Recommendations for Health Care Reform by the Minnesota Universal Health Care Coalition

As members of organizations representing physicians, nurses, labor, faith groups, and advocates across Minnesota, we are deeply concerned about improving the health and health care coverage of our communities. We feel strongly that a single-payer system is the most efficient and equitable way to guarantee affordable health care for all. Affordable access to health care is a fundamental prerequisite for promoting health. Consistent research supports our belief that a single-payer system will offer tremendous cost-savings over our current fragmented multi-payer system.

Absent a single-payer system, we believe a robust public option is an essential outcome of the current national health care reform discussion, and the design of that public option is critical to its ultimate success or failure. A well-designed public plan will protect consumers against discrimination in the health care marketplace, give enrollees a real choice of providers and help to ensure that all Americans have an affordable and accessible option for health care. In contrast, a poorly designed public option could quickly become unsustainable, fail to control costs or expand coverage, and make true reform even more difficult in the future.

As the federal health care reform discussion moves forward, we urge Congress to design a public option that will be viable and sustainable. We believe that Medicare is unusually efficient, and a public plan that possessed Medicare’s low overhead, reasonable provider payment rates and large size would have the ability to compete fairly with the insurance industry and lower overall health care costs. The Lewin Group* has stated in two reports that a public plan that meets the first six criteria below would be able to compete fairly with the insurance industry.

1. The public plan has a large pool of enrollees on the day it begins operations. This pool could be created in part by the automatic enrollment of Medicaid and SCHIP enrollees and a large portion of the uninsured.

2. The public plan is open immediately to all Americans (including large employers).

3. The public plan is authorized to negotiate on behalf of its entire enrollee population to achieve reasonable reimbursement rates for providers and fair prices from drug manufacturers.

4. The public plan is required – along with the private insurance industry – to cover a comprehensive set of benefits.

5. Enrollees in the public plan should receive subsidies that make the purchase of insurance from the public program affordable for all Americans.

6. Premium payments to all insurers should be adjusted to reflect differences in the health status of their enrollees to protect all insurers against adverse selection (higher costs caused by enrolling a disproportionate share of the sick).


There are numerous other criteria that would strengthen the public program. We believe the three criteria listed below should also be considered essential as well:

1. Require providers to accept enrollees of the public program.

2. Prohibit the public program from limiting enrollees’ choice of provider and giving providers incentives to deny care.

3. Ensure that states retain the right to establish their own single-payer systems.


As members of a broad spectrum of the public, concerned about the present state of our health care system, convinced that meaningful reform is possible and vital, we urge Congress to insist that any legislation creating a public program meet these criteria. If the public program does not meet these criteria, it will be unable to lower health care costs. If we do not lower costs, we will not achieve universal health insurance. If we do not achieve universal health insurance this year, we will have squandered a rare opportunity to improve the health and economic security of all Americans.


Charlotte Fisher, RN/NP
President, Greater Minnestoa Health Care Coalition

Reverend Dan Garnaas
Leader, ISAIAH

Chris McCoy, MD
Policy Committee Chair,
Minnesota Local Action Network of the National Physicians Alliance

Susan Hasti, MD
Chair, Minnesota Universal Health Care Coalition

Ann Settgast, MD & Elizabeth Frost, MD
Co-chairs, Physicians for a National Health Program – Minnesota chapter

Dan McGrath
Executive Director, TakeAction Minnesota

Joel Albers PharmD, PhD
Coordinator, Universal Health Care Action Network – Minnesota


* To develop criteria for an efficient, Medicare-like public option, we relied on the papers published by Jacob Hacker in 2001 and 2007 in which he presented a detailed version of a public program. Mr. Hacker is the most prominent advocate of the public option approach. We also relied on evaluations of Mr. Hacker’s papers by the Lewin Group, a subsidiary of United Health Group. Mr. Hacker’s 2007 paper is entitled, “Healthcare for America: A proposal for guaranteed, affordable health care for all Americans building on Medicare and employment-based insurance,” and is available here. The Lewin Group analysis of Mr. Hacker’s 2007 paper, published in 2008, is entitled, “Cost impact analysis for the ‘Health Care for America’ proposal: Final Report,” and is available here.