One can learn a lot in a quick chat with Linda Berglin. I found it so when she was a state senator crafting health care policy through several decades. It's still true now that she's Hennepin County's health policy manager.
A recent encounter with Berglin made me aware that the presidential race isn't the only one in which the future of the Affordable Care Act -- "Obamacare" -- is at stake. How the new law will serve low-income Minnesotans is also on the line on Nov. 6 in races for the state Legislature.
Berglin explained that the new federal health care law will allow the Legislature to extend the benefits of health insurance via the Medicaid program to more low-income people beginning in 2014. Currently, thanks to the actions of the 2010 Legislature and Gov. Mark Dayton in January 2011, childless Minnesota adults with annual incomes less than $8,377 are eligible for Medicaid. Obamacare allows Minnesota in 2014 to also enroll people with incomes ranging up to $15,414 for individuals and $26,344 for a family of three.
But Berglin's GOP successor as Senate health finance chair, David Hann of Eden Prairie, was a vigorous opponent of the Medicaid enrollment Dayton accomplished. If Hann and his fellow Republicans are back in charge in 2013, she said, she fears that those newly eligible for Medicaid won't get the Legislature's green light to enroll.
That could leave those people with few options, especially since the future of the insurance program that serves many of them now, the state-financed MinnesotaCare, is in doubt, Berglin said. People with slightly higher incomes will be eligible for federal subsidies for the purchase of insurance via the new online exchange. But the Affordable Care Act intends that all those whose incomes fall below 133 percent of the poverty line be served by Medicaid.
At least initially, the full cost for those new Medicaid enrollees is to be borne by the federal government. That promises the state's general fund a $1 billion savings through 2019, she said. But some legislators -- and not just Republicans -- question whether that's a promise the financially strapped federal government can keep. Medicaid is historically funded 50-50 by the state and federal governments.
Berglin said she's got one more worry: If the 2013 Legislature fails to OK an expansion of Medicaid, its continued availability to the very poor single adults Dayton covered could also be at risk. That's because it's not clear that the federal government after 2014 will allow states to enroll some low-income adults in Medicaid but not others, she said.
Medicaid has its flaws, to be sure. But it beats the human suffering and high costs associated with going uninsured. Minnesota has long been a leader among the states in extending health insurance to the poor. It would be a shame to go the other way.