Republican control in Washington plus increased GOP power in St. Paul clouds the future for Minnesota’s MNsure health insurance exchange.
Republicans in the U.S. House have long called for repealing and replacing the federal Affordable Care Act, which gave rise to MNsure in 2013, and President-elect Donald Trump backs the idea, too.
DFL Gov. Mark Dayton has resisted Republican calls to dump MNsure, but the clamor likely will get louder with the GOP taking control of the state Senate while maintaining its majority in the House.
“We need to abandon the state exchange, because it’s been very costly and very inefficient,” said Rep. Greg Davids, R-Preston, who co-chairs a legislative oversight committee on MNsure.
Minnesota launched MNsure to implement the Affordable Care Act, which requires almost all Americans to have health insurance or pay a tax penalty. The law called for the creation of state-level online marketplaces where people can buy coverage, and obtain federal tax credits to lower their premium costs.
Minnesota is in the minority of states running their own marketplaces instead of using the federal government’s HealthCare.gov exchange. MNsure is an option for the roughly 250,000 Minnesotans who buy health insurance on their own.
The average premium for these individual health insurance policies is spiking next year by an average of 50 percent or more — an issue that Republicans say helped drive their success Tuesday at the polls. “The election was about what happened with the rates, but also the reaction from the left about what to do about it — they mostly tried to ignore it,” said Sen. Jim Abeler, R-Anoka.
Dayton has proposed that lawmakers meet in a special session to provide rebates to those in the individual market who don’t qualify for federal tax credits. Republicans support the idea of helping individual market consumers, said Rep. Matt Dean, R-Dellwood. He added that lawmakers in a special session also could begin addressing a broader fix for the individual market.
Dayton said Wednesday he doesn’t want any such session to bog down over the future of MNsure and the health law. “The question is: What are the Republicans in Washington going to do?” Dayton asked. “That will dictate the parameters of what we can or can’t do here in Minnesota.”
Republicans likely will provide more flexibility to states, which could let Minnesota re-create in some form a high-risk pool program that seemed to do a better job of spreading costs, said Stephen Parente, a University of Minnesota researcher who studies health insurance markets and has worked with Republicans on health policy proposals.
Continuing MNsure could also fit with a plan to give states more autonomy, Parente said, but it’s unclear how wedded state lawmakers are to continuing the exchange.
Abeler says he prefers the idea of a state exchange over a federal website. But he wants to see what new options might be available to the state going forward.
Dean argues that MNsure is hurting Minnesotans with poor website functions that make it difficult for people to sign up for coverage. But Allison O’Toole, the MNsure chief executive, defended the health exchange’s performance during the current open enrollment period, which started this month.
“In eight days we have more than 20,000 people already enrolled — that’s a record,” O’Toole said, adding, “We have the highest rate of insurance coverage in the state’s history.”
MNsure was hit with website problems and long call-center waits when it launched in 2013. Problems returned Nov. 1 of this year, but state officials say they were quickly resolved and confined to one day. Dayton has alleged that “robocallers” flooded the MNsure call center that day in order to clog up the system.
In Minnesota on Sunday, Trump pledged to repeal and replace the Affordable Care Act, and cited skyrocketing rates in Minnesota as evidence of how the law is a “disaster.” Trump also referenced Dayton’s comments last month that, for many people, insurance under the Affordable Care Act has become unaffordable.
Dayton said Wednesday that he “spoke the truth” when making the comment, noting that a federal report a few days later found premium increases of about 25 percent across the country. As in Minnesota, the spikes apply to the individual market, but not to employer plans and government programs like Medicare that cover the vast majority of Americans.
“I may have provided the point of the spear,” Dayton said, “but the spear was handed to them by the rising insurance prices that have afflicted so many Minnesotans and other Americans.”
Reporter Jeffrey Meitrodt contributed to this report.