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Excerpts from recent Minnesota editorials

April 17, 2014
Associated Press

St. Cloud Times, April 16

Stronger bullying law should help schools

While it's very encouraging the Legislature and Gov. Mark Dayton already this session have strengthened the state law about bullying in public schools, it must be noted the new Safe and Supportive Minnesota Schools Act is only a start.

Whether Minnesota schools live up to the act's name will be driven largely by the standards and guidelines put forth by state Department of Education, how districts apply them and who is ultimately held accountable through this approach.

As this board has noted in the decade-plus effort to address bullying, if elected officials really wanted to make a difference in addressing bullying, they would set their sights on homes, not schools.

Knowing they won't, this act at least offers potential to help all kids feel safer in schools.

For starters, the act better defines behaviors and patterns of behaviors considered bullying — both in person and online. And contrary to some perceptions, the act does allow local schools to adopt and implement their own policies; they just need to be at least as comprehensive as state rules.

Among the best aspects of this change are the focus on engaging and training staff more, as well as stronger efforts dealing with what happens when bullying does occur. For example, a major flaw of the old law was staff stay neutral in addressing bullying. That's kind of like asking a police officer to stop a robber without judging that a crime is being committed.

Another strength of this change is the potential to help more families recognize they play a role in creating safe schools.

Amid those strengths, there are some reasonable concerns to watch. Topping that list is how much time and resources schools have to use to implement the new law. Similarly, the law lacks clarity in how to track whether it's been successful.

Concerns raised during intense legislative debate also addressed religious freedoms and freedom of speech. Some legislators even labeled it an attack on Christianity. That's a reach.

First, are they really inferring it's OK to bully a kid for religious or free speech reasons? And second, what about the accommodations Minnesota public schools make for Christianity now?

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Post-Bulletin of Rochester, April 16

Temporary ban could solve e-cigarette dilemma

Who will act first to tighten rules regarding the sale, marketing and use of e-cigarettes — the Minnesota Legislature or the federal Food and Drug Administration?

On Monday, a report written by the staffs of several members of Congress raised multiple concerns about the suddenly booming industry, most notably the lack of age restrictions and warning labels. The FDA has the authority to regulate the sales and marketing of e-cigarettes but, so far, has taken no action.

Minnesota, on the other hand, began the year with apparent momentum toward major restrictions on e-cigarettes, perhaps even inclusion of "vaping" devices under the state's workplace smoking ban. Health Commissioner Ed Ehlinger indicated his eagerness to do just that, saying, "This is a threat to the health of the public."

But in late March, Gov. Mark Dayton threw a wrench into the proceedings. "We did enough to smokers last session," he said. He's willing to sign a bill that would keep e-cigarettes out of kids' hands but said his reluctance to invoke the Freedom to Breathe Act is due to the lack of conclusive evidence that the vapor poses a health risk to those nearby.

He's right on that count. There is an astonishing lack of scientific data about the risks of e-cigarettes to the users themselves, let alone those who are exposed to secondhand vapors. Such data won't be compiled overnight, but the research is underway.

On April 6, at the annual meeting of the American Association for Cancer Research, researchers presented the results of a study in which human bronchial cells were exposed to e-cigarette vapor. The cells responded in ways that were similar to — but not identical to — cells that were exposed to tobacco smoke.

The researchers stressed this is an early study, and more work needs to be done to conclude e-cigarette vapor can cause cancer in a laboratory setting, let alone in humans. It's a safe bet that we're years away from learning whether a child or adult who lives with a "vaper" is at higher risk of developing lung cancer.

That puts Minnesota in a dilemma: Should the state place tough restrictions on the sale and use of a product until it's proven safe, or should the government stay out of the way unless/until the product is proven dangerous?

We suggest a middle-of-the-road approach: In addition to taking aggressive steps to keep e-cigarettes away from kids, why not include e-cigarettes under the Freedom to Breathe Act for a specified time period, perhaps two or three years? The 2017 Legislature might be in a much better position to make an informed, scientifically sound decision, and if no research demonstrates a health risk from secondhand vapor, then the workplace ban on e-cigarettes could simply sunset.

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The Free Press of Mankato, April 16

Costs key in health care access

While we can all celebrate the number of previously uninsured people who now have health care either through private insurance or a government program, Minnesota must keep a keen eye on costs that could eventually cripple these programs and curtail access.

Nearly 100,000 Minnesotans have signed up for medical assistance, Minnesota's version of Medicaid, through MNsure, the state's website for health insurance. Monthly average enrollment in the program will total about 835,000, a 13 percent increase from 2013.

A Star Tribune report notes that is the highest increase in 15 years and near the top of all states.

The numbers are expected to increase as Minnesota continues a strong push to educate and notify those who might qualify with some 800 so called navigators getting people signed up through MNsure.

The good news is that state officials say the rate of enrollment is likely helping push the state's rate of uninsured people down to about 8 percent last year from a high of around 9 percent in 2011. Reducing the number of uninsured people also helps lower costs because people get preventive care instead of waiting to get seriously sick and going to the emergency room for costly care.

Other good news: Total health care costs in Minnesota also came in below projections, according to a report issued in December by the Minnesota Department of Health. Total costs, private and public, excluding federal Medicare and long-term care spending came in about 7 percent below projections at about $26 billion in 2011.

The bad news is that public health costs continue to rise at rates that are somewhat alarming. In 2009, government program health care costs in Minnesota grew 9 percent. Those rates of increase declined to 4.6 percent in 2010 and 4.7 percent in 2011, according to a mandated state report on the topic.

Those lower rates of growth come on the heels of some reforms including health care homes where health care was more coordinated, and payment reform including payment for outcomes instead of visits. Those programs may have helped push the rate of government spending down, but the report authors from the Department of Health say it may be too early to tell.

Those reforms will be key to the future of keeping health care costs in check as new rules under the Affordable Care Act allow expanding eligibility for medical assistance to adults without children.

The report notes that expanding that eligibility actually may have helped keep overall per capita costs down because those individuals tend to be healthier and younger.

The federal government will pay 90 percent of the expansion of medical assistance cost for the first nine years, but then the state will have to take over.

And the report also estimates that spending on Minnesota government programs will increase at about 12 percent in 2013, 16 percent in 2014 and 15 percent in 2015 and be in the range of 10 percent per year after that.

Much of that may be driven by the demographics. There are simply more people eligible for the programs.

These numbers are clearly not going to be sustainable. So reforms started in 2008 in Minnesota must begin bending the cost curve.

The cost report is required each year as part of the 2008 reform measure in Minnesota and required to be provided to the chairs of House and Senate health committees, including Sen. Kathy Sheran, DFL-Mankato, and chair of the Senate Health and Human Services Committee.

Minnesota is off to a good start on health care cost reform, but we must continue and expand the reforms. Then, we will not only be able to help 100,000 more people have health care, but we will be able to pay for it responsibly and sustain affordable access for all.

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