Physician Patient


Minnesota Physician-Patient Alliance, Inc. ("MPPA") is a not-for-profit organization committed to improving our health care system. We do this by communicating information to the public and within the industry about important health care issues.

MPPA believes that efficient, quality health care depends on strong doctor-patient relationships. Interference in the doctor-patient relationship by third parties such as health plans and the government, is widespread in today's health care system and often limits what doctors or patients are allowed to do, altering market-based reimbursement, and undermining the traditional ethics of the medical professions. While the intentions of the third parties in interfering with the relationship may be honorable (for example, to control costs or improve quality), ironically the cumulative effect of this interference is unnecessarily high costs and reduced quality. Efforts to reform health care, therefore, must first and foremost address the issue of strong doctor-patient relationships.

The MPPA board consists of physicians, health care consumers, and others who share these concerns and values. We seek to communicate our message by collaborating on research and publication, sharing information about market developments, and individually being active in a variety of health care and community organizations.

To see who belongs to MPPA, please visit our Who We Are page by clicking on the link to the right. To see some of our communications, click on one of the Publications links to the right. If you would like to learn more about MPPA or our positions, click on the Contact Us link to the right.

MPPA was established in 1997 as a Minnesota 501(c)3 charitable nonprofit organization. If you would like to be added to the MPPA listserv, the respected MPPA online discussion group, send us your contact information and we will add you.

Nov 17

What are patients and families (consumers) told when they ask their doctor, other “healthcare provider,” employer, health insurance company, Medicaid or Medicare (or other government program) representative: How much does this procedure, drug, or encounter cost? How much must I pay?

From your experience, please share the answer(s) you’ve heard.

Before Minnesota consumers can make intelligent, value-based, health care choices, they need to have actual price transparency in a competitive Minnesota health care marketplace.

Do you agree that this is a worthy goal?.

If so, what will it take to get us there?

How do Minnesota consumers today shop for heath care value?

And what public policy reforms will encourage them to do so?

What specific public policy proposals will be proposed (or bills that should be filed) at the Minnesota legislature in 2018 to enhance true consumer health care price transparency in Minnesota?

Let your Minnesota legislator know.

Oct 20


Merrill Matthews, PhD wrote the introduction to my 2017 book (with Dave Racer) titled Passion for Patients at

The Limits of Trump’s Health-Care Order
At the margins it will improve availability and affordability, but Congress still needs to act.
President Trump signs an executive order on health care, Washington, D.C., Oct. 12.

By Merrill Matthews
Oct. 19, 2017

Give President Trump an A for effort with his latest executive order, which tries to expand health-insurance options for individuals battered by exploding premiums and fleeing insurers. At least somebody is trying to do something after congressional Republicans failed to repeal and replace ObamaCare. While the executive order represents progress, Congress still needs to act.

Mr. Trump is directing three federal departments—Labor, Treasury, and Health and Human Services—to consider ways of providing more flexibility for association health plans, short-term insurance, and health reimbursement arrangements.

Associations have been offering their members access to various types of health coverage for decades. The best known example is AARP. Those polices are “fully insured,” meaning a licensed health insurer underwrites them and bears the risk. And because federal law before ObamaCare left insurance regulation primarily to the states, association-offered policies must comply with regulations in whichever state they’re sold.

But there is a safe harbor: the Employee Retirement Income Security Act of 1974, better known as Erisa. Widely varying state insurance regulations made it difficult for large companies with employees in multiple states to offer uniform coverage to their employees. Erisa allows large employers, as well as groups of employers known as Multiple Employer Welfare Arrangements, to “self-insure.” This means the employer, not an insurer, pays the medical bills.

Erisa pre-empted self-funded plans from state insurance regulations, so state legislatures and insurance departments have not been able to micromanage them as they do small-employer and individual plans. That freedom made self-funded plans very popular. For decades medium-size and even small employers have looked for creative ways to leave fully insured coverage for a self-funded plan.

Several associations, especially those representing small employers, such as the National Federation of Independent Business and the National Association of Realtors, spent years trying to persuade Congress to allow associations to self-insure and to offer their members the same coverage across state lines largely free of state mandates. But Congress never changed the law.

Since the passage of ObamaCare, however, states are no longer the driving force behind most insurance mandates and regulations. Washington is. The health law imposed some requirements on self-funded plans—free preventive care, no annual or lifetime limits, no pre-existing condition waiting period, children as old as 26 can remain on their parents’ policy, etc.—but ObamaCare’s 10 essential benefits are not mandated. Most self-funded plans retain at least some freedom to create their own benefits package.

Mr. Trump and congressional Republicans are hoping the Labor Department will identify a way to allow associations and small employers to create self-insured plans—or something similar. That change could allow them to adjust benefits and offer more affordable coverage to more people. A more straightforward solution would be for Congress to change the law.

The health-insurance industry opposes this step because self-funded plans bypass insurers. Others fret that association plans will be a “race to the bottom” of coverage. According to a July 2016 report from the Employee Benefit Research Institute, some 60% of the 155 million American workers and their dependents with employer-provided coverage are in self-funded plans now and glad to be there. Would you prefer less-regulated, self-funded health coverage from a company like UPS—or the ObamaCare exchange?

The executive order also seeks to roll back HHS-imposed restrictions on short-term, limited-benefit policies, or “bridge policies.” If this measure succeeds, people would again be able to keep those policies for a year instead of three months, the limit imposed by the Obama administration. But such policies have always been a minuscule part of the insurance market. They are not qualified coverage under ObamaCare, and purchasers would still face penalties for being uninsured. It’s unlikely there will be a mad dash to enroll in them.

If HHS were to find that purchasing such a policy constituted an approved “hardship” and temporarily exempt buyers from the mandate’s penalty, that could help more people who have little or no affordable ObamaCare options gain at least some coverage.

Finally, some employers make tax-free health reimbursement arrangement deposits, which employees use to pay for certain eligible health-care costs. Mr. Trump wants to expand HRA options, though it’s unclear how much flexibility officials can provide without changing the law. Still, it can’t hurt and may help. Expanding health savings accounts would be better, because that money belongs to the individual. But that would take legislation.

The intent behind Mr. Trump’s executive order—to expand access to affordable coverage—is spot on. And it may achieve part of this goal. But even if federal agencies become creative in their efforts to identify safe harbors from ObamaCare, it is unlikely to make much difference without action on Capitol Hill.

Mr. Matthews is a resident scholar with the Institute for Policy Innovation in Dallas.

This Commentary appeared in the October 20, 2017, Wall Street Journal print edition.