Minneapolis Star Tribune, Aug. 15
Be wary of candidates who promise an ACA opt-out
It's remarkable that 2012 Republican presidential candidate Mitt Romney got through the entire campaign without having to explain the glaring problem with the highly touted first item on his promised first-day-in-office agenda: allowing states to opt out of the Affordable Care Act.
As his party has so often reminded the nation recently, the president isn't king. If he'd won, Romney would have had to follow the health reform law. The ACA does indeed allow states to opt out of some key requirements to pursue their own health reforms. But the first year that becomes possible is 2017 — four years after Romney would have taken office.
The law also doesn't just allow the states to do whatever they want. Whatever states pursue, the result must cover at least as many uninsured as the ACA. Coverage and cost-sharing must also be at least as affordable as the ACA's. That's a high bar.
While Romney never got called out for the factual gaps, Minnesotans shouldn't make the same mistake this coming election season.
Voters who hear a similar opt-out pitch from Minnesotans on the campaign trail ought to demand details about how it would work. It's clear to anyone who does their homework that this "plan" is based much more on wishful thinking than reality.
The opt-out strategy is known by a different moniker in Minnesota. Here it's called the "waiver" approach — as in, Minnesota will just get a waiver from the U.S. Department of Health and Human Services and go back to pre-ACA days before MNsure, the strengthened MinnesotaCare program, the coverage mandate, the new subsidies to help consumers buy insurance and affordable coverage for those with pre-existing conditions.
Generally, it's Republicans who are peddling the simplistic strategy. The list includes Jeff Johnson, who won the Republican gubernatorial primary. Kurt Zellers, the former Minnesota House speaker who lost in the primary, was an even stronger proponent. Republican legislators also have pushed the global waiver. (Worth noting: Proponents often confuse this broad opt-out with a more limited waiver some states have been granted under a different law to experiment with the Medicaid program. The two aren't the same.)
Like anything else that sounds too easy, the waiver solution ought to inspire healthy skepticism. There is indeed a part of the ACA that allows states to pursue their own reforms and potentially get exemptions from running an exchange or the coverage purchase requirement. It's Section 1332, better known as the "State Innovation Waiver" or the "Wyden Waiver," after the Democratic senator from Oregon who championed it.
Note the word "innovation." The intent was to allow states flexibility to accomplish the ACA goals of broadening coverage and finding ways to deliver better care at less cost.
Health experts generally agree that waiver applications, which must be approved by HHS, aren't likely to go anywhere unless they can demonstrate insurance coverage increases.
Section 1332's safeguards to maintain affordability, cost-sharing protections and comprehensive coverage also work against Republican proposals that tend to shift costs to consumers, such as high-deductible plans. In addition, Minnesota would likely need to pass a law to ask for a waiver, which could be challenging given that DFLers control the state Senate through 2016.
Some conservative commentators have complained that the requirements rule out anything but single-payer systems — a Medicare-for-all type system — getting approved. Vermont is pursuing one, and experts generally agree that the state is the first and likeliest to succeed.
HHS officials would not comment on whether Minnesota's pre-ACA system would qualify for a 1332 waiver, but officials did note that the uninsured rate here dropped by about 40 percent since last September. The implication: Officials believe the law is working well in Minnesota, suggesting that a return to pre-reform days is a long shot.
Could Minnesota get a waiver if it simply plans a return to a pre-ACA system? Henry Aaron, a Brookings Institution expert, said the state's chances would be "zero." John McDonough, author of an influential book on health reform, said such an approach "would in no way pass muster under the ACA." McDonough is director of executive and continuing professional education at the Harvard School of Public Health.
What's most disappointing about candidates using the waiver pitch is that they're completely missing the point about innovation. The state has long been a health care standout. But as the drop in uninsured shows, there was room for improvement.
Instead of going backward, Minnesota ought to be pursuing an innovation waiver to find new ways to deliver better care at less cost while expanding coverage. The state needs new ideas from its leaders — not ill-informed promises about turning back the clock.
St. Cloud Times, Aug. 20
Landowners fighting CapX win again
Last week's 24-page ruling from Scott County District Court Judge Caroline Lennon involving the CapX2020 power initiative and Minnesota's "Buy the Farm" law provides several important points worth noting as CapX and affected landowners consider their respective next moves.
The most important statement the case of David and Florence Minar of rural New Prague makes is it marks the third major legal development in the past 16 months that stands firmly on the side of affected property owners.
In May 2013, the Legislature amended the 1973 law to force utilities to buy entire properties, not just easements. And shortly after that, the state Supreme Court ruled landowners who chose the Buy the Farm option are entitled to additional compensation for relocation expenses and the cost of buying a comparable property.
Lennon's ruling, which could be appealed, essentially cites the court ruling and those legislative changes in determining Buy the Farm applies to the Minars. CapX must pay its $1.4 million estimated value.
CapX had sought an easement to construct two towers covering about about 1 acre of combined area on the Minars' 132-acre dairy operation. However, Lennon ruled the construction and towers would negatively affect the Minars' 100 percent grass-fed dairy operation known as Cedar Summit Farm.
Indeed, one of their sons testified the project made him decide to not buy the farm from his father and carry on the family-run business.
While the ruling is a big victory for the Minars, it's unclear how it will affect other potential claims.
Lennon noted the operation's uniqueness and quoted the Supreme Court's statement that, "In each case, reasonableness is determined under a totality of the circumstances." Among factors considered are the farm's use and products, its years in operation, who (if anyone) lives on-site, effects on the rural landscape, and whether the purchase burdens the utility.
This ruling favors the Minars because the family has operated the farm for seven decades, and it now produces and sells organic products on site. Not only could consumers view those products negatively if a power line is erected, but Lennon noted CapX has been able to buy and sell other properties for the line with no burden to the utility.
Obviously, this ruling won't end all the legal battles between landowners and CapX. It does, though, reiterate the importance of providing fair compensation to landowners with limited, if any, options.
The Free Press of Mankato, Aug. 21
People are key to peace in Ferguson
The perfect storm of urban circumstances has enflamed the small suburb of Ferguson, Mo., at a time when the nation feels racial rift from every corner.
How the people of Ferguson answer will go a long way to uniting or dividing us on what seems to be an unceasing issue of race and justice.
We all know the story too well. Unarmed black teenager Michael Brown was shot six times, two times in the head, in a chase involving a white police officer, who apparently had word that Brown had been involved in a robbery, the stolen items being cigars.
The national social implications of the case exceed those at stake in the Trayvon Martin case. Brown was shot by a police officer, not a citizen crime watcher like George Zimmerman. The nature of the Ferguson shooting seems excessive, but other details remain unclear.
The sound of the police silence on this case early on was deafening. For several days, Ferguson police refused to name the officer involved and declined to provide even a short summary of the event. Even a little information on the case would have prevented the incentive for a national protest. But as the days wore on, well-meaning protestors as well as agitators descended on Ferguson.
Concerned local citizens were clearly part of the protests. But as Missouri State Patrol captain Ron Johnson who is in charge of the scene notes, those throwing Molotov cocktails, rocks and firing shots were not from Ferguson. Some of the most violent protestors arrested are from out of state. Only four people of the 57 arrested on Monday were from Ferguson, according to police reports.
The people of Ferguson now have the power to turn this into a peaceful protest, but a protest nonetheless. They must meet with the agitators and make very clear that the violence is not the way to justice. And the non-violent local protestors need to make clear to the agitators that their behavior and presence is "not welcome," says Eugene O'Donnell, a former prosecutor and police officer who now teaches at the John Jay College of Criminal Justice.
He told The Associated Press that such a conversation would go a long way to quelling some of the violence.
Another expert, Thomas Nolan, also a former police officer in Boston and professor at State University of New York, told the AP that police have to scale back the military looking style of their operation and reduce harsh methods of crowd control like the so-called sound cannons.
Ferguson police and the State Patrol also have to meet with the non-violent protesters and listen to their concerns. Already, Ferguson city leaders are vowing to increase the number of black police officers they have on their force. Currently only 3 of 53 officers are black.
Finally, the media must play a significant role in bringing about peace. That doesn't mean it turns its cameras and notebooks away from the violence, but only that it turn those cameras and notebooks to the efforts at peacekeeping as well.
The violent protests make for good pictures and video, but responsible media must also show sides of the story where progress is being made on reducing the violence.
It's easy, and almost automatic, for media to make these protests larger than they are. That will only enflame the situation and play into the hands of those outside agitators who are counting on just that kind of media coverage.
As is the case in many of these situations, the well-meaning people of Ferguson have to take back their community and take control of it. Their leaders must listen and respond. Justice will prevail if we make sure it can.