There almost certainly will be a Minnesota-made and Minnesota-run version of the health exchange called for in the 2010 Affordable Care Act, thanks to legislation passed last week to create a homegrown online insurance marketplace.
The question now — after a bitter three-year political battle over whether to leave this key health reform to federal officials — is whether there’s enough buy-in from state consumers and key industry stakeholders to make this promising new marketplace work.
That’s why the exchange governance decisions that now quickly fall to Gov. Mark Dayton are so critical to its future success. Appointing a board of directors comprised of civic-minded pragmatists — whose members are widely respected for their expertise and are committed above all to making this marketplace work — will steer the exchange back toward the middle ground sorely missing in the long debate over it. That’s key to building the confidence needed to get the public and businesses to rely on it.
While lawmakers are smoothing out key differences between the exchange bills passed in the Minnesota House and Senate, both versions authorize Dayton to make important personnel decisions. He will appoint six of the seven members of the exchange’s board of directors — subject to legislative confirmation — and is required to do so by April 30.
The board is required hold its first meeting within 60 days of enactment. The seventh member, the state’s human-services commissioner or a designee, is also in effect a gubernatorial appointee to the board, since this state official serves at the discretion of the governor.
The board appointments could be some of the most critical decisions Dayton makes during his time in office. The exchange is one of the cornerstones of the federal health reform law. As many as 1.3 million Minnesotans — about one in five state residents — will use the marketplace to determine eligibility for new federal tax credits for individuals or small businesses to buy health insurance. The exchange also will help eligible people enroll in medical assistance programs.
To say the board will have its hands full during early operations this fall is an understatement. Massive amounts of data moving in and out of the exchange present monumental information technology challenges. There will be a steep learning curve as consumers, businesses, health insurers and medical providers acclimate to the new website and as bugs are worked out. The exchange needs the state’s best thinkers to guide it and reassure stakeholders through this make-or-break period.
Dayton’s office said this week the search for board members will begin after the bill is signed. As this process begins, this page hopes that the governor is guided by the “Team of Rivals” concept made famous by a Lincoln biography.
The state will not be well-served by a board of like-minded individuals. Appointees should have expert knowledge in key areas (information technology and health economics, for example) but also represent a diversity of thinking on what’s best for health care. Vigorous debate on the board is critical to ensuring that policies are thoroughly vetted and that the best decisions are made.
At the same time, board members must work well together and find ways to compromise.
Minnesota’s reputation as a national health care leader rides on how well this exchange works. State lawmakers made the right call on building a state-run version. But a political process that left this important issue untouched for two years, then passed sweeping legislation to enact it in half a session, has undermined the public’s and the business community’s confidence in the exchange. By making well-rounded choices on board appointees, Dayton can make significant strides to rebuild that trust.