Is MNsure on life support after election?
One of the biggest questions raised by the election results this week is what it all means for the unpopular MNsure state health insurance exchange. Minnesota was among a handful of states that chose to develop and operate its own health insurance exchange following passage of the Affordable Care Act.
But all of a sudden, the survival of both the ACA and MNsure may be on the line due to new political realities, according to the Star Tribune’s prognosis.
Republican control in Washington plus increased GOP power in St. Paul clouds the future for Minnesota’s MNsure health insurance exchange.
Republicans in the U.S. House have long called for repealing and replacing the federal Affordable Care Act, which gave rise to MNsure in 2013, and President-elect Donald Trump backs the idea, too.
DFL Gov. Mark Dayton has resisted Republican calls to dump MNsure, but the clamor likely will get louder with the GOP taking control of the state Senate while maintaining its majority in the House.
“We need to abandon the state exchange, because it’s been very costly and very inefficient,” said Rep. Greg Davids, R-Preston, who co-chairs a legislative oversight committee on MNsure.
About $460 million has been spent on developing MNsure’s eligibility and enrollment system. But persistent technical problems led counties to add 250 employees this year at an estimated cost of $27 million to Minnesota property taxpayers.
There’s still the possibility that a special legislative session could be called to address steep double-digit premium increases that confront thousands of Minnesotans next year.
Dayton has proposed that lawmakers meet in a special session to provide rebates to those in the individual market who don’t qualify for federal tax credits. Republicans support the idea of helping individual market consumers, said Rep. Matt Dean, R-Dellwood. He added that lawmakers in a special session also could begin addressing a broader fix for the individual market.
Dayton said Wednesday he doesn’t want any such session to bog down over the future of MNsure and the health law. “The question is: What are the Republicans in Washington going to do?” Dayton asked. “That will dictate the parameters of what we can or can’t do here in Minnesota.”
If Obamacare survives, it may be significantly revamped to allow states like Minnesota to have more flexibility.
Republicans likely will provide more flexibility to states, which could let Minnesota re-create in some form a high-risk pool program that seemed to do a better job of spreading costs, said Stephen Parente, a University of Minnesota researcher who studies health insurance markets and has worked with Republicans on health policy proposals.
Continuing MNsure could also fit with a plan to give states more autonomy, Parente said, but it’s unclear how wedded state lawmakers are to continuing the exchange.
The financial woes facing many Minnesotans became a national talking point that may resonate in Washington well after the campaign.
In Minnesota on Sunday, Trump pledged to repeal and replace the Affordable Care Act, and cited skyrocketing rates in Minnesota as evidence of how the law is a “disaster.” Trump also referenced Dayton’s comments last month that, for many people, insurance under the Affordable Care Act has become unaffordable.
Dayton said Wednesday that he “spoke the truth” when making the comment, noting that a federal report a few days later found premium increases of about 25 percent across the country. As in Minnesota, the spikes apply to the individual market, but not to employer plans and government programs like Medicare that cover the vast majority of Americans.
“I may have provided the point of the spear,” Dayton said, “but the spear was handed to them by the rising insurance prices that have afflicted so many Minnesotans and other Americans.”