It's not nice to mess with the Mother of MinnesotaCare

For veterans of Minnesota health policy wars, the House Health and Human Services Reform Committee provided a memorable moment on March 16. I regret that I wasn't there. Fortunately, the crackerjack House audio recording system and a few spies were.

On the docket were bills to repeal both MNsure, Minnesota's much-maligned Obamacare insurance purchasing exchange, and the older, more beloved MinnesotaCare. At some point during the proceedings, the bills' sponsor, Republican Rep. Matt Dean of Dellwood, became aware of the presence of a newly registered lobbyist in the listening audience — one Linda Berglin.

That would be former state Sen. Linda Berglin, the DFLer and feminist pioneer who represented south Minneapolis for more than 38 years. For at least 20 those years, she was this state's most significant shaper of health policy and a nationally recognized leader in the field. She was a chief designer of MinnesotaCare in 1992.

Berglin now deploys her health policy chops at Hennepin County, where she is among the godparents of Hennepin Health, a pioneering effort to combine health care for the poor with other social services to both improve results and reduce costs. That work brought her to the basement hearing room of the State Office Building on a March Monday night.

Berglin says she wouldn't have come just to watch Dean push for her progeny's repeal. "I wouldn't have wasted my time," she told me last week. But neither could she bring herself to leave the hearing. Her presence reportedly caused a mild stir as Capitol newbies were quietly informed that the Mother of Minnesota­Care was present — and didn't look happy.

Dean must have felt Berglin's gaze as the committee cast an 11-10 vote in favor of MinnesotaCare's repeal. One Republican, Rep. Dave Baker of Willmar, joined all the DFLers in voting no.

Then Dean did the gracious thing: "Before we leave this, I just want to acknowledge the great work that MinnesotaCare has done for Minnesotans," he said. "Also, we have former Sen. Berglin, who is here, who probably did more to design that and to make sure that care was available for Minnesotans for many, many, many years. I want to acknowledge her, acknowledge her work within that, and also her willingness to work with anyone as we move forward."

That last line may have been Dean's hopeful note. He said he approached her a few moments later and asked in jest what her fee might be as a consultant to design a successor health insurance scheme for the 100,000 low-income Minnesotans now insured by MinnesotaCare.

Then his tone turned serious. Would she help him? he asked. He told me that she paused, gave him a long look and said slowly, "I could."

If Dean is as serious as he professes to be about making health insurance affordably available to all Minnesotans, he'll make that entreaty again at a more opportune, less visible moment — and pray that Berglin says yes. When it comes to figuring out how to do right by both low-income Minnesotans and taxpayers, nobody has a better track record.

Likewise, if Dean is serious — and I believe he is — he'll drop the notion of using the repeal of MNsure and MinnesotaCare as a budget-balancing tactic this year. The replacement of MinnesotaCare as we've known it for 23 years may be in order at some point a few years hence. But rush that point in order to book savings in the 2016-17 human services budget, and a lot of low-income people could get hurt.

This is a job for a tried-and-true approach — a between-sessions, bipartisan health care reform commission. Every major state health care move since MinnesotaCare in 1992 originated in such a panel. A seat at those tables was always reserved for Linda Berglin.

Why consider change when MinnesotaCare has provided mostly decent, affordable insurance coverage for more than 100,000 people a year for so long?

Dean's answers: At a state cost projected to approach $500 million per year by 2020, it's expensive; its funding source, a 2 percent tax on health care services (sometimes called the provider or "sick" tax) is set to expire in 2019; federal help for MinnesotaCare ($242 million in 2014) has been more meager than expected, and the MinnesotaCare population will have more insurance choices if it is turned loose on either MNsure or its successor exchange (Dean would plainly prefer the latter).

Berglin would take issue with some of those points. But her big concern isn't for the survival of her policy baby. It's for the fate of the MinnesotaCare population. None of those people have access to employer-subsidized health insurance. All of them are people whose incomes are between 133 percent and 200 percent of the federal poverty level.

For a single adult this year, that's between $15,654 and $23,540. Make less than that, and you qualify for Medicaid. Make more, and you're already buying insurance via MNsure and receiving a federal tax subsidy based on your income to help cover the costs.

Dean's notion is that the MinnesotaCare population could migrate to the exchange, too. They likely would not find insurance as affordable or as comprehensive as MinnesotaCare. But Dean is also willing to sweeten the federal subsidy with state dollars. He doesn't yet know how sweet.

The problem Berglin sees is that people with incomes that low often don't have steady jobs. Their income is unpredictable. Insurance that's deemed affordable for them via MNsure at enrollment time might be unaffordable three or six months later. If their insurance lapses and they become ill, they'll wind up in the emergency room, in debt and on Medicaid — and providers will be stuck with uncompensated care costs.

Those are the very ills that MinnesotaCare was created to prevent. It offers health insurance consistency at any time of year at an affordable price. For single adults making $17,500 this year, MinnesotaCare's premium is $29 per month.

Take away that option, and the uninsured rate that has so nicely dropped since MNsure began would climb again, she fears.

Ten years ago, when a GOP governor and House majority set out to whack MinnesotaCare to balance the state budget, its preservation was so important to the DFL-controlled Senate that senators defended it through a government shutdown.

Minnesotans should know soon whether this year's House majority wants to run that play again. Republicans may think that with the Affordable Care Act the law of the land and Berglin out of the Senate, it will produce a different result. But as Dean saw for himself on March 16, Berglin hasn't completely left the field.

Lori Sturdevant is a Star Tribune editorial writer and columnist. She is at lsturdevant@startribune.com.