Insurance exchange a step toward health equity for all

In the United States and here in Minnesota, your health, and your ability to get health care or health insurance, has a lot to do with who you are.

A report released last year from the Centers for Disease Control and Prevention, (CDC), a part of the U.S. Public Health Service, put numbers to what many people have known for a long time — that access to health care is harder for the poor, for racial minorities, for the less educated, and for the those with preexisting conditions.

African Americans have HIV infection rates that are eight times higher than average. Rates of cancer are over 25 percent higher; the heart attack rate is 30 percent higher, the stroke rate is 41 percent higher and the diabetes rate is double that of White Americans.

What are the factors that drive these disparities? Poorer access to medical care and medicine, poorer living conditions, poorer health education — and just plain being poorer.

Income plays a big role. Unemployment rates are higher for racial minorities, and those with jobs earn less than average. That means fewer have access to employer-provided health care. Those with health plans often find that their insurance doesn’t cover as many conditions, have higher out-of-pocket expenses, or don’t provide family coverage.

Inadequate and unhealthy housing is another reason. More than 27 percent of all African Americans live in rental housing that’s classified as unhealthy — peeling lead-based paint, no smoke alarms, and insect or rodent infestations.

The biggest factor by far in the health disparities is access to health care insurance. African Americans have uninsured rates that are over 57 percent higher than the general population. For Latinos, the rate soars to 197 percent.

An even bigger factor in whether someone has health insurance is their level of education. High-school dropouts have 400 percent the un-insurance rate of college grads, and even those with some college but no degree are more than twice as likely to be uninsured.

The consequences of being uninsured or underinsured are fewer doctor checkups and medical screenings for conditions that can be cured with early diagnosis, like diabetes, heart disease and cancer. Infant mortality rises, and people don’t live as long.

That’s why improving access to quality health insurance is the key to improving health. Along, with Rep. Erin Murphy in the Minnesota House, I’ve introduced the “Healthy Minnesota Exchange.”

It is drawn to implement a key provision of President Obama’s Patient Protection and Affordable Care Act (PPACA), which calls for the creation of health insurance exchanges in each state. Under the PPACA, there is a mandate for everyone to be covered by health insurance. For those who cannot afford insurance, subsidies and tax credits will be available to eligible individuals and small businesses to make coverage more affordable.

The exchanges negotiate prices with insurers, giving everyone access to the lower rates that big employers get with their health plans. It provides a single point of entry where small businesses and individuals can select plans that work best for them. It would also serve as the place that families apply for Medical Assistance, and the Children’s Health Insurance Program (CHIP).

In addition to all these things, the Healthy Minnesota Exchange would cut red tape and onerous application forms, providing a “no-wrong-door” approach that serves people no matter their language or background. The coverage would be portable, meaning that if a policyholder loses a job or becomes self-employed, they can keep their insurance.

The Healthy Minnesota Exchange would be governed by a board that reflects the diversity of those who would be served by it. It would require that seats be reserved for people served by the exchange, as well as employees and small employers.

Health care is a basic human right. If enacted, the Healthy Minnesota Exchange will improve health equity between rich and poor, between communities of color, and in every corner of the state.

Statistics for this column came from the CDC Health Disparities and Inequalities Report, 2011.

Sen. Jeff Hayden represents District 61 in the Minnesota Legislature. He welcomes reader responses to sen.jeff.hayden@senate.mn.