The state legislature is recessed for their spring break and will return to the capitol Tuesday April 7. One of the key issues they will be debating in the session's final six weeks is the future of MNsure, the state's health insurance exchange. Nearly everyone agrees that the exchange's creation and its first two years of enrollments have been flawed. However there is no clear consensus on what to do to fix MNsure's problems. The Governor, the Senate and the House all have differing ideas on how to proceed. As one would expect, the House Republicans have proposed the most sweeping legislation. Here is a brief summary of the various MNsure proposals that are advancing in the state legislature.
Senate:
Senate File 139. Dept. of MNsure. This is the DFL Senate's only major proposal. It would repeal the MNsure board, make MNsure a state agency, and the MNsure CEO a commissioner serving at the pleasure of the governor. This proposal would require all MNsure funding to be appropriated by the state legislature like any other state agency. This avoids the concern and financial problems due to lower than projected enrollments in MNsure qualified health plans. The bill also would authorize agents and brokers assisting enrollment of Medicaid recipients to be paid $70 per enrollment, the same rate as navigators.
House:
House File 1664. Federal Exchange. This is the proposal for the complete repeal of MNsure and would make the state a member of the federal exchange effective January 1, 2017. It sets up a contingency to waive this directive if US Supreme Court rules against federal subsidies in June shortly after the legislative session adjourns.
House File 1665. MinnesotaCare II. The bill would remove MinnesotaCare as a Basic Health Plan under the ACA. MinnesotaCare would no longer be a government program and would offer private insurance to this population through the health insurance exchange. Persons would qualify for the federal subsidies and cost sharing offered through health insurance exchanges. Proposes yet disclosed state subsidies to provide a 94% actuarial equivalent coverage for plan enrollees. This could occur even if the state goes to federal exchange with federal approval.
House File 5. MNCare reform. This is the House's MNsure proposal that was introduced on the first day of the session. It is the most modest of the House MNsure fixes. It increases the number of MNsure board members from 7 to 11 and includes an insurance producer. The major feature of this reform bill would allow for qualified lower income persons and small employers to purchase a qualified health plan outside the insurance exchange and receive federal subsidies (requires a waiver from the federal government). Many believe that MNsure would not be able to compete directly with the private market, thus there is considerable opposition from Democrats to this proposal.
Governor Dayton:
MNSure Viability Task Force. The governor has proposed the creation of a blue ribbon task force to review MNsure and make recommendations on its future. The governor included in his recommendation the possibility that going to the federal exchange would be an item of discussion. This is somewhat significant since it's the first time the governor has said federal exchange in the same sentence with MNsure. Many at the capitol feel that this is an attempt to avoid any changes in MNsure this legislative session while awaiting the task force report. MNsure supporters believe that another year will prove MNsure's success. MNsure opponents view the task force as a stall tactic.
