With President Obama's victory in hand, it's full steam ahead on implementing the federal health care law.
States face a Friday deadline to say whether they'll build their own heath insurance exchanges in 2014, or else live with a version being designed by the federal government. In a month, they'll need detailed blueprints that show they'll be ready to flip the switch.
Meanwhile, businesses that were sitting on the sidelines now must figure out how to help their workers get insurance.
"The story of this election is that there is nothing anymore that justifies waiting," said Kate Johansen, a lobbyist with the Minnesota Chamber of Commerce.
The work ahead for states is daunting, even for Minnesota, which is ahead of many other states in laying the groundwork for a homegrown exchange. This will be a new online marketplace, required by the Affordable Care Act, to help consumers and small businesses shop for coverage.
A new DFL-led state Legislature portends a less contentious path to creating exchanges and expanding Medicaid benefits to more low-income Minnesotans.
But when lawmakers convene on Jan. 8, they will have just a few months to get up to speed on the most significant regulatory overhaul of the health care system in four decades.
"We should have been having these discussions starting on March 24, 2010 [the day after the health care law passed]," Johansen said. "The issues are complex. We have a huge freshman class, and health care is a difficult issue. That's a lot of work to do in a very short amount of time."
Outside of the Legislature, a paucity of details in the run-up to the presidential election and the hurried nature of the law's passage in 2010 have left hospitals, doctors, insurers and business leaders hungry for answers about how the 906-page law will affect them.
"We're trying to figure it all out," said John Puckett, co-owner of Punch Pizza. With 150 workers and seven Twin Cities locations, Puckett needs to pick a path for his employees' health care coverage in the next year.
He's foggy about what medical costs his plan will need to cover, and what penalties the company might face even if it offers the right kind of policy and some of his workers can get a better deal on the state-run exchange.
"If you're General Mills, there are a lot of options," Puckett said. "But for a small- to medium-sized business, it's really unclear. We'll have to get a lot more education."
Questions for insurers
Minnesota's health care insurers say they're strained by the unknowns as well. With the election over, they need the feds to clarify the law's requirements in short order, so they can design health plan choices and set rates.
Insurers that intend to sell their health plans on the exchanges must file their rates for review by the Minnesota Commerce Department by May 17.
"It feels more like a sprint than a marathon," said Julie Brunner, executive director of the Minnesota Council of Health Plans, which represents most of the state's private insurers. "There's huge pressure building within the plans to get on with this work."
Gov. Mark Dayton failed to get an exchange bill passed by the GOP-controlled Legislature, but he still reeled in more than $70 million in federal grants to build a staff and hire contractors to build the high-tech backbone.
Authorization in March
Legislators will need to have a bill in place in March to authorize an exchange so the system will be ready to enroll people in health plans in October. Divisive issues such as how it will be run and financed will have to be worked out, in addition to complex IT matters. The system will need to safeguard sensitive consumer data, as it will verify such information as income, criminal history and legal status.
While the election "ushered in a new reality," discussions already are underway with legislators to get the ball rolling on a bill, said Commissioner Jim Schowalter of Minnesota Management and Budget, whose office will oversee construction of the exchange.
"We have a lot of work to do here," he said. "This is a really big project and it's also going to be under very tight timelines."
Ken Wilmes, owner of Industrial Fabrication Services in Lake Crystal, Minn., is no fan of the law and sees nothing but trouble ahead. The company pays 100 percent of insurance for all 65 full-time workers at its plant west of Mankato.
"Premiums have been going up for years," he said. "It's only going to get more expensive because it'll force us to cover more items that we don't have to cover now ... like contraception coverage. It's just a huge overreach by the federal government."
Jackie Crosby • 612-673-7335