“Skin in the game” and “price transparency” are phrases often heard in the health care debate. They refer to reforms already in broad use to encourage consumers to comparison-shop and get better value on care, such as high-deductible health plans and publishing medical procedure prices.
But the time-consuming research increasingly demanded of consumers should also be expected from Minnesota lawmakers when it comes to health care policy, especially when these decisions involve spending millions of taxpayer dollars. The momentum building behind a critical bill to extend the state’s “reinsurance” program suggests that political leaders aren’t willing to do the hard work to ensure they’re getting the most bang for the public’s buck. Legislative leaders need to consider if there are better options to deliver consumer price relief.
Lawmakers originally passed reinsurance in 2017 to offset the cost of coverage for the slender slice of Minnesotans who buy health insurance on their own, meaning they don’t get it through employers or government programs such as Medicare. About 155,000 people, about 3 percent of the population, get coverage this way, buying on what is known as the state’s individual insurance market.
Rate hikes have long plagued this market and continued as the federal Affordable Care Act (ACA) was fully implemented mid-decade. Steep price increases projected for 2017 laudably spurred lawmakers into action. Two major reforms passed during the 2017 session to stabilize the market. The first directly discounted eligible consumers’ insurance premiums by 25 percent. The second was the reinsurance program, which went into effect into 2018. The two-year program reimburses insurers 80 percent of enrollees’ medical costs when bills fall between $50,000 and $250,000.
Reinsurance did help and debate over extending it three more years is merited. Rates declined significantly on average in 2018 and again in 2019. And, although lawmakers had set aside up to $271 million a year to cover costs, a Feb. 12 report projects the first year’s cost at $140 million, though the final figure won’t be available until later this spring. So far, federal aid also appears to have covered payouts for the program’s first-year costs.
But an important question still needs to be asked: Is there a better way to help consumers? While the rate decreases under reinsurance were welcome, they reflect an average. Not all consumers saw decreases. Nor did the rate declines ensure affordable coverage. Monthly premiums are still expensive on the individual market, and plans often have high deductibles — a dollar amount consumers must pay out of pocket before coverage kicks in. The ACA provides tax credits to those who are financially eligible. But those who make 400 percent or more of the federal poverty level aren’t eligible for the law’s assistance. For this group, coverage can still be out of reach or unusable even with reinsurance.
These consumers should be helped, but reinsurance isn’t the only option. For example, would the 25 percent discount program that Minnesota used in 2017 provide more relief? That program also came in well under cost expectations. State lawmakers appropriated $312 million, but reimbursements totaled $137.3 million. Another option: a state tax credit to help some or all of the consumers who make too much to qualify for the ACA’s tax credits. Or what about pooling the individual market and putting it out for a competitive bid among Minnesota insurers? Allowing consumers to buy into the state-run MinnesotaCare program is another option that also should be fully vetted as the reinsurance program’s future is weighed.
No questions were asked about these other options at a Feb. 12 Minnesota House Commerce committee hearing. Committee chair Rep. Laurie Halverson, DFL-Eagan, is the reinsurance bill’s chief author. By an editorial writer’s count, less than 10 minutes at that meeting was spent debating the bill before members forwarded it to the House Ways and Means Committee. During this time, a DFL legislator acknowledged not fully understanding reinsurance even after the committee previously had an informational briefing. Rep. Greg Davids, R-Preston, also spoke in favor of the bill, noting that U.S. Sen. Amy Klobuchar supports reinsurance. Klobuchar does, but she also cosponsors bills that would allow the public to buy into Medicaid or Medicare. By that logic, Davids should support a MinnesotaCare buy-in.
There’s still time to have a more informed debate about reinsurance and other options. At a minimum, House Speaker Melissa Hortman must ensure that the reinsurance bill is heard by a House committee with deep health care expertise. The same holds true in the GOP-controlled Senate.
When reinsurance was passed in 2017, it was supposed to be a temporary fix, a bridge to something better when its two years expired. Legislators unwilling to explore what that might be are taking the easy way out.