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Viewpoint: Perspective of health care reform

This summer I and other members of the Minnesota House of Representatives met almost weekly with the Chair of the House Health and Human Services Finance Division and members of stakeholder groups to track the national health care reform discussion. We collaborated to influence the discussion by communicating directly to Washington DC and to our federal delegation while also coordinating a response and input from the high-quality, low-cost states as members of Congress continue to consider and debate health care reform proposals.

Recently I co-signed a letter from the Minnesota Health and Human Services legislators that asked the federal delegation to support our efforts on Medicare reform as part of the current national health care debate.

We strongly support enacting health care legislation this year that will include significant reform of Medicare's geographic payment inequities in order to achieve President Obama's goal of reducing health care costs while giving states an incentive to maintain their existing high-quality, low-cost delivery systems. Without this type of significant reform, Minnesota could be hurt by the federal efforts.

Our support helped Congresswoman Betty McCollum secure a U.S. House

agreement between House leaders and members from the Quality Care Coalition that the health care reform bill (H.R. 3200) include a study to look at geographic adjustment factors in the reimbursement formulas to be completed one year after enactment. Our focus is on payment reform that will revise the current Medicare formula that rewards quantity, not quality.

The president and Congressional leaders are well aware that, compared to national averages, Minnesota already provides high-quality, low-cost health care. Minnesota's health care system is ranked #1 in the country for quality and is ranked #43 in Medicare per patient spending.

Minnesota spends 20 percent less per patient than the national average and 31 percent less than in the highest cost state. In 2006, Medicare saved $1 billion in Minnesota relative to national average spending and $1.52 billion relative to the highest cost state.

Across-the board cuts in Medicare provider rates without any mechanism to reward this high-quality, low-cost care will lead to greater cost-shifting, will stifle health care innovation, and could harm Minnesota's patients if providers use higher volume to compensate for under-payments. Given our goal is to reform our payment system that rewards innovation, higher quality, and lower costs, we recommend eliminating Medicare's geographic variation and opting to pay Medicare providers on the basis of high quality and low cost.

Reforming the Medicare system to move away from existing geographic inequalities toward a system that emphasizes health care value would deliver significant financial savings to the federal government and the Medicare program.

Our hope is that any new reforms will reward the level of innovation and quality of care our providers consistently demonstrate. Minnesota has a long history of ensuring our health care delivery system promotes both quality care and access. We want to ensure any health care reform proposal put forward will protect and nurture Minnesota's quality health care.

Congress and the Obama Administration are currently considering proposals to reform the nation's health care system. There is a shared consensus in Congress that the bill must include an individual mandate, guaranteed coverage, subsidies or tax credits to ensure affordability, expanded access for the uninsured, and cost containment reforms.

The three health care bills being considered by the House and Senate also include some type of public option insurance proposal. As the debate continues to unfold before the nation, we need to ensure that we get the best value for our health care dollars by measuring outcomes and rewarding providers who deliver quality care.

As an author of the successful 2007 and 2008 health care reform bills in the Minnesota House, many features of which are now being looked to as a model for national reform efforts, I will continue to work with my colleagues to ensure that Minnesota's nation leading reforms are enhanced, and not derailed, by the national efforts.

We, who are from high-quality, low-cost states like Minnesota, would not fare well if the savings to pay for expanded access is achieved through blunt cuts throughout existing systems rather than true reform. True reform requires that the federal government incentivize those in other states to perform as well as Minnesota. I will continue to work for true reform that protects our seniors while lowering cost and improving system delivery for all.

Julie Bunn is the state representative for District 56A, which encompasses Lake Elmo and a portin of Woodbury. She is a Lake Elmo resident.