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Author’s note: As the November election approaches, this is the first of several monthly features in which candidates for various offices will address questions about specific issues that affect citizens of Mower County and the surrounding areas. For this article, I submitted questions to State Rep. Jeanne Poppe (DFL-27B) and challenger Patricia Mueller (R) regarding health care in the district.

These are their responses.

Q: How would you rate the overall state of health care in District 27B?

Poppe: Overall, you would expect us to have a strong state of health care because we are served by Mayo Clinic, a

world-renowned health care leader. However, I would say the state of health care in District 27B is less strong than it was even five years ago.

If you are mobile and can travel to the regional center of Austin or go directly to the mother clinic/hospital in Rochester, you can access service. We know that smaller communities no longer have in-town access to a clinic, doctor, or health care provider. While the service provided is certainly top-rate, the access is limited and the cost is high. During the pandemic, tele-medicine has become much more common. Unfortunately this too doesn’t provide equal access since many rural areas of Minnesota lack reliable internet service. People who do not have health insurance through an employer or government-sponsored health insurance would agree that their health care is unaffordable as well. Even for the vast majority of Minnesotans who currently have employer-based coverage, we know that the cost of prescription drugs and out-of-pocket expenses are growing each year.

Health care also encompasses dentists, mental health therapists, alternative medicine providers, pharmacies, nursing homes, and dementia care facilities. Although we have a number of providers in most of these areas, we are not as fully staffed as the need is for mental health coverage. For those with family members with Alzheimer’s the cost for care is very high, either in-home or in a facility.

I wouldn’t characterize ourselves as in a health care “desert” with little access, but for many within our district, the access is limited and the cost is high. In many rural areas, the rising cost of health care is a constant concern.This is true throughout the country, and it’s a persistent problem that Minnesotans are asking lawmakers at all levels of government to address.

Mueller: Health care is an important and complex issue as rural Minnesota has different needs and concerns.  I believe the overall state of health care in 27B is good, but spotty. There are countless nurses and doctors who provide top-rate medical care to those in need. These people are on the front line. We are fortunate to have the Mayo Clinic, who continues to offer cutting edge medical advances through research and innovation, close by; however, it is becoming too common for citizens of smaller communities to watch their local clinics close, forcing them to find other care that is further away because of monopolies. The cost of health care is often prohibitive for people with insurance premiums eating away large parts of a family budget while offering very little coverage.

Q: What concerns have you heard from voters when it comes to health care in the district? What do you think are necessary steps to address those concerns?

Poppe: I hear many concerns related to the cost of health care. We know that some people who need to go into the individual market for insurance have informed lawmakers about the cost and the limits on the type of care it covers, and we know people on employer-based coverage have rising costs, too.

Many farmers are paying an extraordinarily high cost for extremely limited coverage. I had one farmer tell me their health insurance is more of a “risk” insurance, in place to cover catastrophes that would otherwise bankrupt them, but does nothing to allow for preventative or “routine” health needs. A number of people wait to get surgery for new knees and hips until they are of Medicare age in order to get more coverage. Mental health concerns can go unresolved when a family doesn’t have the financial resources or local access to providers to address the family’s needs.

One thing that could be done is to allow access into the public programs we have in Minnesota – a public option for Medical Assistance or MinnesotaCare. Early in my professional career I worked for a county social services agency, primarily with families and individuals who were in need of health care cost coverage for unexpected hospitalizations or nursing home care. We had at that time the ability for families to “spend-down” to get to eligibility. Now too often there is a hard cut-off – if you are at a certain level you are eligible, if your income is at a higher level, you are not eligible – and some people who could afford to pay something are left without coverage.

This system puts people who have greater health care needs in a position of choosing to work or not based on what kind of coverage their employer can provide. Allowing buy-in for lower cost government-sponsored programs is how we can rely less on the employers to provide that coverage. Taking this out of the employment situation might also put different considerations for sick-leave or family medical leave policies into an employer’s benefits package. Businesses could spend less and yet seem to offer more to employees, and those who are unable to work at a full-time job could still benefit by getting some support for their health care needs.

This year, the Legislature and Gov. Walz took action to deal with the unbelievably high cost of insulin which resulted in more than one death of someone who depended on insulin who, due to inability to afford the life-saving prescription, rationed their dosage and died as a result. The Alec Smith Insulin Affordability Act, named after a 26-year-old who was in this situation, became law effective July 1, 2020. We also passed the Prescription Drug Price Transparency Act as a means to hold drug companies accountable and increase public pressure to lower prices.

Mueller: The problems of accessibility and high cost of health care can be tackled by creating a more transparent pricing system and allowing patients to shop for both a health care plan and provider that is personal and mobile. Because of the mystery in medical procedure pricing, patients do not know how much they have to pay for medical care until after the services are completed. The inflation of prices is only compounded when insurance companies limit competition through networks, or when there is essentially a single provider, as is our situation in Southern Minnesota. This makes it very difficult for startup insurance companies/providers to enter the marketplace. Patients need to be in control of their health care by having the freedom to find a plan that fits their needs and know how much they will pay through price transparency.

This system allows for many different types of plans to meet the individual needs of the citizen, which is what Minnesota had before the adoption of the Affordable Care Act. For people who could not afford insurance or were not insured through their employers, Minnesota offered low-cost insurance through MN Care. For people who rarely went to the doctor, Minnesota offered a low cost major medical plan. None of these options are available to patients when the government controls health care with burdensome regulations.

Limiting burdensome regulations also allows for innovative medical advancements. For example, it is now acceptable for doctors to provide consultations through telemedicine or on-line ‘minute-clinics. Quality Pork Processors opened clinics for employer-based provisions for basic personal and family care.

It is good to continually reflect on how to make health care match the needs of the patients in the 21st century.

Q: Do you think Gov. Walz took proper steps in responding to the coronavirus pandemic in Minnesota? Do you believe continued preventative steps should be taken?

Poppe: The coronavirus pandemic is not something any one of us want to be experiencing. The governor took immediate and appropriate steps to try to limit the spread and prepare health care settings for the potentially high numbers of cases initially expected. There isn’t a playbook to identify exactly how to do this.

It was more than 100 years ago when we had the last worldwide pandemic, and although medicine has improved in the past century, the basics for keeping yourself safe and limiting exposure remain the same – wash your hands for 20 seconds, wear a mask when in public, limit your time around others, and stay home if sick.

Gov. Walz has talked with health care professionals, the Chamber of Commerce and business leaders, school officials, and community leaders all over the state. He is trying to make the best decisions for Minnesotans knowing more than we know and determining the value of public health strategies informed by public health experts.

If each of us wore a facemask, we can be more safe and more open. But if we continue to disregard basic strategies for limiting exposure and spread, we seem to continue to present ourselves as not responsible for the greater community. 

I have encouraged opening up our Main Street businesses with appropriate protocols and encourage people to wear masks. I would also like to see our schools open this fall as I believe there are seen and unseen benefits to operating in a classroom environment. But as I drive around Austin on any given day, I see large gatherings of people in front yards and garages, or groups of young people playing basketball. No masks and no six feet of distancing.

Right now, there are increases in cases every day in Austin and Mower county. We can all do something to prevent the spread, but not enough of us seem to think it is our responsibility to do anything. The governor is considering requiring wearing masks as some of our larger cities have required. That may be the next phase to implement, but it would be so much better if people just realized we live in a community and we are not all the same regarding health and resources. Someone may get the virus and not even be aware of it, while others in our midst could be hospitalized in very ill health.

I believe we are not out of the woods and this summer and fall will be determined by the level we all choose to take on the responsibility for ourselves, our friends, neighbors, and strangers in the grocery store.

Mueller: Regarding Gov. Walz’s handling of the pandemic, I respectfully disagree.

In the early stages of the pandemic when we did not have enough information to make an informed decision, I understood the need for a 15-day shutdown to flatten the curve. Once we had a better understanding of who in the population was the most vulnerable and how the virus spread, the governor should have taken steps to protect that population. Instead, the governor kept his peacetime emergency powers (which are still in effect) and continued to place COVID-19 infected patients in long term care facilities, where we had the highest mortality rate in the country (81 percent).

Instead of providing guidelines for a business to open up, Gov. Walz kept businesses closed (but not all), which resulted in thousands of lost jobs costing billions of dollars, effectively shutting down our economy. Both lives and livelihoods are important. Many of the businesses were already taking precautions before Gov. Walz ordered them to shut down because they care about their customers and their employees! Many people criticized these business owners for being callous to the health of others for wanting to open. This idea couldn’t be further from the truth. The government was making it extremely difficult for them to make a living, which caused a whole host of other problems, including depression and wondering how to feed their own family. The notion that the government can close your small business and label it “non-essential” is appalling. Many business owners of 27B were very frustrated at being forced to follow a policy that might have been necessary for the metro. This response by Gov. Walz demonstrates extreme government overreach and highlights the folly of a “one size fits all” policy. 

I am proud of how our local community rallied around our local businesses. The people of 27B are strong and I am excited to represent them in St. Paul.

Q: Do you have anything else to add?

Poppe: COVID-19 has uncovered many disparities we have throughout the state. Many individuals work through mild sickness due to not having paid sick leave, and this pandemic has shown the need to address that in some manner. For those who have lost jobs, it has shown how dramatically dependent many are for their employment-related health insurance benefits. Mower County is a “hot spot” and clearly the spread is real. The benefits of having good individual health and maintaining the collective health of our community is important.

One other piece of legislation to highlight this year has to do with grain bin safety. Tragically, Minnesota led the nation in the number of grain bin accidents resulting in death last year. This year, we put an emphasis on creating a program to strengthen education and encourage purchase of safety equipment to use on the farm. Accidents are often preventable. Working in a bipartisan fashion, the Legislature provided support for our farmers during these challenging and emotionally stressful times.

Mueller: No response provided.