Report From the States

Minnesota's New Health Commissioner Effectiveness Questioned

Twila Brase, RN

Jan Malcolm, Vice President of Public Affairs for the Allina Health System, Minnesota's largest HMO, was appointed on January 19 as Minnesota's new Commissioner of Health. We question whether Commissioner Malcolm, a top-ranking HMO executive, can effectively deal with the problem of managed care.

Following the 1973 federal HMO Act, Minnesota transferred regulation of HMOs out of the Department of Commerce, where all other insurers are tightly regulated, and into the Department of Health. Citing this relationship between the Department and HMOs, many organizations and legislators have been justly concerned the regulatory duties of the Department of Health may be hampered by the Department's dependence on HMOs for Medicaid enrollment, public health initiatives, and access to health data. One concerned legislator, Rep. Ron Abrams (R-Minnetonka), has introduced legislation since 1997 to transfer HMO regulation back to the Department of Commerce, but has thus far been defeated.

Commissioner Malcolm may carry a bias favoring the industry for which she has worked. Her allegiance to managed care can be seen in her press conference comments quoted in the St. Paul Pioneer Press, where she stated, "I really see my career as having been an attempt to do health care reform, to make health care more accessible and more of uniformly high quality. I've always seen managed care plans as a tool to do that."

The public outcry over managed care has increased as health care quality and access have decreased: Enrollees wait longer for appointment and tests, local clinics are not allowed in provider networks forcing patients to travel further distances, patient-doctor relationships have been broken, access to medications and treatment are arbitrarily denied as medically unnecessary, patients pay out-of-pocket for care denied, and patients are forced into litigation to access care.

While proponents of managed care cite such complaints as mere anecdotal evidence and advance managed care as the only solution to rising health care costs, we should point out the projected 5-13 percent increase in 1999 premiums and a 1997 quote by Senator Don Samuelson, chair of the Health and Human Services Finance Committee. After he was assured that placing people with disabilities into managed care would save the state money, he said, "My drawer is full of promises like that in my 26 years...So far all I've seen in managed care is more costs in more ways...It certainly hasn't saved any dollars I can see." (May 7, 1997 HHS Conferences Committee).


Ms. Brase is president of the Citizens' Council on Health Care. Web site:

Originally published in the Medical Sentinel 1999;4(3);113. Copyright©1999 Association of American Physicians and Surgeons (AAPS)