Senate DFLers have introduced a bill that would eliminate the MNsure board, and create a new state department to manage Minnesota's health insurance exchange.
Coupled with MNsure legislation last week from leaders of the new Republican majority in the House, the bill from top Senate Democrats helps establish the terms of debate over reforming the health exchange during this year's legislative session.
Sen. Tony Lourey, DFL-Kerrick, said the bill was driven by frustration among legislators and the public about who to hold accountable for problems at MNsure, which the state launched to implement the federal Affordable Care Act.
Under the bill, the governor would have a clearer line of authority over the exchange, Lourey said, while the Legislature would have more direct oversight for MNsure's budget. The legislation is not an indictment of the current seven-member board, he said.
"I think we got the governance structure wrong," Lourey said Wednesday in an interview. "It was too much to ask of a board. This is a very core public function."
Gov. Mark Dayton told reporters Wednesday that he hadn't reviewed the proposal, but called it "a big shift."
"We'll just have to see," Dayton said. "There are a lot of proposals coming in about MNsure, and as long as they're with constructive intent of improving its operations, I think it's all fair game for being considered."
Republicans said they viewed the legislation as a positive step, because DFLers are acknowledging problems at the health exchange. But they questioned particulars in the bill.
Rep. Tara Mack, R-Apple Valley, said her party would continue pushing House legislation that would let consumers get federal tax credits for health insurance even if they bypass MNsure. By eliminating the board of directors plus a legislative oversight committee, Lourey's bill would eliminate "the only avenues the public had to air grievances, raise concerns and make sure that MNsure is accountable," said Mack, who is chairwoman of the health and human services reform committee in the House.
Sen. Michelle Benson, R-Ham Lake, questioned whether the bill would simply create "more government," but added: "It's an acknowledgment by Democrats that we need to make changes, and that's a huge step."
Lourey's bill would make MNsure a state department alongside other departments like those for agriculture, health, human services and transportation. The MNsure commissioner would be subject to a salary cap that currently does not apply to the MNsure chief executive.
MNsure would not be restructured under the bill, Lourey said. The same people doing the work of the exchange today would continue to do so, he said, adding: "I think there's a lot that's right."
In a statement issued Wednesday evening, Senate DFLers credited MNsure with helping to significantly reduce the number of Minnesotans who lack health insurance. People can use MNsure to buy private coverage, or enroll in the state's public health insurance programs.
But DFLers added in the statement: "Technical glitches made the important process of accessing coverage frustrating for many and the public-private governance of MNsure did not provide enough transparency for the public, legislature or industry."
In the prepared statement, Lourey said: "One of the most frequent concerns regarding MNsure, and it is a concern I share, is making sure that the exchange is fully accessible and fully accountable to those it serves. This includes making sure that all the actions and decisions are in a cost effective, efficient and transparent way."