Chickens, Eggs, and Institutions: Minnesota Launches Health Care Homes

Publication Date: August 2009

Publisher: Nelson A. Rockefeller Institute of Government

Author(s): Richard P. Nathan; Lawrence D. Brown

Research Area: Health

Keywords: Employee benefits; Health insurance; Medical homes

Type: Report

Coverage: Minnesota

Abstract:

In mid- 2009, health care reform again stands high on the national agenda and so policymakers confront anew a dilemma: Can universal coverage and containment of the rate of growth of health care costs be achieved simultaneously? If not, which comes first, the chicken or the egg?

The Obama administration has promised to address both coverage and costs. Minnesota, as progressive a state on health policy as the U.S. federal system has to offer, is striking a different balance between coverage and cost controls. Having achieved 93 percent coverage of its residents (highest in the nation until Massachusetts surpassed it), Minnesota passed in 2008 a law that seeks to fix "the system" and slow the growth of costs as a presumed prelude to resuming its longstanding quest to reduce the number of uninsured.

This report focuses on the logic underpinning, and the implementation challenges facing, health care homes in hopes of illuminating issues we consider central in cost containment. These are the institutional, political, bureaucratic, and federalism challenges that take center stage once the ink has dried on the theoretical model and some very tough policy tasks surface. Whether reformers (national, state, or both) commit themselves to system repairs
on the back end of coverage expansions (Massachusetts) or on the front end (Minnesota), institutional considerations will be critical to success.