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Most people would rather file their taxes than shop for health insurance.  And the person they trust the most for advice on choosing a health plan is, for better or worse, their mother.  Such are the findings of studies by the Consumers Union, the policy and action arm of Consumer Reports.

On May 14^th, Lynn Quincy of the Consumers Union presented highlights from three recent consumer testing studies to a work group that is helping design the Minnesota Health Insurance Exchange.   The Exchange, which will launch in 2014, is a critical element of health reform.  Over one million Minnesotans are expected to use it to compare and purchase health plans and determine whether they’re eligible for public insurance programs or tax credits to make their health insurance more affordable.  A well-built Exchange can also offer increased protections and security to people buying insurance by making sure insurance companies play by the rules, and offer affordable, quality plans.

The studies found that people dread shopping for health insurance.  This may be obvious, but the implications are complex.  Because people want to get it over with, they take short cuts when comparing health plans, Quincy explained, and the short cuts often lead to uninformed choices.  Bad choices can result in people not having the insurance they need when they get sick.  And that, along with poor insurance options, can lead to inadequate care, unpayable bills, and for too many, even bankruptcy.

Here are some of the reasons people hate shopping for health insurance, according to the Consumers Union, and how the Exchange can try to help:

1. People can’t assess the value of different plans.  Most people don’t just want the cheapest plan, they want the plan with the best value –  the one that offers the best coverage for the price. But most consumers find it hard to assess the value of different plans.  This is because the jargon is difficult (what is the difference between coinsurance, cost-sharing and co-pays?), the concepts aren’t clear (who pays 20%, the patient or the plan?), and many cost-sharing amounts are unknowable at the time people are purchasing health insurance.

2. People need a manageable number of choices.  The studies typically asked people to compare just two health plans at a time.  Even with that limited set of choices, people had trouble assessing value, for the reasons described above.  The report concludes that comparing a large number of plans, all with varying features is “an impossible cognitive task.”  It’s not surprising, then, that behavioral research shows that an abundance of plan options does not help people make better choices, and that people generally prefer fewer choices that are truly different from each other to an unlimited number of choices.

3. People don’t trust insurance companies.  Even when people have access to good information about health plans, they don’t act on that information if they don’t trust the source.  And most people do not trust information they get from insurance companies.  They believe insurers are “tricky,” and they worry that important details will be hidden in fine print.  Many people don’t even trust what their employer has to say about the health plans they offer.  Who do people trust to give good advice about choosing a health plan?  Their mothers.  But let’s face it, our moms are as likely to have trouble understanding plans as everybody else!

So how can the Exchange help?  The Consumers Union recommends 3 priorities:

First of all, an Exchange could help people assess the value of plans by displaying the “true insurance value” of each plan: how plans compare on total annual cost (premiums plus out-of-pocket costs) based on average health care expenses of populations similar to the person applying in age, family composition, and other characteristics.  That way people can compare one meaningful variable across plans, rather than trying to calculate premiums, co-pays, deductibles and coinsurance for each plan themselves.

Second,  an Exchange could choose to offer a manageable number of plans with meaningful differences between them.  It can do this by limiting the number of plans on the Exchange to the best value plans on the market and reducing the number of features that can vary between plans.  This will help consumers avoid “choice paralysis,” the condition where an overload of choices leads consumers to make decisions that aren’t in their best interest.

Third, the Exchange will need to work hard to earn the people’s trust.  Better yet, it should work to earn the trust of our mothers.

This will be an ongoing endeavor, and the best strategy for success will be to ensure that consumers have a powerful voice in the policy-making process.  First steps should include keeping insurers off the Exchange’s board of directors, partnering with trusted community organizations to help people navigate the Exchange, and bargaining with insurers on behalf of consumers for high-quality plans at good prices.  If it can do this, shopping for health insurance on the Exchange could be more fun than filing your taxes, and truly improve access to quality health care in Minnesota.

Anna Odegaard

Anna Odegaard is a policy professional with SEIU Healthcare Minnesota. 

The legislative session is newly finished.   Over the course of a contentious few months, TakeAction members and leaders were an integral part of defeating several right-wing attacks on health care and our state budget.  We are now setting our sites squarely on November where a radical restructuring to our voting system will be on the ballot.

The GOP kicked off the 2012 session with several bills to put the state’s new “Health Benefits Exchange” directly into the hands of corporate insurance industry.   GOP legislators moved these industry-driven bills behind closed doors and in the dead of night, skirting rules about public notice and public testimony.  (At one point, Senate GOP Chair David Hann called a 9pm committee hearing on a Friday night with less than half-hour notice, and allowed only a right-wing think tank to testify on his bill.)

But TakeAction Minnesota members and leaders refused to hand our Exchange over to the insurance industry.   We made clear that we cannot allow the fox to guard the hen house of our Health Benefits Exchange.   Over 400 individuals joined a meeting with Commissioner Rothman on March 25, 2012 to call for a people-centered health Exchange instead that works to improve health for all Minnesotans.  At the end, only one industry-driven proposal passed the Minnesota Legislature.  TakeAction and our allies urged Governor Dayton to “Pitch the bill,” which was then quickly vetoed by Governor Dayton.

TakeAction Minnesota also played a key role in scuttling a series of dangerous, right-wing proposals to restrict the state’s ability to invest in education, health care, and other needed services.  GOP leadership sought to place a “supermajority” amendment on the 2012 ballot, which would have required a 2/3 majority in the Minnesota Legislature to pass a revenue increase.  TakeAction teamed up with other key organizational partners to reveal the damaging impact of the “supermajority” amendment, lobby against the proposal at the Capitol, and organize constituents to urge their legislators to oppose the measure.    The opposition to the supermajority amendment grew throughout session, and its authors eventually failed to receive the support they needed to push this proposal onto the November ballot.   In a final act of the session, Governor Dayton also vetoed a GOP tax bill that would have increased the state’s deficit by granting irresponsible tax breaks to Minnesota businesses.

One key ballot measure did pass the 2012 session – and TakeAction Minnesota now has our sights squarely on defeating “photo ID” in November.  The “photo ID” ballot measure seeks to shift political power into the hands of the wealthiest 1% and corporate special interests by robbing thousands of Minnesotans of the right to vote if they lack a current photo ID.   Photo ID would permanently restructure the Minnesota electorate and deprive thousands of seniors, young people, individuals with disabilities, and communities of color of their rights to vote.  TakeAction Minnesota is playing a leadership role in the Our Vote Our Future campaign, which is organizing statewide to defeat photo ID in the Fall.   TakeAction joins many other organizations in urging NO votes on both photo ID and the marriage amendment in November 2012.

Liz Doyle

Liz Doyle is TakeAction Minnesota’s Associate Director.  

My earliest memories are about keeping quiet.  I remember coming home from grandma’s house to have my mouth washed out with Lava soap; my mom’s threatening steely eyed death stare when I spoke out of turn; and her mouthing the words “big mouth” at me while she imitated the gestures of a hand puppet.  Later a step-father would embed in my psyche the importance of keeping secrets.  I had no voice.

My experience in the justice system only compounded my feeling that I didn’t have a voice.  When I insisted I was not guilty of the crime — my court appointed attorney — threw his arms up in the air and exclaimed “What do you want me to do for you?”  I thought: “Do your job.  Stand up for me.  Tell the judge I’m innocent.”

Instead, I kept quiet out of fear and took the plea agreement. During my sentencing the attorney thought I should make a formal apology to the judge. I tried to speak but I was sobbing so hard that no one in the courtroom could understand me.  The demonstration of emotion angered the judge.  He sternly reprimanded me, and then sentenced me to prison.  I still had no voice.

So my story goes.  I know that I am not the only one out there whose voice has been stolen. Parents, grandparents, teachers, schools, courts, prisons, systems, societal structures, and erroneous worldviews steal our voices.

But one thing I’ve learned is that we don’t have to buy into powerlessness of silence anymore.  We can be heard.  We can demand change.  We can take back our voices.

On Wednesday, May 9^th, I had the privilege along with 200 of my close friends to reclaim our voices in a most unusual place – Target Headquarters. We marched into Target with our voices strong chanting “Red shirt, Khaki pants, — all we want is a chance.”  My friends and I had found our collective voices. We were not willing to stand back and watch as big corporations throw communities of color under the bus by keeping them out of the job market.  We drew from our personal stories; we had done our homework, community leaders stood at our side and we were ready to take on a giant in the business world…Target.

Because we were raising our voices in unison, we couldn’t be ignored even by Target.  Soon three Human Resource representatives appeared and were ready to discuss our demands.  Before it was over we were setting appointments to meet later this month.  Finally, we had been heard!

Reclaiming my voice as 200 of my close friends did the same was an overwhelmingly powerful moment.  Our voices united cannot be silenced.

Jill Barnes

Jill Barnes is a leader in TakeAction Minnesota’s Justice 4 All Campaign.

The conversation about the development of a Minnesota Health Benefits Exchange is moving quickly at the State Capitol.  Beginning in 2014, over 1 million Minnesotans are expected to use the Exchange to choose among health coverage options and obtain federal tax credits to offset the cost of that coverage.  The Exchange is a key component of the Affordable Care Act passed in 2010.

GOP legislators have introduced a series of bills that construct pieces of a health insurance exchange driven by the insurance industry.  Senator Gerlach (Apple Valley) has a proposal to establish an Exchange that has no ability to serve the interests of consumers.  Senator Hann (Eden Prairie) has introduced proposals to divert tax credits under the Exchange into thousands of industry insurance brokers.  Senator Hann also has a proposal to restrict entities who can fully serve as “navigators” in the Exchange to only licensed brokers.  TakeAction and our allies have been working hard to uncover the true intent of these proposals — to hand over our Exchange to the insurance industry — and voice our opposition to this approach to the Exchange.

Meanwhile, Senator Hayden and Representative Erin Murphy have introduced a proposal that would construct an Exchange designed to work for consumers.  The “Healthy Minnesota Exchange” proposal would be able to negotiate for better prices and quality for health care coverage, support community-based organizations to serve as navigators in the new system, and ensure that individuals can easily move into public or private health coverage, depending on what works best for their families.  We are proud to be working with these legislative champions for Minnesotans on an Exchange that improves people’s health rather than increasing insurance company profits. 

TakeAction members and leaders continue to play critical leadership roles on this issue.  Over 400 individuals from TakeAction Minnesota and six other organizations gathered on Sunday with members of the Legislature and Comissioner Michael Rothman to call attention to the needs of people in the health exchange.  TakeAction leaders have also testified on the Exchange at the Legislature, participated in working groups of the Health Exchange Task Force, joined meetings with legislators and contacted Governor Dayton.  Just today they are at the Capitol visiting their legislators to say we don’t trust the insurance industry to run our Exchange. 

Our work on the Exchange also coincided with the second anniversary of the Affordable Care Act.  On March 23, two key TakeAction Minnesota leaders joined a small roundtable with HHS Secretary Kathleen Sebelius, Governor Mark Dayton, Senator Al Franken, Congresswoman Betty McCollum that highlighted the significant benefits the ACA is offering women in Minnesota and around the country.

TakeAction Minnesota will continue to work in the remaining days of session to fend off industry-driven attacks on the Exchange, and construct an Exchnage that fulfills its potential for a healthier and more equitable Minnesota. 

Liz Doyle 

Liz Doyle is TakeAction Minnesota’s Associate Director.  

On Friday March 23, the Secretary of Health and Human Services, Kathleen Sebelius, visited Minnesota to celebrate the second anniversary of the Affordable Care Act. The Secretary is visiting various cities across the country to hear women’s health care stories both so she can understand the realities of our current system, as well as how the law is changing lives in tangible ways. I had the privilege of attending the Minnesota gathering last Friday with my mother, Kathryn and a handful of other Minnesotan women whose lives have been changed by health care reform at the home of Minnesota Nurses Association President Linda Hamilton.  Governor Dayton, Senator Franken, and Representative McCollum were also in attendance.  I felt honored to be presented with this opportunity.

One by one, each woman shared her story. More often than not, the narratives shared were filled with emotional trauma, heartbreak and uncertainty due to lack of access to critical care or the financial means to pay for health care for themselves or their children.

Unfortunately, our stories are the norm across the United States; and there are millions more that speak to the terrible realities of what it means for individuals and families who experience long term lack of insurance.  For me, hearing the stories of these women was, as it always is, a comforting as well as powerfully humbling experience. It is a reminder that I am not alone in my fears and struggles, but also that, while life is fragile, we are unbelievably strong in the face of adversity. Moreover, we are strongest when we have family, friends and community members to support us in our struggles.

Those of us who were gathered at that meeting are symbolic of what the Affordable Care Act can do for Minnesotans: It will allow a young woman battling breast cancer to work part-time without risking her COBRA health insurance, provide small businesses with options for insuring their employees, and provide myself and two other teenagers with pre-existing conditions access to health insurance without lifetime limits or the constant fear of being dropped. The law is not perfect, and it is complex, but it does save lives.

Minnesotans have an opportunity ahead of us to support our families and neighbors with the implementation of the Affordable Care Act. Now more than ever, we need to stand together and urge our leaders to create a system that will aid in the health of all Minnesotans. Life has no guarantees, especially when it comes to health — we need to support our fellow Minnesotans through life’s uncertain times.

Abby Schanfield

Abby Schanfield is a student at the University of Minnesota and a leader with TakeAction Minnesota’s Together For Health Program.  Thanks to the Affordable Care Act, she can be insured through her parents until she is 26, and no longer has to worry about lifetime limits on healthcare or denials due to pre-existing conditions.  See coverage of the event and Abby’s story in the Star Tribune and the Pioneer Press.  

While big-money insurance corporations amass premiums and fees to add to their already excessive “reserves” and administrative costs, the lack of access to affordable health care is a serious problem for rural Minnesotans — whether they are farmers, small business owners, students or workers. An example is in agriculture, where many farmers depend on a spouse with an off-farm job for coverage, and beginning farmers say health insurance is one of the biggest impediments to getting started.

We need a health care system in Minnesota in which everyone is in and no one is left out. Effective, efficient models for this kind of universal care are already in place in other countries and are widely popular. In Canada, for example, a recent national poll found 86 percent supported keeping their health care system public.

Now Minnesota has the opportunity to make health care more accessible and affordable. Under the Affordable Care Act passed by Congress in 2010, states are empowered to provide their citizens access to a health benefit exchange, through which individuals and small businesses can look into health coverage options and compare health plans. One big benefit — the exchanges can help millions of low and middle-income families buy down their premium with public dollars, based upon their income.

Minnesota has wisely chosen to set up its own exchange, which means we can establish our exchange to meet the unique needs of our state. While the exchange is an opportunity to make health coverage more affordable and accessible, there’s a big risk that the health insurance industry will dominate the process and force an exchange that’s little more than an online corporate marketing plan for their over-priced insurance.

Gov. Mark Dayton is now set to start making decisions about the structure of our exchange. Minnesotans have an important choice to make. Will we let our exchange be governed by the insurance industry, which will maintain the status quo of a confusing, expensive and inequitable system that prioritizes their profits over our health? Or will we create a democratically governed exchange that can negotiate prices with insurance firms, address geographic and racial inequities in health care, and make decisions that prioritize the interests of the people of Minnesota?

Minnesota has a long history of citizen engagement in our democracy. We have the power to shape our health care system, starting with taking control of our health care exchange. If we ever doubt our power to effect meaningful reform, we need only to look to our neighbors up north. The reform movement that ultimately won universal access to care in Canada got its beginnings in farm country — Saskatchewan Province.

In the first decades of the 20th Century, most rural Canadians had little access to medical care. Sparsely populated “rural municipalities” took it upon themselves to address the problem, voting to retain doctors through the use of taxpayer funds. Over the course of the following decades, rural municipalities stayed at the forefront of modern health care improvements in North America: passing legislation for municipal hospitals, authorizing publicly funded treatment for tuberculosis and creating health districts, which allowed rural residents more options in their health care.

Very much a grassroots movement, Saskatchewan’s progress in health care was the result of rural people taking local action to address health care needs in their communities, and the provincial government responding by authorizing and extending the reforms. In 1946, under the leadership of Premier Tommy Douglas, Saskatchewan became the first province to provide universal coverage of hospitalization and preventative care. A Baptist minister turned organizer and politician, Douglas preached the social gospel and dedicated his life to the fight for universal health care for all Canadians.

Other provinces adopted reforms similar to those of Saskatchewan, and in 1962 the Canadian federal government passed universal health care legislation. In the years since, Canadians consistently give their public health care system high marks, and in 2004 Douglas was voted the “Greatest Canadian” of all time by the people of Canada.

We too have the power to change our broken health care system. An important first step is to organize to use the health benefits exchange to improve health care options for Minnesotans now.

The key is this: The people of Minnesota need to run the decision-making process for our new health care exchange, not the insurance industry. An exchange that belongs to us will move us toward a health care system that works for rural and urban people alike.

Paul Sobocinski is a crop and livestock farmer in Redwood County and an organizer with the Land Stewardship Project.

Keep The Teeth in Minnesota’s Interim Ordinance

In Big Stone County, where I live, a proposed aggregate quarry by a North Dakota-based corporation has united local residents around protecting the ancient granite outcrops that gave the county its name.

Strata Corp. applied for a conditional use permit at the county level just before Christmas, and though Strata’s own planning process has been six years in the making, citizen input was limited until the Planning & Zoning Commission’s initial public hearing on January 5th.

The room was packed with citizens who were reeling from what seemed to them like an incredibly fast process where there were many more questions than answers. Most residents had no idea the project was in the works until community members staged a grassroots organizing effort to take outreach into their own hands–writing letters to the commissioners and local papers, having one-on-one conversations with other residents, and collecting signatures on petitions in opposition to the project.

While the county’s permitting process continues despite growing opposition to the quarry from residents across the county and region, the Ortonville Township Board took action to protect residents in and around the proposed quarry site by passing an interim ordinance to place a moratorium on the project and to develop their own planning and zoning commission.

Education and action on potentially harmful developments is going on across the state–in southeastern Minnesota, counties have enacted interim ordinances to check the rapid expansion of frac sand mining, which is changing the face of the landscape and destroying productive agricultural land.

But legislation moving through the Minnesota House and Senate would diminish the power of local governments to protect their citizens and communities.

House File 389 and Senate File 270 weaken township, county and city local control. The proposals weaken the power of local governments to enact interim ordinances (also called moratoriums). An interim ordinance allows local governments to quickly put a temporary freeze on major development. This power is essential when the community is caught off-guard by unanticipated and potentially harmful proposals, especially those from corporate interests and outside investors, such as frac sand mines, big box stores like Wal-Mart or a large-scale factory farm. This bill favors corporate control over local control. [Action Alert: Legislation Weakening Local Control Moving Forward at State Capitol. Land Stewardship Project. 24 Feb 2012.]

Some have tried to frame this issue as a fight between liberals and conservatives or between pro-development and environmentalist factions. But the faces at public hearings have belied those characterizations–this is a fight for community that brings together citizens from all walks of life and all political perspectives.

The real fight is for local control in the face of corporate greed–about the right of citizens to determine what’s best for their communities through a democratic process vs. a desire by corporations to weaken that power and steamroll that process.

At the root of the debate is an age-old tension between the rights of business and the rights of neighbors within the unwieldy democratic process. Proponents of the new law, primarily Twin Cities builders, say developers who have spent tens of thousands of dollars planning a project deserve to have those investments protected from politically arbitrary decisions by government officials.

“It happens regularly,” said James Vagle, public policy director for the Building Association of the Twin Cities, which has been trying to get the law through the Legislature for several years. “We were following all the rules … and a project gets stymied.” [Marcotty, Josephine. "Should locals have the power to stall controversial projects?" Star Tribune. 21 Feb 2012.]

A developer’s complaint that they spent many years and dollars in the planning process and were “following all the rules” only to be  “stymied” by “politically arbitrary decisions” sounds reasonable, doesn’t it? Except that “following all the rules” isn’t a pass to do whatever you want, especially when local governments are also following all the rules to ensure citizens have a say in the development of their community.

To suggest that because a corporation dots its i’s and crosses its t’s, it should get to build, mine, and blast whatever it wants wherever it wants flies in the face of our democracy. To suggest that a community whose citizens come together across socioeconomic and party lines to halt an undesirable project and begin a lengthy and complex process of planning for the future is “arbitrary” in any way shows ignorance of the democratic process at best–contempt at worst.

Instead of “playing by the rules,” corporations are trying to change the rules–to take the teeth out of local control via the interim ordinance and make it virtually impossible for smaller units of government and the citizens they represent to exercise their right to determine what kind of community they live in and how their resources are used.

What you can do to protect local democracy and your community:

To learn more about the fight for people power vs. corporate power at the state capitol, to find out who has supported this democracy-weakening legislation, and to find contact information for your legislators, see Land Stewardship Project’s latest Action Alert on the subject, or contact LSP’s Bobby King: bking@landstewardshipproject.org or 612-722-6377.

Rebecca Terk is a community-based food systems organizer for the Land Stewardship Project. Her original blog post can be read here.