Ready for reform
ST. PAUL -- Minnesota is just a few steps away from some of the biggest health insurance reforms in recent history.
Lawmakers have worked out a final plan from House and Senate proposals to run a health insurance marketplace required under the federal Affordable Care Act, commonly referred to as Obamacare. It is close to approval after passing the House early Friday.
"This is the most significant, positive health care reform in Minnesota in the last 50 years," said bill author Rep. Joe Atkins, DFL-Inver Grove Heights. "This is a clear compromise between the House and Senate positions on the exchange."
Representatives approved the bill 72-61 just after midnight, and it appears likely the Senate will approve it Monday. Gov. Mark Dayton is expected to sign the measure, giving Minnesotans a mainly online system to compare and buy health insurance.
But backers are not celebrating just yet.
"Until I see the governor's pen flying across the page, I'm not done," said Senate author Tony Lourey, DFL-Kerrick.
Lawmakers have a March 22 deadline to pass a bill so the marketplace can start operating in October as required. The federal government will set up an exchange if the state does not.
"We've got a lot of unique tools in Minnesota, and a federal one-size-fits-all exchange would not be able to leverage all of those assets we've worked so hard collectively to build together," Lourey said of the push to set up a state exchange.
The state bill would create a mostly online marketplace where Minnesotans could compare and buy health insurance. It would establish a seven-member board to manage the program, which some Republicans have said is an issue.
The board can establish criteria insurance companies have to meet to be included in the marketplace after 2014. Those that are federally qualified automatically will be included in the first year.
"While it will take a year to implement, the state will eventually be able to negotiate with insurers for the best plans, those that are higher quality and more affordable," said Jamie Gulley, president of SEIU Healthcare Minnesota.
Rep. Jim Abeler, R-Anoka, said insurance carriers need a more predictable system.
"They don't have $5 million to take a shot in the dark and not get picked," he said.
Abeler, the only Republican on the joint panel that hashed out the final bill, said he had been willing to support some form of a health insurance marketplace but was not satisfied with this final result.
The state will fund the program, expected to cost roughly $60 million per year, by withholding 1.5 percent of insurance premiums in the first year and 3.5 percent after that.
The exchange also can take a loan from state funds if it needs more cash.
The Senate's original proposal would have funded the marketplace with money from the tobacco tax in Minnesota.
Financing was a major piece of discussion, Lourey said, but in the end he said he believes the system is fair.
"I think we have a bill that can work for industry and for people," Lourey said.
More than a million Minnesotans are expected to buy health insurance through the marketplace, including thousands who are uninsured. People who do not have Internet access could call or visit in-person sites to purchase health insurance.
Republican representatives said if some provisions in the original bill had remained in the final version, including banning funding for abortions in the marketplace plans, the bill might have garnered more support,
Republicans also raised privacy concerns about the data provided to the marketplace.
"It increases the size, the scope and the power of government," said Rep. Mary Franson, R-Alexandria. "This is going to decimate the health care that we know and love in this great state."
"The Democrats' insurance exchange was bad last week and it's worse today," House Minority Leader Kurt Daudt, R-Crown, said. Daudt said the exchange will cost Minnesotans more, harm small businesses and middle-class Minnesotans and limit choices in health insurance coverage. "It's the wrong move at the wrong time."
The bill started with more bipartisan support but now mainly is backed by Democrats.
Senate Minority Leader David Hann, R-Eden Prairie, called the exchange "extreme."
"It's not going to get any support outside the DFL caucus," he said.
Lourey said he understands why Republicans might not want to back the bill.
"At the end of the day it's pretty hard (for them) to embrace the cornerstone of the Affordable Care Act," he said.