What is the future of MinnesotaCare?
An interviewer asked that question and Liebling explained the
history of the program. MinnesotaCare is 25 years old and originally
was a state-funded program for people who didn't qualify for
Medicaid (called Medical Assistance in Minnesota). It was aimed at
low-income people--mainly working people, small business people and
farmers--who couldn't afford insurance. The program originally
required no premiums, no out-of-pocket payments and no copays.
Gradually, a small premium and some out-of-pocket payments were
Prior to the Affordable Care Act (ACA),
MinnesotaCare was funded by a health care provider tax, which,
Liebling called "a wonderful source of funding" because, as health
care spending grew, the tax revenues grew and kept up with the costs
of funding the program. Under the ACA, MinnesotaCare was converted
to a Basic Health Plan (BHP) and the federal government took over
much of the funding for the program.
Recently, the federal government took away
a lot of the funding for MinnesotaCare, Liebling said, and the
provider tax is set to sunset at the end of 2019. "I'm very much
afraid that Gov. [Mark] Dayton may be presiding over the end of the
program," she said.
Liebling has supported a single-payer
health care system for years. "A system of insurance-run health
care has such flaws," she said. "We're seeing it collapse." She said
one of the problems with the insurance system is that it breaks
everyone into different risk pools, which raises costs. "We should
start by putting everybody in one pool," she said.
Deciding that everyone should have health
care, Liebling said, is a productivity issue, an economic issue and
a pocketbook issue. "It's also an issue for the industry of our
state, because we have a very health-care-heavy state economy," she
said. "The ACA did wonders for our state. When people have coverage
of some kind, hospitals get paid. Doctors get paid. And we have a
lot of them." And she pointed to the large long-term care system and
supports for people with disabilities in the state, which employ a
lot of people.
"We can't afford to leave anyone behind,"
Liebling said. "We need everyone--people of every race, color,
national origin, sexual orientation and ability status--to be at
their highest productivity, because more of us are aging. We need
everybody in. It's not charity to worry about bringing everybody in,
Raise the gas tax, but in the context of
making the overall tax system more progressive. Liebling made
that statement in response to an interviewer's question about
transportation and transit funding. Liebling said she struggles with
gas-tax funding, because of the regressive nature of the tax. "I'm a
proponent of progressive taxation," she said. "That doesn't mean
every single piece of taxation has to be progressive. But overall,
it has to be progressive. People who are comfortable should be
paying much more than people who are struggling to get by every day.
I don't want to raise the taxes of people who are of lower and
modest income. They can't afford it."
Liebling said there are things about the
gas tax that are attractive: it's a user fee and it's dedicated
We should raise the fees on trucks because
trucks drive up the costs of road and highway maintenance and
construction. Liebling made that statement and said trucks can
pass on the higher fees and spread them through the cost of goods
they carry. "Trucks are a tremendous wear and tear on the road
system," she said.
The Legislature should fund more of the
cost of transit. Liebling made that remark after saying that the
Legislature, under the Republicans, doesn't want to fund transit.
She said the Legislature sets up "a very artificial fight between
the metro area and Greater Minnesota. It tries to pit people against
each other. I think we're all connected."
"We've got to have good transit in the
metro area," she continued. "It's absolutely critical for economic
competitiveness. A lot of money in the state is generated in the
metro area, which goes to the rest of state and helps support
Greater Minnesota. Minnesotans understand that we all do better when
we all do better. That's true geographically. If metro people can't
afford to get to their jobs, that's a problem for all of us."
Provide students two tuition-free years of
public postsecondary education, whether in college or technical
school. Liebling made that proposal, saying it would create a
K-14 system of education. "I'd love to see four years free," she
said. "Higher education is a public good that benefits all of us and
should be for everybody. But first I'm proposing only two years,
because I think that's actually doable right now in Minnesota. It's
a competitiveness issue for Minnesota. It would help keep students
here and would boost our economy tremendously."
She said the state's Postsecondary
Enrollment Options (PSEO) program tries to do a lot of different
things: help students earn free college credits, provide enriched
courses for students whose schools don't offer them and provide an
option for students who want to leave high school. She said the
state is offering free college credits through PSEO, "but we're not
doing it for everybody."
Liebling said the public high schools
don't want to promote PSEO, because they lose funding when students
participate in the program. "Like health care, it's too much about
where the money flow is," she said. "We're shuffling money around,
when we should be focusing on students and their education."
We're seeing the results of class
differences early in the education system. Liebling made that
statement in response to an interviewer saying that income disparity
is a huge problem. The interviewer pointed out that students
enrolled in IB (International Baccalaureate) and AP (Advanced
Placement) classes are good students, who will be the leaders in
society. Meanwhile, he said, students in regular classes or
alternative programs are not engaged and "can't get their eyes out
of their cell phones. The best teachers want to teach in IB and AP
classes. The other kids get what's left over."
"There's a problem with not having enough
teachers," Liebling responded. "And there's a movement now to
de-professionalize teachers, when we should be going the other way.
Wouldn't it be wonderful if we said we need teachers and we value
teachers? Let's give them a free education in exchange for a certain
number of years of service."
We must support families and focus on the
youngest children. Liebling made that remark and said we must do
more for early childhood education. She said home-visiting programs
have been shown to be effective. "If I could wave a wand, I would do
that for every family," she said.
"It's hard being a parent," she continued.
"So few people have a grandparent available or a supportive
community that can help. We need to recognize this as a society and
give people more support, right from the beginning. Help them learn
parenting. In some countries, when people have a child, it's a grand
occasion for the whole society and you get resources wrapped around
you. In our society, when you have a child, you're on your own.
That's wrong and it hurts all of us."
We need to focus more resources on the
youngest children, including parent education and support, Liebling
The University of Minnesota's Rochester
campus is working really well. Liebling made that remark in
response to an interviewer's question. The campus is growing, she
said, and attracting a lot of students. "Students are very happy and
there are a lot of connections with the community and with the Mayo
Clinic," she said. It's relatively low cost, because the campus
doesn't have any buildings yet.
Are we getting what we pay for in higher
education? An interviewer asked that question and said the
accountability is not there, either in higher education or health
care. Someone dictates the price and the government feels it needs
to pay that, he said. That doesn't happen in places like France,
Germany or Great Britain.
Liebling responded by saying that the
University of Minnesota (U of M) is a land-grant institution, so the
Legislature can't dictate what the University can spend money on.
The share being paid by the public is going down, she said, and the
U of M says that's why tuition is going up. "This is not just a
Minnesota issue," she said. "The cost of higher education has
outpaced other things."
The interviewer said there should be
pushback if the U of M and Minnesota State keep raising their
prices, i.e., tuition. "No one's saying 'Why does it cost so much?'"
Liebling responded that some people are
asking that, but there are no studies of why tuition keeps rising.
She said Minnesota's private colleges definitely have a role to play
in the state, but said their high tuition means that their students
get a lot of state grant money, at the expense of the public system.
"How much of private education does the public need to be
responsible for?" she asked.
As more people leave the workforce through
retirement and fewer young people are coming in, how can Minnesota
maintain an outstanding workforce? An interviewer asked that
question and Liebling replied that people are working longer. "Sixty
is the new 40," she said. "But we have to make sure that everybody
in the younger workforce is able to work at the top of their game."
She said we don't work hard enough to get to people who are not
traditional members of the workforce, like those with felonies on
"We can't afford that anymore," she said.
"Don't tell me you can't find employees when so many people need
work," she said. "Maybe they need a little more support. We must
help people pull themselves up." Immigration is very important for
Minnesota, she said. "We won't have a large enough workforce without
it," she said. "We must be sure immigrants get integrated quickly,
so they can get into the workforce."
Perhaps there could be a program in
Minnesota where we encourage people to go to places they wouldn't
ordinarily go or try out types of work they wouldn't ordinarily try.
Liebling offered that response to an interviewer's comment that
employers are saying they can't find qualified employees.
Liebling said there could be some sort of matching program and
perhaps the state could forgive some student loans if, for example,
someone took a job in a rural area that has a hard time attracting
Can we validate what people can learn on
their own or does everything require a formal education? An
interviewer asked that question, offering the example of his son, a
filmmaker, who didn't go to college, but learned much of his craft
Liebling noted that there are many online
courses now in the public college system. She believes there is
still value in a traditional college education, though not
necessarily as much as there used to be, since the economy is not
what it used to be. "A lot depends on employers," she said. "They
have to be willing to say, 'Well, you don't have a degree, but show
me what you have.'"
She expressed concern that "you don't know
what you don't know if you're only learning from YouTube. And people
need emotional intelligence. They need to learn to interact and to
work with people. A lot of people are growing up with technology and
they may miss the personal interaction pieces if we don't have some
structure to get them out of their homes."
5. Public-Policy Process.
Unfortunately, the Legislature doesn't
necessarily use the good ideas that are proposed by outside people
and organizations. Liebling gave that response to an
interviewer's question about whether Minnesota's public-policy
process is working to develop good ideas for policymakers.
"Minnesota is lucky to have so many people engaged in trying to
develop solutions to public problems. But a lot of times, it's not
about good ideas. It's about politics," Liebling said.
The governor does have a role to play in
the public-policy process. The governor puts forward proposals and
can bring together people to form those proposals. "There's more of
an opportunity to draw on that," she said.
Starting a Minnesota Institute of Policy
Development, similar to what Washington State has, is an intriguing
idea. Liebling made that proposal, saying if we had such an
organization, it would be somebody's job to think ahead, so we're
not only looking at a two-year or four-year cycle.
She said she was talking about something
like the old State Planning Agency, which was established by the
Legislature in 1965 and abolished in 2003 by executive order of
then-Gov. Tim Pawlenty. It would do planning and policy development,
she said. "We used to have that and it's a problem that we don't."
It's a huge problem that the Legislature
does not adhere to the state Constitutional requirement that
legislative bills be restricted to a single subject. Liebling
made that remark in response to an interviewer's question about what
the governor could do to encourage the Legislature to abide by the
"Omnibus bills are overused," Liebling
said. "They're used to bury things. That's a game that has been
played for many, many years. It has really gotten out of hand." We
need legislative leaders who have a commitment to abide by the
single-subject requirement. "It's their decision," she said. "We
should hold them responsible for it."
The governor has a few levers--the veto
power and moral persuasion--that can put pressure on the
Legislature, she said, but this is mainly a legislative issue. The
governor must be very clear at the beginning of a legislative
session which things will draw the veto. Then he or she must follow
through. "I think that's been a problem," she said. "You have to let
people know early and often and stick to it," she said.
Over the years, Liebling said, the courts
have given conflicting rulings on the single-subject requirement, so
the boundaries are not clear. There are egregious examples of it,
she said, but most of the time it is a matter of degree. So it's
hard for a governor to draw a bright line and threaten a veto over
the single-subject requirement.