Since being elected in 2018, Rep. Jeremy Munson has been singularly focused on health care reform. He often tells the story about how he first became interested in health care when he, as a self-employed husband and father of 2 living in Lake Crystal, a small town south of Mankato, had to shop for health insurance for his family and found his choices limited and unaffordably expensive.
In the two years that he has served so far, he has championed practical solutions to the harsh realities of paying for health care in Minnesota today. To do that he has first had to counter solutions that did not work, or were simply another expensive band-aid on the problem and would result in more taxpayer money being spent to create more dependency on that money.
He argued against reinsurance. Usually, reinsurance is defined as when the Government (or some third party) agrees to pay insurance companies for taking on risk that they cannot afford. Last session, the legislature passed a reinsurance bill that awarded money to private insurers, to try to lower private market health insurance rates that had skyrocketed in Minnesota since the federal Affordable Care Act went into effect. This year they wanted to do it again.
Rep. Munson explained that one year later we now know is that all it would do was hand the insurance companies a bundle of money, supposedly to “buy down rates” but which they could use as just another revenue stream, neatly separating them from their core task which is to manage risk. Others, including many Republicans, argued that reinsurance had worked to keep rates low. Rep. Munson pointed out that transferring money from taxpayers to the insurance companies was just redistributing money, not saving the market as was claimed and not if it was going to be done on an ongoing basis. Permanent subsidies are simply socialism by another name he argued.
Munson also argued against the Governor’s so-called “Minnesota Care Buy-In.” The Governor’s plan was to take a program that was designed for people with specific problems that made it impossible for them to access the private insurance market, due to low or irregular income and expand it to anyone who wanted to “buy in.” Expanding a program to that extent would undoubtedly require large and ever-increasing subsidies. It would undercut the private market for insurance, eventually killing it and remain the only option in a relatively short period of time. Just as many people have argued with Obamacare, the end result, a single payer system was something Governor Walz also supported.
At the end of session, in the heat of last-minute budget negotiations, a coalition of special interests got together and lobbied in favor of continuing the provider tax, which was scheduled to sunset in 2018. They claimed that if the provider tax went away, Minnesota Care would be left unfunded. Rep. Munson pushed back on those claims, on social media and on the floor of the House, showing with Minnesota Management and Budget’s own numbers, that Minnesota Care is funded mostly with Federal dollars. Money from the Provider Tax was being skimmed off into the General Fund to fund items that weren’t health care related.
Rep. Munson has advocated for practical solutions that work, and despite one year as a freshman and one year in a minority caucus Munson has led the effort to bring health care price transparency. He co-authored legislation that was signed into law, requiring pricing for hospitals’ most frequently billed services to be made public.
In 2019, he co-authored and was on the conference committee for a bill, which required price disclosure from Pharmacy Benefit Managers (PBM)s, and, also, lifted the gag order on pharmacists to disclose and offer the lower cash price of prescription drugs to insured patients. By providing transparency, the PBM bill aims at exposing and preventing kickbacks, price fixing, and steering within the pharmaceutical supply chain. At the time Rep. Munson said, “Since my election, I have sought to bring price transparency to all levels of health care and health insurance, so patients can make informed decisions on what they are buying with their hard earned money. The complexity involved in prescription drug pricing is one of the largest challenges. This bill addresses that complexity by ensuring we have information about how drugs are priced and made available to consumers in Minnesota.”
PBMs are a little known but important entity in the health care system. They are positioned between the Health Insurance Organization, the Health Care Provider, and the pharmaceutical industry, to develop the “formularies” or lists of prescription medications insurers will cover. They are supposed to balance the costs, benefits, and the various interests of the different organizations, as well as their own.
The increasingly important role PBMS play and the lack of information about their decisions has led to calls for transparency on pricing and drug formularies. This session’s PBM bill was the first attempt at providing such transparency and accountability in an industry responsible for a growing percentage of our State’s healthcare costs.
The PBM bill goes into effect on August 1, 2019. Munson’s provider price transparency bill from last year, which requires doctors and clinics to post prices in their waiting room, went into effect July 1st.
Rep. Munson would like to take transparency a step further and tie it to actual cost savings. He is the chief author in the House of “Right to Shop” legislation which would create an incentive for patients in non-emergency situations to shop around for the best value for procedures and services. If they find a better price, they would be able to split the cost of the savings with their insurer and bank the savings for other health care expenses. State-based Incentive-based programs exist in Kansas, Kentucky, Massachusetts, and New Hampshire. Some large private companies offer incentive-based programs for their insurance groups.