The Affordable Care Act has been in the Republican Party’s cross hairs since its 2010 birth. This week’s election means that the party now has the political trifecta it needs to dismantle the law: Donald Trump will be in the White House, and the GOP controls the U.S. House and Senate.
That repealing some or all of the health-reform law is likely atop President-elect Trump’s agenda does not excuse Minnesota lawmakers from providing relief to consumers facing steep price hikes on the individual health insurance market for 2017. Gov. Mark Dayton has proposed a reasonable though costly $313 million plan to substantially discount premiums. The lack of progress in setting a date for a special legislative session to enact this is reprehensible. Minnesotans need to know now if help is coming for premiums due for Jan. 1 coverage.
The state aid issue must be settled swiftly, but sweeping postelection uncertainties mean a far more deliberative approach is critical in enacting other state-level changes. This week, the Minnesota Medical Association, the Minnesota Hospital Association and the Minnesota Council of Health Plans also urged a go-slow approach to react to what Congress and the new president will do.
Several reforms that have been prominently touted by Minnesota Republicans, who will likely control both state legislative chambers, don’t address postelection concerns. There may not be a federal healthcare.gov marketplace to send Minnesotans to if MNsure is shut down. The same problem holds true with a proposal to allow Minnesotans to access federal subsidies outside MNsure. There may not be any more federal subsidies for consumers — a regrettable reversal that would increase the uninsured rate.
Resurrecting Minnesota’s former publicly-run high-risk insurance pool, which served high-cost patients denied insurance coverage, may not be so simple, either. Trump told the Wall Street Journal on Friday that he is open to keeping ACA protections for those with pre-existing conditions. But if insurers still can’t deny coverage, who would go into the high-risk pool? And how would this pool, or a similar but more workable “reinsurance” strategy, be paid for?
That brings up the biggest question of all: the level of future federal funding for Minnesota’s public-health programs. These are substantial sums. Minnesota received $6.35 billion in fiscal 2016 for its medical assistance program. Another $335 million helped pay for MinnesotaCare. It’s premature to act until state lawmakers know how much they can afford to do.
Trump’s broad call to roll back regulations could mean that states will take the lead in coverage and controlling costs. This could be a positive development in a dismal health-reform landscape. Providing quality, affordable care has long been a widely shared goal in Minnesota, which has a laudable history of public-private teamwork. It’s now needed more than ever.
Lawmakers who campaigned on how much the ACA hurt consumers have a special responsibility to ensure that the law’s rollback would not put coverage even further out of reach.