, without worrying about whether they will have health insurance or not. Her plan is a thoughtful and detailed step toward incentivizing doctors and hospitals to improve quality, and ensure patients and families get high value care regardless of socioeconomic status."

-Ezekiel Emanuel, MD, PhD
 Vice Provost of Global Initiatives
 Chair, Department of Medical Ethics and Health Policy
 Levy University Professor
 Perelman School of Medicine and The Wharton School
 University of Pennsylvania
 Author of:
 Healthcare, Guaranteed: A Simple, Secure Solution for America (2008)
 Reinventing American Healthcare (2013)
 Prescription for the Future: The Twelve Transformational Practices of Highly Effective Medical Organizations (2017)

Health Care Expert Maureen Reed Endorses the Healthy Minnesota Plan

"The Healthy Minnesota Plan tackles all the tough issues of health care reform."

Health Care expert Maureen Reed

Health care expert, physician, former HealthPartners medical director, and former chair of the University of Minnesota Board of Regents Maureen Reed

"The Healthy Minnesota Plan tackles all the tough issues of health care reform. It is courageous, it is comprehensive, and it is long over-due. Minnesota needs the grounded, common-sense leadership that Rebecca provides in this plan. Like you, I’ve watched family members stay in jobs they dislike because they need health insurance. For years I’ve personally purchased high-priced, after-tax individual insurance. I’ve seen small NGOs limit their activity because high insurance costs sucked their resources. And I've felt the increasing frustration of health care professionals. What a waste of talent, money and enthusiasm! Minnesota can do much better. The Healthy Minnesota Plan shows us the way."

-Maureen Reed, MD
 former VP and Medical Director, HealthPartners

Economist, health care expert, and former lawmaker Julie Bunn applauds Rebecca's Otto's Healthy Minnesota Plan

"Rebecca Otto's Healthy Minnesota Plan is a giant step in the right direction—a unique, value-driven approach that is serious about tackling rising costs."

Health Care expert Julie Bunn

Health care expert, economist, and former lawmaker Julie Bunn

"Rebecca Otto's Healthy Minnesota Plan is a giant step in the right direction if we want to realistically tackle rising health care costs while maintaining or improving quality. It is a responsible Plan that goes much farther than rhetoric; it looks at how we can actually get this done in a way that maximizes our current assets and directs them to tackle the issue. While the problem should ultimately be solved at the federal level, Rebecca Otto's Plan, if enacted, will get done in Minnesota what the feds seem unable to do - provide universal, affordable, guaranteed, and comprehensive health care for our citizens."

-Julie Bunn, PhD
 Economist, health care expert, and former Minnesota legislator


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