The Supreme Court’s historic ruling on Affordable Care Act subsidies last week lent some momentum to Minnesota Republican legislators’ calls to scrap MNsure and move to healthcare.gov, the federal government’s health insurance marketplace.
While that strategy should be on the table as a state task force weighs Minnesota’s next health reform moves, calls to make that switch happen swiftly are premature. Consumers have already gone through massive changes under ACA reforms. Moving too quickly to require them to buy through the federal marketplace would create more upheaval.
Delegating control over the marketplace to the federal government could also potentially handcuff Minnesota’s ability to innovate as new opportunities to do so become available in 2017 under the ACA.
Despite bipartisan calls to reform MNsure in the past session, Minnesota stayed the course. Part of the reason was uncertainty over the King vs. Burwell decision. Until the Supreme Court ruled on the case last week, it was unclear whether the law’s subsidies to help consumers buy coverage would be available only through state-run marketplaces such as MNsure. In a 6-3 decision, the justices ruled that this aid is available to consumers who buy through healthcare.gov, too.
But the looming ruling was just one reason lawmakers maintained the MNsure status quo. DFLers wanted to jettison MNsure’s independent board and make it a state agency. After years of working to stall or undermine the ACA, Republicans pushed, among other things, to scrap MNsure altogether and move to healthcare.gov.
Neither measure gained traction because both parties failed to make a compelling argument. More tellingly, neither proposal drew strong public support from the state’s world-class health care industry.
Thanks to Gov. Mark Dayton, the state is in a laudable place to consider its next moves on health reform. Dayton pushed for a task force to weigh MNsure’s future and state opportunities under the ACA’s innovation waivers. These waivers allow states wide latitude to redo the ACA and use federal funding to do so.
At this point, there are serious questions about moving to healthcare.gov. Would the state give up the chance to innovate through the waiver? Many experts believe that having a state-run marketplace such as MNsure is critical for customized reforms. The move also could leave state taxpayers paying to finish modernizing the Department of Human Services’ antiquated computer system. This monumental task is being done as part of MNsure’s technology platform; federal dollars are helping to pay for it.
The reasons for building MNsure are still in place: local control and the ability to tailor the ACA to Minnesota. The task force that will weigh its future — to be named later this summer — also should look closely at the benefits of making the switch, such as potential cost savings.
Task force members should be given the time to be thorough. What’s needed now are careful policy recommendations, not snap decisions.