Our current system of health care access has evolved into one with great economic disparity. Under the terms of the federal Affordable Care Act, I supported the establishment of our state-run, market-based insurance portal, MNsure. For the future, I support a single-payer health plan, with comprehensive coverage for every Minnesotan.

Those who get their health insurance through a group plan because they (or their spouse) work for a large employer have access to some of the best health care in the world, at reasonable prices. The group plan provides lower premiums, better coverage, and reduced prices from providers. Those who cannot qualify for a group plan must purchase their coverage on the open market, and pay higher premiums, have poorer coverage, and pay the providers' full prices. The cost falls disproportionately on those who can least afford it, such as those who cannot find full time employment and those in the kind of low-skill service jobs that are often outsourced by corporations. It also acts as a disincentive to job creation through small business start-ups, since a person with an idea for a business may have to weigh the consequences of giving up their family's health insurance coverage obtained through their employer.

Under the federal Affordable Care Act, young adults may be covered under their parents' health insurance through age 26. This transitional coverage is important, because in today's economy many young adults take longer to obtain permanent, full-time employment with benefits. Preventive care is covered with no copay - so our system can truly be called health care. Pre-existing conditions cannot be excluded from coverage, so people with chronic conditions like diabetes or Crohn's disease can afford ongoing treatment that helps them avoid more serious complications. And lifetime caps on coverage are not allowed, so people won't face bankruptcy or foreclosure because they or a family member has a catastrophic health problem like cancer or a serious accident.

In the 2013 session, as required by the ACA, we passed legislation to create MNsure, Minnesota's state-run, market-based health insurance portal. Unfortunately, because the previous legislature had failed to act, there were only a few months to set up the system. As everyone is aware, the system has had many start-up problems. However, it did function better for Minnesota residents than the results in states that fell back on the federal system. One of the jobs of a state representative is to assist constituents when they have difficulties with state agencies. We were able to help each of the handful of district residents who reported difficulties obtaining a policy through MNsure. Aside from the difficulties with the portal, the results for Minnesota residents have been better than in many other states, especially those that defaulted to the federal system. Our health insurance premiums are among the lowest in the country, and Minnesota's uninsured rate is currently at a new low. The legislative oversight commission will continue to investigate the practices that led to the shortcomings, and work toward solutions.

In the United States, we spend 1.5 to 2 times more per capita for health care than people in other countries with similar economies and standards of living, but we have a lower life expectancy and poorer health outcomes, and leave many people without health coverage. We spend more, and we get less. These costs are spread out over many stakeholders. Individuals pay insurance premiums, copays, and percentages of medical bills (or the whole bill if they have no coverage). Employers sometimes pay part of insurance premiums, but also pay costs associated with negotiating and administrating the plans they offer. The states and the federal government pay costs for Medicaid and Medicare, as well as the costs of the medical programs of the Veterans' Administration. Every bill from a provider (doctors, clinics, hospitals) must include the costs of keeping track of the differences in coverage and payment schemes for each patient. All of this complexity causes administrative costs to be a significant reason total medical costs are higher in the United States than elsewhere. We also all share the costs of unpaid bills for people who cannot afford to pay them.

I am in favor of a single-payer, comprehensive health insurance plan for all Minnesotans, because it will allow us to provide health care access for all Minnesotans at a lower cost than we currently bear. This is not a "government takeover" of health care. It is a change in how we pay for health care, not in how your doctor treats you. It does not mean the state would take over your clinic. Some of the cost savings come from reduced administrative costs. Some come from delivering care in more appropriate ways. For example, currently the uninsured often end up getting care at hospital emergency rooms, since they cannot be turned away there. Every paying patient shares the extra cost of this inefficient delivery of care. Some predicted cost savings come from better outcomes due to better access to preventive care.