The Relationship Between Reducing Costs, Improving Quality and Expanding Coverage

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While Massachusetts has charted a path on health coverage reform, Minnesota has set the standard on cost containment through collaborative efforts by public and private health care purchasers and by passing major legislation in 2008 that will reform payment policies, promote health (medical) homes, emphasize prevention and public health, and lead to even greater cost and quality transparency.[i] Of course, Minnesota has also been a quiet leader in the area of expanding coverage, boasting the lowest uninsurance rate in the nation after Massachusetts.

While many coverage advocates are concerned that taking on cost containment, systems improvement, and coverage expansion at the same time will make comprehensive reform politically impossible, the recent trend in states is to address these issues together. This may be particularly important in the near future given the economic downturn and the growing concern of Americans related to rising health care costs. Cost concerns are an impetus for reform, but cost-cutting initiatives (especially those with short-term savings) are likely to raise opposition from some provider groups.  Opposition from affected stakeholders increases when the amount of money in the system is decreasing under certain cost containment strategies rather than when it is increasing as it might under a coverage expansion program.[ii] 


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[i] For a full description of the Minnesota reforms, see page 35.
[ii] “Intersection of Policy and Politics in State Coverage Expansion Campaigns,” presentation by Walter Zelman, AcademyHealth Annual Research Meeting.