March 12, 2013
Dear members of the Health Insurance Exchange Conference Committee
Minnesota’s new Health Insurance Marketplace or “Exchange” is one of the most significant undertakings and one of the most sweeping new pieces of health infrastructure that will impact so many Minnesotans. As you work to finish the Health Insurance Marketplace Act, we ask that you bring due focus to Minnesota’s equally significant racial disparities in health, and take opportunities to address them through this bill.
In 2011, people of color and tribal populations made up 13% of Minnesota’s population as a whole, but 31% of Minnesota’s uninsured. In Minnesota, infant mortality is more than twice as high for African Americans and Native Americans as the state average, lack of prenatal care is 3 to 7 times more common among Asians, Latinos, African Americans and Native Americans as among whites, and African Americans are 30% more likely to die of cancer than whites. Although the majority of enrollees in the Exchange will be white (71%), a significant decrease in the percentage of people of color who are uninsured is projected to occur– from 20% to 9%.
That projected improvement in coverage rates for people of color cannot be taken for granted, nor is it enough. One of the few points of consensus among all members of the Exchange Advisory Task Force was that a core focus of Minnesota’s Exchange should be addressing health disparities. More importantly, Minnesota cannot significantly improve health, approach universal coverage, or control skyrocketing health care costs without tackling health disparities head on.
There are several opportunities to address health disparities and set the Exchange on the path to further progress on this issue, even in this bare bones legislation, and it is important that this attention to health disparities be included in the very foundation of Minnesota’s Exchange.
- We urge adoption of the Senate language including reduction of health disparities as a core purpose of the Exchange.
- We urge adoption of the Senate language including attention to health disparities among the criteria that may be considered by the board in selecting plans to be offered on the Exchange.
- We urge adoption of the Senate language regarding Navigators and In-Person Assisters which clearly references federal requirements for Navigators, extends Navigator conflict of interest standards to In-Person Assisters, and does not confer personal liability on Navigators and Assisters. The latter is included in the House language and would make it nearly impossible for community based organizations, including those based in communities of color, to participate in these key programs.
- Both the Senate and House versions of the bill reference health disparities among the areas of expertise that may be grounds for selection as one of the three experts to be seated on the board. We urge that the language be clarified to specify that one of the three expert seats must be awarded to someone with expertise in health disparities.
- The House version of the bill specifies that the board must include someone experienced with disabilities and someone from outside the 7 county metro. We urge that language be added to require that at least one of the board members must include someone representing communities of color experiencing health disparities.
Thank you for your attention to these important matters,
Mitchell Davis, Jr., Director Health & Wellness
Minneapolis Urban League
Member of the Health Exchange Outreach, Communication and Marketing Work Group
CEO The Stairstep Initiative Companies
Member of the Health Insurance Exchange Advisory Task Force
Alliance for Racial and Cultural Health Equity
Dr. BraVada Garrett-Akinsanya, CEO
Makeda Norris, Consultant and Health Promotions Training Specialist
Impetus – Let’s Get Started
Doran Schrantz, Executive Director
Paul Sobocinski, Policy Organizer
Land Stewardship Project
Arnie Anderson, Executive Director
MN Community Action Partnership
John Woodwick, Executive Director
Minnesota Valley Action Council, Inc.
NARAL Pro-Choice Minnesota
Vina Kay, Director of Research and Policy
Organizing Apprenticeship Project
Debra Holmgren, President
Clarence Jones, Director
Q Health Connections
Alicia Howes, Clinic Operations Manager
St. Mary’s Health Clinics
Sarah Greenfield, Health Care Program Manager
Take Action Minnesota
 U.S. Census State and County Quick Facts, Minnesota, quickfacts.census.gov
 Health Disparities by Racial/Ethnic Populations in Minnesota, MDH, December 2009 p. 10
 Gruber and Gorman Analysis Update, PPT delivered by April Todd-Malmlov to the Exchange Advisory Task Force, p.10