Rep. Erin Murphy. Representing St. Paul District 64A

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Health Care Reform: Opportunities and Challenges for Minnesota
Testimony of Representative Erin Murphy
July 20, 2009

Good morning. My name is Erin Murphy. I am a registered nurse and a State Representative from district 64 A in St. Paul. Thank you for holding this hearing in Minnesota and for the invitation to testify today.

We must reform health care in America. In the middle of the debate, it may seem impossible to traverse the sharp policy and political questions before us but we must. The status quo is unsustainable and unacceptable. While individuals expect and often receive excellent care and cure, American lacks a coherent system of care delivery and payment. The result is a highly fragmented system delivering fragmented episodes of care.

Too little attention is paid to the ultimate goal of health.
Americans are paying a high price for underwhelming individual and population outcomes. We are in that rare moment of opportunity to change course. We must change course.

I am delighted to have the opportunity to share with you a perspective from Minnesota. As you well know, Minnesota is an innovator and has long the lead nation’s efforts in health policy, value and reform. Along with our upper Midwestern neighbors, we are a high value low cost state.

We must reform the nation’s health care delivery and payment systems to set the foundation for continued innovation and demonstration in Minnesota. We must embed what we know is working in Minnesota and the upper Midwest to deliver high value for lower relative cost across the Country. Finally, we must ensure that every American is covered so they get the right care at the right time for a good price.


For many years we have focused on coverage as a primary solution. That so many Americans lack coverage for needed care is wrong, plain and simple. That health care is so expensive that necessary treatment of disease is financially out of reach for so many is wrong, plain and simple. Relying on the emergency room as the primary point of care for the uninsured is wrong, plain and simple.

Getting everyone into coverage is imperative, morally and financially. An individual mandate and guaranteed issue of coverage, regardless of preexisting condition will yield more coverage with shared responsibility between individuals and insurers. A public option will give Americans a choice between private coverage and a publicly backed coverage that is portable.

A public option provides opportunity to further drive delivery and payment reforms. If the public option cements the status quo in terms of payment and delivery, it will compound the problems with which we are already struggling. But if the public option serves to propel reforms, it enhances efforts to deliver better care for a better price.

Minnesota has worked over two decades to assure coverage employing Medicaid, Minnesota Care and General Assistance Medical Care. The Governor’s line item veto of General Assistance Medical Care has undermined 20 years of effort in Minnesota. I ask that Congress consider this as it contemplates any state maintenance of effort. Maintenance of effort is an important means to balance state and federal efforts. Allowing state flexibility in policy reform while maintaining access provides state policymakers with the tools necessary for continued innovation.

Delivery Reform

Our fragmented delivery system is providing fragmented care and we are paying a high price. Care for those with chronic conditions such as diabetes and heart disease accounts for upwards of 60 percent of all Minnesota’s health care costs. This stark fact has served as a focal point in Minnesota. We must pursue policies to prevent the onset of disease and invested in care that will keep those with chronic conditions healthy and out of the hospital

Payment Reform

Current payment is weighted to specialists and procedures and away from interventions to maintain health. For example, a surgeon is paid more for the amputation of a diseased diabetic limb than is a primary care provider for disease management preventing the loss of the limb.

Medicare sets the standard in payment. I urge the inclusion of large scale payment reform such as accountable care organizations or a total cost of care model Without similar, or even more aggressive payment reforms in Medicare, our health care system’s growth will be unsustainable. Medicare’s participation is essential in order to create a critical mass of payers in the new system.

Short of large scale change, I urge state flexibility in Medicare payment. A Minnesota or upper Midwest demonstration in payment will permit us to demonstrate the Congress and the nation the means to deliver high quality care for a better price.

Achieving significant health care reform in this country has for decades been a uniquely challenging and complex issue. The grind between dogged political frames has proved insurmountable for policy makers. Entwined state and federal policy and funding, limits state policy reform efforts and calls for federal action. The urgency of growing costs and shrinking access compels our action. 40 years ago, America put a man on the moon, a seemingly unachievable goal. We did that- and we will do this too. We must.

Thank you for your courage and hard work. I stand with you in your efforts to enact federal reform while promoting and protecting the value the care delivered in Minnesota.