"The closure of a rural hospital can have a devastating negative impact on the communities it serves," the writer says. (Rogelio V. Solis/The Associated Press)

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Like you, I’m continuously shocked by skyrocketing prices, whether in the checkout line at the grocery store or at my kitchen table, paying monthly household bills. So, it didn’t surprise me to recently read that since enactment of the so-called Affordable Care Act, health care spending per Minnesotan has surged nearly 27% between 2013 and 2021. I know this from personal experience: Before enactment of the ACA, my once affordable monthly health care premium has doubled in less than 10 years.

And while much of the attention has focused on how much consumers spend each month to keep our families fully insured and healthy, not much attention has been paid to a very disturbing trend happening throughout greater Minnesota. Many of our rural hospitals are suffering. They are encountering a grim financial crisis and, as a result, many are forced to reduce much-needed services to those they serve or close their doors entirely.

Since 2005, six hospitals in greater Minnesota have closed their doors. Many others, such as the Fosston hospital in rural Polk County, recently announced that they must curtail some services provided at that 25-bed critical access hospital. That hospital has been operating for over a century in northwest Minnesota. And most recently, the New Prague hospital announced that it will no longer be providing labor and delivery services. Expectant mothers will need to travel one hour away to Mankato to find a hospital providing services that were until recently in their own backyards.

If no policy changes are enacted, the situation throughout greater Minnesota could get much, much worse: 42% of our rural hospitals have experienced losses in providing patient services, which undermines the hospital’s bottom line. This increases the likelihood of curtailing what services these hospitals will provide in the future or shutting their doors permanently.

The closure of a rural hospital can have a devastating negative impact on the communities it serves. Researchers at the University of Washington found that populations served by rural hospitals experienced mortality rate increases of 5.9% after closures, likely due in part to increased travel times for appointments or during health emergencies, or from patients forgoing medical appointments and/or health care providers leaving these communities.

Why is this crisis happening in our rural areas? A likely reason is that we have a broken health insurance market in Minnesota. Three insurers control 94% of the group market in the state. As a result, these insurance companies are profiting while many Minnesotans struggle with high insurance premiums, sky-high deductibles or worse — they have decided to forgo health insurance entirely. And while consumers struggle, their local hospitals are forced to contend with government and private insurance reimbursements that increasingly fail to cover even the minimum costs of patient treatment.

And despite paying more for health insurance, many consumers are getting less. A Kaiser Family Foundation study found that “nearly 17 percent of in-network claims were denied in 2021.” One major insurer was even found to be consistently underpaying reimbursements and inappropriately denying coverages, leaving hospitals to struggle with their own costs of care to patients. Considering the fact that many of our state’s rural residents are aging and live across a vast area without nearby local hospitals, we have a genuine health care crisis in the making.

Minnesota’s health care ecosystem is clearly out of balance. Progressives on the left are seizing this opportunity to push for a European-style single-payer health care system. This radical solution will only make matters worse for those in greater Minnesota who already have to drive great distances to access care: Single-payer systems famously exacerbate access to treatment, and often provide second-rate treatment, making the solution to Minnesota’s existing problem even worse.

And yet policymakers are focused on price-fixing in health care rather than problem-fixing.

Across the state, more and more of us struggle with the costs of care, have less insurance coverage than a decade ago, and hospitals can’t afford to keep the lights on and doors open due to low government and private insurance reimbursement rates.

Policymakers would be wise to focus on the biggest looming crisis facing Minnesotans: We need swift and meaningful action that will encourage competition in the insurance market that will ensure proper funding for hospitals and provide genuine health insurance choices throughout the state. Without these basic reforms, our broken insurance market will likely get sicker and more and more Minnesotans will be forced to make the worst choice: forgoing health care altogether.

Annette Meeks is CEO of the Freedom Foundation of Minnesota.