Political leanings divide Minnesotans on health goals, drivers

Minnesotans are anything but twins when it comes to their views on health policies and priorities. Two-thirds of Minnesotans are split right down the middle – one group wants a health system rooted in marketplace competition while the other side favors more government involvement.

What makes this division most challenging is that the respective positions on health policies and priorities are not defined by demographics (for example, gender and age) or personal economics (income and employment status, among other factors), but mainly by ideology. In fact, if Minnesotans can’t find a way to bridge their ideological differences, the challenges of health cost, access and quality will be increasingly difficult to resolve.

These are among the findings of research conducted by Minnesota HealthBasics, a unique collaboration of leaders from Medica, TwinWest Chamber of Commerce, Minneapolis Regional Chamber of Commerce, Minnesota Building and Construction Trades Council and North Memorial Health Care.

It is believed to be the first time such a diverse group from business, labor, health care and insurance has collaborated on comprehensive research to understand the values, knowledge and priorities Minnesotans bring to health policy.

The HealthBasics collaborative is not proposing policy solutions. Instead, the group set out to identify the priorities and values Minnesotans bring to the discussion of health care. In the next phase of the initiative, the research findings will form the basis for conversations HealthBasics will host with Minnesotans in a variety of forums.

  • Minnesotans generally align themselves into four distinct groups. The largest two of which represent 67 percent of the state’s adults and are mainly shaped by ideology. Members of these two groups are consistent in their views and their views consistently are in opposition to those held by members of the other group:
  • Free Marketers: Thirty-four percent of Minnesota adults are in this group. They are ideologically conservative. They support marketplace competition to achieve health priorities and see only a very limited role for government. Their favor affordability and quality as higher priority goals than broader access.
  • All-Insureds: Another one-third of Minnesotans – 33 percent – are the mirror image of the Free Marketers. This group is ideologically moderate to liberal. Their highest priority is universal coverage and see government as the better vehicle to achieve the goal.

The other one-third of Minnesotans also divides into two groups, but they are far less ideologically defined:

  • Cost-Conscious: Eighteen percent of Minnesotans are driven by the issue of health care costs. While they align with the All-Insureds on the role of government, their primary concern is affordability. Not surprisingly, this group has the lowest earners and more households with kids than the other three segments.
  • Managed Competitors: About 15 percent of Minnesotans see universal coverage as the most important goal, but believe it is best achieved through marketplace competition. They are open to some government intervention – including some limits on costs and earnings – but generally favor marketplace competition as the best way to achieve their policy goals.
How Ideology Divides Minnesotans
Free Marketers All-Insureds
Priority Goal Affordability Universal coverage
Cost Drivers Malpractice suits, inflation Aging population, technology
Cost Controls Marketplace competition Government imposed limits on costs, earnings, salaries
Personal Responsibility Higher premiums for those with poor health habits (smokers, those who don’t exercise, etc.) People shouldn’t be penalized for poor health


This separation of Minnesotans into ideological silos on health policies and priorities reflects a national trend. A survey by Pew Research in June found that Republicans and Democrats “are more divided along ideological lines…than at any point in the last two decades.” Pew found that many of the most partisan Americans believe the policies of the other side aren’t just “misguided,” but “threaten the nation’s well-being.”

The good news is that the ideological split in Minnesota may not yet be as divisive as the Pew survey reflected. The political hot-button issues that were examined in the HealthBasics survey haven’t reached the boiling point in Minnesota. For example, while a majority think there is too much waste, fraud and abuse in the health system, it’s not an intensely held opinion by most Minnesotans. Likewise, health care spending for undocumented aliens or unemployed welfare recipients divides Minnesotans, but sentiment on both sides of those issues generates the strongest opinions among less than a third of the state’s adults.

The survey was conducted and analyzed by Daves and Associates, an independent, nationally-recognized research firm.


About the Research: All members of the collaborative were involved in designing and analyzing the research. Medica underwrote the cost of the research. The research included two components. Six focus groups were conducted in July in three Minnesota cities. The findings from the focus group were used to develop a statewide telephone survey of 1,000 randomly dialed Minnesota adults (650 interviews were conducted on landline phones; 350 on cell phones). The survey was conducted Aug. 11-15 and has a margin of sampling error of plus or minus 3.9 percentage points, at a 95 percent confidence level.

Minnesotans Reflect on Health Policies and Priorities

Additional HealthBasics Research Findings

Minnesotans have a pretty good sense of where our health dollars are spent. Minnesotans know, for example, that hospitals (about one-third of health care spending) and physician services (about one-fifth) are the major expenses. Minnesotans do overstate how much is spent on prescription drugs (18 percent say it’s where the most money is spent, compared with real spending of less than 9 percent of all health care spending). (NOTE: The actual spending is based on data published by the Minnesota Department of Health in 2013).

Minnesotans recognize the cost drivers and agree on some solutions. Minnesotans generally recognize that several trends are driving health costs higher, from an aging population to new drugs and technologies. Minnesotans tend to place much more blame on hospitals charging too much than Americans in general (compared to a 2014 Kaiser Family Foundation survey). State residents offer a variety of solutions, and sometimes there is broad consensus. For example, most Minnesotans believe that making available easy-to-understand information on how much hospitals and clinics charge for their services and the success rate of doctors would be effective in controlling health costs.

But, most of us don’t recognize the overall cost. A bit less than one-fourth of us recognize that Minnesota spends more than the national average on health care. According to national data compiled by the Wall Street Journal in 2013 (based on 2009 spending, the latest year for which national data were available), Minnesotans spend $7,409 per capita, about 9 percent above the national average.

Solutions are for others. A strong majority of Minnesotans say when it’s all said and done, we don’t want limits placed on our own interactions with the health system. Minnesotans want whatever treatment is prescribed by a physician; we want to see specialists without referrals; and, we want our health insurance to pay the full cost of care. And never mind the contradictions. For example, while 52 percent agree that doctors often order too many tests and treatments that don’t really improve a patient’s health, only 41 percent agree (and 39 percent disagree) that insurance companies should work with medical professionals to evaluate the effectiveness of expensive treatments and services, then pay only for the ones that are most successful. In fact, 67 percent of us say that insurers should pay for every treatment or service a doctor prescribes.