Health Inequities & Policies in Minnesota: In Conversation With Sen. Carla Nelson

Healthcare disparities are pervasive. I sat down with Senator Carla Nelson to get her take on health inequities in the state of Mineeosta, and to ask her about steps that have been taken in recent times and the ones that are being planned in the near future to improve the healthcare delivery landscape for Minnesotans. 

Check out the full interview here: https://youtu.be/xbDWAydy9k0

Here is the transcript of the interview:

ISHA: Hello everyone. My name is Isha Kapoor. I am a senior at Mayo High School, and today I'm joined by Senator Carla Nelson, who will be discussing with me healthcare policies that have already been implemented in Minnesota and what's currently on the docket, as well as how we can improve healthcare access across the state. So hi, Senator Nelson, thank you so much for joining me today. 

SEN. NELSON: Great to be with you. 

ISHA: So my first question today: I have been serving on the Olmsted County Public Health Services Advisory Board, as well as done some shadowing work at the local Salvation Army Clinic. [Through these forums], I have gained some insight into the healthcare inequities that currently exist in our society. So could you please share, for starters, how you define health care inequity and what [does it mean] to you in the context of your work? Also, what are some of the specific issues and disparities in this space? 

SEN. NELSON: Well, thank you first for having me here today, and really, I'm quite encouraged to hear about your involvement with the local Salvation Army Clinic [and your membership on the Olmsted County Public Health Services Advisory Board]. They do a wonderful job. So our future looks bright when we see young people like you getting involved in these important missions. Well, I think the first thing to know is [in] any health policy, it's very important that we ensure that everyone has access to quality, affordable healthcare, and sometimes that is the challenge: making sure that access is there, making sure it's affordable, and making sure it's high-quality. But those are the things that we expect, and I think we should expect. As you know, Minnesota is an interesting state in looking at healthcare disparities, or quite frankly, other disparities as well. But one of the things we know is that we have a very dense city population if you think about that. Rochester is the third largest city in the state, and then we also have a large part of Minnesota that is very rural, outstate residents, and they all require care. They all require health care: high-quality, affordable, accessible healthcare. So it's the job of legislators to ensure that our state has laws that will allow for the expansion of high-quality healthcare in rural, suburban, [and] urban areas. Those areas are very different in what that healthcare can look like and how it might be delivered. But the thing to remember is that we all expect that to be high-quality, affordable, and accessible. That does not change. Now, I'll just give you an example of one policy that could be helpful. As you know, the high cost of prescription drugs is one of the biggest drivers in medical costs, and there's a legislation called “Sharing the Savings Bill.” It's something that I've authored in the past [and I] will continue to move forward with this. Some other states have already done this, by the way, and what that aims to get at is the high cost of prescription drugs so that drug companies that offer rebates to insurance companies to say “We're going to cover your drug.” Let's call it Drug ABC -  Drug ABC manufacturers will pay a rebate or a premium or something to the insurance companies if they put that Drug ABC on their covered list. Well, it seems what's happening is the rebates are going to the insurance companies. However, the rebates, or the savings, should [not go] to the insurance companies. The savings should go to the people who are paying for those drugs, and that's very simple. It seems simple in my mind, but clearly, it's not simple to get past, but the point is, we should make sure that those savings from any type of rebates for drugs on formularies or insurance plans, actually go to the people paying the bill, and that would be to the patient. And so, we would like the patients to benefit directly from any negotiated rebate discounts. That's what I'm looking for. The rebate legislation would obviously lower the consumer out-of-pocket costs and so that would be incredibly important. And that's just one of the things that we can do. And it's again, making sure that everyone has that high quality, affordable, accessible health care. 

Now we know, in our city, Mayo Clinic is leading the way in looking at innovations. There are great healthcare innovations that help people get the health care that they need, where they need it, when they need it. And that includes many things that we will see even expounded upon in the Mayo Clinic “Bold Forward Unbound” proposal. And I know you've been following that. There has been a lot of excitement about that, and of course the more we learn, the more we know that it's important that that type of high-quality medicine reaches every corner of the state, and we can do that now. We can do that more readily now through some of the wearable devices through the ability for telemedicine. That's another proposal that I've worked on through the years: expanding telemedicine [and] telehealth. I think it's important that we look to embracing those new innovations, particularly in the healthcare arena. And I think that can do a couple things. One, it can help eliminate health disparities and healthcare is getting to people who need it, when they need it, the right care that's needed. Regardless of where they live. So those are just a couple things that are important. 

ISHA: Okay, yeah, that's amazing. I wasn't aware of a lot of these policies, and I try to follow the healthcare space as much as I can, at both the state and national levels. But that's really interesting. Those were some proposals that I hadn't heard of yet, so thank you so much for bringing those up. So this next question is a little bit more Minnesota-specific. How significant or severe are the healthcare disparities in our state compared to the country as a whole? And what do you think are some of the specific drivers or barriers in our state? And also, if you could potentially comment on what are some of the competing priorities that would be [great]. 

SEN. NELSON: Well, certainly. I just want to say healthcare disparities are everywhere. And full disclosure, as a former teacher, I fully believe that education disparities often lead to many of these other disparities, whether they be health disparities, poverty, housing disparities, any of those things. So much of that comes back to education. So I would be remiss if I didn't talk about the importance of making sure every Minnesotan is well educated and all Minnesotans deserve that. But our state is no different than other states in [regards to] having vast disparities in many areas. So the next thing I'm going to talk about: we're going to compare how we rate [compared] to other states, and then what is the priority, and why do I think this particular thing? It's called the Nurse Licensure Compact or known as the NLC. It would allow Minnesota to join the vast majority of other states that already have a Nurse Licensure Compact, and we're kind of an outlier in that we haven't participated in that yet. It would make Minnesota healthcare more competitive, and it would most importantly, directly affect the nursing crisis in our state. I think we all know that we have a nursing crisis. I think we all know how important nurses are. Nurses are that link that is essential in good healthcare. And so, it's unfortunate that Minnesota remains an outlier in not adopting the Nurse Licensure Compact, which would allow nurses who are licensed by their national boards to practice in Minnesota without going through the Minnesota licensure. And of course, most other states do that already, and they all have to pass the same boards. They all have to pass the same test. So why would we forbid others from other states coming into practice in our state? We did so during the pandemic, by the way. We allowed nurses from other states to come in and practice in Minnesota. We should open that up. There was actually no opposition to this bill, except there was one small segment that was opposed and that happened to, interestingly enough, be the Nurses Union, which represents only about 20 percent of nurses in the state. So they're very much a minority. But I would say that the military, all the health organizations, the hospitals, all supported saying, “Let's let these licensed nurses into our state,” so I'm hoping that should be a priority. Another place where our state is an outlier, which in a sense can also lead to disparities, is that we are a high tax island. So, as you might know, we are one of the very few states that is a high tax state no matter what indica you look at. You can look at income taxes. Our income taxes, for example, are higher than almost any other state, and even our lowest rate is higher than the highest rate at other places. So it's really a bit of a challenge. I think the moral of this story is [that] Minnesota should look hard about being an outlier, whether it be an outlier in getting qualified nurses into our state, or whether it be in being a high tax island. So I think those things are important. And when it comes to priorities, I think it's important to look at legislation that creates opportunities for Minnesotans in all areas, whether it be education or economic growth or high-quality healthcare. I think the focus should be on empowering Minnesotans, and some would look at that as opposed to empowering government. So I have great confidence in Minnesotans and really would like to see us do more empowering of Minnesotans. 

ISHA: Yeah, that's really interesting. I think you brought up some really interesting points there, but yes, healthcare disparities are definitely an issue that is more all-encompassing and goes beyond just Minnesota. But thank you for bringing up some specific drivers in Minnesota, as well as kind of informing me of the different priorities that currently exist. So you sort of touched on this in a previous question, but in your role, Senator, what initiatives or policies have you specifically been involved in to address healthcare disparities, as well as to equity in healthcare access and outcomes? How do you ensure that the marginalized [voices] and underserved communities within our state are included in the decision-making processes regarding healthcare policies and programs? 

SEN. NELSON: Yes, very good questions, very thoughtful questions. I mentioned two already, as far as the policies that will address disparities and equity. [First is] “Share the Savings” so that those savings go to the consumer, which is most important to consumers who might have [a] less[er] income or less resources. We want to make sure that they don't have to overpay for their medicines because insurance companies are taking the rebates. I also mentioned the Nurse Licensure Compact, which, of course, is getting us to where most other states are, which is allowing more nurses to practice in our state. The other thing I would say [is that] it allows our nurses to practice elsewhere as well. 

I will say this: these things often take a few years. There was another one of my initiatives called the Copay Reform. It took several years, but it was signed into law earlier this year and that again is what I learned from my constituents. One of the issues was [that] some of the medicines, some of our newer pharmaceuticals, quite frankly, have been revolutionary in changing one's outcomes with rheumatoid arthritis or other ailments. However, they're very expensive, sometimes over 6 thousand dollars a month, for example, [in the case of] the constituent that I spoke with. And so I started thinking about that, and she mentioned to me, “You know, we do have insurance, but that doesn't kick in until we've paid the full deductible upfront.” And some of those high deductible plans have pretty significant deductibles now. And so I started thinking about that and I thought, “Well, she knows, her doctors know, that she's going to have this medicine ongoing at least for the next year, and we know the cost every month. Why is it that her deductible has to be met in full? Why couldn't it be one twelfth of the deductible each month being met for that high prescription cost?” I mean, that was more than a house payment. And so I think there are things that you learn from your constituents, and then you have to think about it and work through all the processes. But I will say I'm glad the Copay Reform was signed into law now, and every Minnesotan does have an opportunity if they choose to have an insurance policy that has the Copay Reform in it. It's those things that you wouldn't think they'd be so hard, but they are hard to get through. 

And then one other piece I have [certainly] faced: aging parents. We see our senior population growing, and one of the things that I also noted from my own experience and also from my constituents was that a lot of seniors would rather stay in their homes longer than leave their home and go into some type of assisted care or long-term care or housing with services. And so one of the challenges is that with a little bit of support, many Minnesotans would be able to stay in their homes longer. And we know that if they can stay in their homes longer, it decreases the cost of that ultimate long-term care. And it is also where they want to live. And so there's something called “Live Well at Home” grants. And some of my constituents here in Olmsted County told me about how valuable those grants could be, and so it would expand home and community-based services so that Minnesotans can age in their own homes. That's where they want to be, they're more comfortable, and it's less of a burden on our care facilities. I'm glad to say that was signed into law this year, and so it's small things like that that can help all Minnesotans live well in their own homes. And so I was glad to see that pass as well. 

ISHA: Yeah, congratulations on your Copay Reform, that's amazing! It's nice to see those little steps that progressively pave the way for a more equitable healthcare landscape in the years to come. So thank you so much for your work on that. So specifically, what strategies or innovations do you believe hold promise in advancing healthcare equity in the future and reducing disparities in healthcare access and outcomes? And what would you pin down as the most important steps that we need for the future?

SEN. NELSON: That is a very good question, a broad question. I've mentioned some of the things that I thought were helpful going forward, and I would just add that any of those things, really, that need to get done are going to be bipartisan efforts. And it's important you have good relationships with all your colleagues and advocacy efforts. One of the things that I've learned from my experience is when something's working, you want to keep it; you want to keep your resources there. I'll give you one example that has worked for probably the last six years. 

And that was something that would help all Minnesotans be able to afford their health insurance because quite frankly, health insurance is pretty important in allowing all Minnesotans to get that care that they need. And one of the things that had happened [after] the Affordable Care Act (ACA) on the national level was that small business owners, which are the majority of businesses in our state, and farmers, particularly those two groups who buy their insurance not as part of a big group policy, but [who] buy what's called ‘Shop Insurance’ or they buy their own insurance. And one of those challenges for those smaller employers and farmers is that the cost post-ACA for those smaller policies grew exponentially, just massively, and so Minnesota was one of the first states [to create] a reinsurance plan [so] that the state would help hold down those premiums. We used to do that in a different way, but the ACA wouldn't allow that anymore. So we had to come up with a different way where we could help hold down those premiums for all Minnesotans, so 1) they would have health insurance, and 2) they would be able to get the care that they deserve. And that was called the Reinsurance Program. We did that, for I think it was six years, and then unfortunately, this year, it was actually rather shocking that we did not do that. Even though we, you know, had a 19 billion dollars surplus, the state did not invest in that reinsurance program, so I am concerned about Minnesotans, particularly Minnesotans working in small businesses and farmers, and what this is going to do to their health care costs. The estimates for that are starting to come in, and there is an excess of a 10-20% increase in costs. And my fear is that we're going to see people not have that insurance, or we're going to see those employers [possibly] go out of business. But so you know, sometimes there are unintended consequences and I think that was one that we missed. 

But those types of innovative things like the Reinsurance Program that was touted across the nation, and some of the other things I mentioned like Copay Reform, Nurse Licensure Compact, all those things could be helpful. 

ISHA: Yeah for sure, I completely echo. So my final question for today, just in the interest of time, is what advice would you give young innovators or those starting out who are passionate about healthcare equity and want to make a difference in the fields. 

SEN. NELSON: Oh well, I think you're a great example! I think the first thing is that we need advocates. We need people who are interested in their government. You know, democracy is everybody's business, and sometimes people get so busy they're not involved. I think it's important that everyone get involved, everyone be aware. I encourage people to listen to all sides of every argument respectfully, and then try and sort through with their critical thinking, what it is that might be an avenue forward to achieve those goals that are of interest to them and always be open to learning new things. None of us have a corner on knowledge. I think that's one of the things that I learned as a teacher is to [believe in] continual improvement, continuous lifelong learning. Those things are really important, and also, I think what you're doing is really critical. I mean, this is the second or third time we've met. We talked about the science fair many months ago, and you know, that's an example of advocacy. So I encourage people to be aware, be lifelong learners, be respectful, meet with legislators, and be involved in your community. I think those are the things that will help passionate advocates on particular issues, whether it's healthcare equity or quality education or jobs or building the workforce. Any of those things: we need you. You are the future. 

ISHA: Well, thank you so much, that's really, really great advice. I think that is all we have time for today. But thank you once again, Senator, for your time today. I know your [schedule is] super jam-packed, but thank you so much for making the time for this interview. I learned a lot, and I'm hoping our blog readers [will] learn a lot as well. 

SEN. NELSON: Well, thank you so much— joy to be with you. Look forward to [seeing] the blog myself.

ISHA: Yes, I will send that over to you once it's done!

SEN. NELSON: Well thank you so much, have a wonderful holiday, and I look forward to hearing from you!

ISHA: Yes, you too. Thank you!