Teamwork still will be needed to build a Minnesota health exchange, even though the DFL now has the legislative votes and the governor's signature to unilaterally make the new online health insurance shopping site a reality.
The health exchange is a critical component of the 2010 Affordable Care Act (ACA), not only because it will harness competition to help individuals buy coverage but because it's also the mechanism by which consumers will determine their eligibility for subsidies to help buy insurance. Those subsidies represent one of the many ways the ACA will give working families a helping hand.
With more than a million Minnesotans expected to use the exchange beginning in 2014, it was a no-brainer to capitalize on the state's health expertise and build a custom-made version instead of letting the federal government impose one. But a Minnesota-made exchange, despite this concept's roots as a conservative health reform, has long been mired in an unproductive politics.
The state's Republican legislative majority saw opposition to the exchange as a way to thwart "Obamacare" and failed to pass enabling legislation or take advantage of opportunities to work with the Dayton administration on the project. State officials made remarkable progress building the exchange, but fell short on creating buy-in from those who will use the exchange first: small businesses and those who buy individual plans.
The newly elected DFL legislative majority will smooth the exchange's path toward reality. Voters decisively answered the festering question about whether the state should have an exchange that complies with the health reform law. That debate is over. Enabling legislation will almost certainly be passed during the upcoming session, avoiding a likely legal challenge over the governor's ability to get it started without lawmakers' imprimatur. Now the discussion can focus on building an exchange that best serves Minnesota.
The state is submitting a general exchange blueprint for federal review in mid-November, but major decisions about process and policies still loom. The new DFL leadership can create the sorely needed buy-in by inviting the business community and Republicans back to the table. The main mission for Minnesota's exchange: getting consumers to use it. Gathering good ideas and forging a consensus among stakeholders will create the foundation to make that happen.