Scrappy Medicaid coalition derailed ill-considered health 'reform'

It is to Minnesota's credit that so many of its citizens stood up to stop an ill-informed legislative effort — one backed by a controversial out-of-state special interest group — to roll back historic health care coverage gains.

The grass-roots defeat of a bill specifically designed to kick poor people off the publicly run Medicaid program is one of the rare bright spots of the gridlocked 2018 session. The dogged advocacy by 154 Minnesota nonprofits, medical providers and faith-based groups reflects the state's long commitment to health care access — for example, through pioneering programs such as MinnesotaCare. The advocates' success in St. Paul also stands out nationally as other states consider similar measures.

"I was just blown away from the federal level, having an eye on many states that are in similar circumstances. The breadth of the organizations that rose up to oppose this legislation was really incredible to me,'' said Hannah Katch, a senior policy analyst at the Washington, D.C.-based Center on Budget and Policy Priorities.

Among the groups opposing the bill: AARP, Allina Health, the Minnesota Coalition for Battered Women, the Amherst Wilder Foundation, Essentia Health, Catholic Charities of St. Paul and Minneapolis, the Minnesota Budget Project, the Minnesota Council of Churches, the Minnesota Rural Health Association, the National Alliance on Mental Illness and Lutheran Social Service of Minnesota.

That these groups prevailed is remarkable given the early momentum for Medicaid reform. In March, House Speaker Kurt Daudt and Sen. Michelle Benson, R-Ham Lake, appeared at a news conference to tout the legislation. At first glance, the bill sounded reasonable. It would have required "able-bodied" people enrolled in Medicaid to work or seek work. But dig deeper, and the reality is that the costs of this reform would have outstripped savings while creating new hurdles for care.

Bigger counties reported that they would have had to spend millions to handle the new reports enrollees would have had to file to prove they were employed or looking for work — making this another unfunded mandate from the state. In addition, the additional red tape and the inevitable paperwork mix-ups could have led to people eligible for coverage getting cut off. Exemptions from this requirement also weren't broad enough to adequately protect people who have a mental illness. The bottom line: It would have cost more to cover fewer people had the measure passed. No one should be in favor of that.

It was hard to find a Minnesotan testifying for this, but a wealthy special interest group, Americans for Prosperity, was eager to lend a hand for ideological reasons. That the scrappy Medicaid advocates prevented this bill from getting to Gov. Mark Dayton's desk is an achievement.

The coalition deftly blended traditional and modern communications in its campaign. There were community forums and advocates who tirelessly spoke before community groups. The @ThisIsMedicaid Twitter account smartly raised awareness about Medicaid, which has covered poor families, the disabled and the elderly for decades.

The key to the coalition's Capitol success, however, may have been the Minnesotans on Medicaid who testified before the Legislature. At one Senate hearing, it was clear that their personal stories had an impact on legislators and likely led to discomfort about tinkering with the program.

Minnesota owes a debt of gratitude to its Medicaid advocates. Those in other states fighting the same changes should take heart. "Show up, keep talking … and never give up,'' said Susie Emmert Schatz of Lutheran Social Service of Minnesota. "You never know what story or moment will change a vote in your favor or finally make a light bulb go on.''