It’s time to remove for-profit HMOs from Minnesota

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It’s taken as a given that business competition is good, that the profit motive benefits the community, and that regulation harms the ability of businesses to flourish. But this premise does not make sense for health care.

Access to health care is a human right. No one should avoid care because they can’t afford it or fear they’ll be driven into bankruptcy. No one should have care denied or delayed because an insurance company deems the care unnecessary despite the opinion of the patient’s own health care providers. People should not have their health compromised or lose their lives because of the business of health care. But it happens every day.

That’s why we brought forward HF 3529/SF 3543, the Non-Profit HMO Act, which restores the previous Minnesota requirement that health maintenance organizations be nonprofit. HMOs are a health insurance option that use networks of health care providers to treat a patient population for a prepaid cost. The intent for HMOs is to provide care that is both high-quality and cost-effective, so it’s essential that HMOs’ incentives to provide quality care do not come second to financial performance.

Both nonprofit HMOs and for-profit HMOs face this challenge. But adding in the profit motive — in which the HMOs have a fiduciary responsibility to maximize the profits of their investors — only leads to more frequent denials of care and bigger problems.

Until 2017, Minnesota HMOs were required to be local nonprofit organizations. Their explicit purpose was to meet the needs of Minnesota’s communities. That year, however, amid negotiations over the state’s individual health care market, Republican lawmakers slipped the provision into the discussion and used it as a bargaining chip. No debate, no public hearings and no analysis.

The health care market is increasingly consolidated, and increasingly shifting away from concerns about the well-being of patients. In the Medicare Advantage market, UnitedHealth Group had a 27% market share in 2022. It has been accused of fraud by a whistleblower, accused of fraud by the U.S. government, and it overbilled for services, according to the U.S. Department of Health and Human Services Office of the Inspector General.

The Office of the Inspector General said, “Managed Care Organizations in several states inappropriately delayed or denied care for thousands of people enrolled in Medicaid, including patients who needed treatment for cancer and cardiac difficulties, elderly patients and patients with disabilities who needed in-home care and medical devices.” It points out that this puts people of color and those with lower incomes at increased risk of lower quality care and poorer outcomes.

The corporatization of health care extends to other parts of the system as well, with troubling results. Primary care providers have been acquisition targets for insurers, private equity firms and hospital systems to the detriment of their ability to give their patients the best possible care. Similarly, nursing homes are increasingly owned by for-profit companies with a negative impact on quality, even as profits increase.

Even nonprofit organizations need to meet costs, have reserves and invest in their organizations. However, for-profit HMOs’ primary responsibility is to shareholders and higher profits, not better care for patients. It does not suit Minnesota well to have HMOs that favor profit optimization over patient care.

Six years ago, when Republicans allowed for-profit HMOs into Minnesota, there was no evidence that they would benefit the public, and there is no evidence now. While the profit motive may have standing in classical capitalist economic theory, it’s not the reality of what’s best for our community health care, and it’s certainly not the reality of what’s best for Minnesotans in need of care.