Minnesota is in a sensible place to carefully and expertly consider the future of MNsure and other health reform opportunities that become available under the Affordable Care Act (ACA) beginning in 2017. That shouldn’t change because some state Republican lawmakers have issued another hasty call to jettison MNsure in the wake of last month’s U.S. Supreme Court ruling upholding a key part of the federal health reform law.
Thanks to Gov. Mark Dayton’s urging during the last legislative session, a soon-to-be-appointed task force representing Minnesota consumers, businesses, medical providers, insurers and a bipartisan array of policymakers is set to begin thoughtful deliberations about the state’s next health reform moves. As part of that, the task force will weigh whether to scrap MNsure and move to the federally run healthcare.gov online insurance marketplace.
This deliberate approach will serve the state well. Changes potentially impacting medical care, costs and coverage for thousands of Minnesotans should be considered cautiously and from a wide-ranging perspective. What’s best for the state’s health care system should be the top priority. That’s why the approach outlined elsewhere in Opinion Exchange by Rep. Greg Davids, R-Preston, one of a number of state GOP lawmakers calling to scrap MNsure, is premature.
Davids’ argument begins on the premise that the state built MNsure mainly to avoid the kind of uncertainties that came to a head in a much-discussed case recently decided by the Supreme Court. Last month, in King vs. Burwell, the high court ruled that subsidies to help working families pay monthly health insurance premiums are available through both state and federal marketplaces. The losing plaintiffs had contended that this aid could only flow to those buying coverage through state-run sites like MNsure.
But the push here to build MNsure came soon after the ACA’s 2010 passage, when many of the state’s leading medical providers, insurers and members of the business community pushed to build a “made in Minnesota” marketplace. The reason: doing so offered a chance to tailor it to unique-to-the-state programs such as MinnesotaCare (which provides affordable coverage to working families) and to use federal dollars to overhaul Minnesota’s badly antiquated human services computer system, which determines eligibility for Medical Assistance.
Obviously, MNsure’s rollout has fallen well short of expectations. But many of the problems at MNsure, such as the inability to smoothly process coverage changes, also remain struggles for the healthcare.gov site. Where is the evidence that moving to healthcare.gov would be an improvement?
The state would also still have to update the human services computer system. Moving to healthcare.gov would not magically solve this long-festering problem, nor the eligibility and billing issues it creates. Switching would instead potentially scrap the work and progress MNsure has slowly made on this, and stick the state with the full bill, a reality that must be factored into any claims of cost savings.
The lack of high-profile public support for the GOP plan from the state’s leading medical providers, insurers and the business community is telling. Minnesota’s task force is the cautious, conscientious way to take up MNsure’s future and other health care reform opportunities. The state should stay the course and give the group time to do its work.