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Partisan vs. Particular: Building a Health Exchange That Works for Minnesota

February 08, 2012 By Sarah Greenfield, Guest Commentary

Recently an editorial ran in the Star Tribune calling on the GOP to start participating in Minnesota’s Health Exchange development, and calling on Governor Dayton not to move too far ahead without them. Calls for bi-partisanship, cooperation, and compromise are all the rage. And for some good reason—recently, gridlock has crippled our state legislature and US Congress.

Unfortunately it can be hard to decide what to compromise on, or not, when it comes to a Health Exchange because most of us don’t know enough about what a Health Exchange is, and why it matters. So let’s step back for just a minute.

The Patient Protection and Affordable Care Act (ACA , also referred to as “Obamacare”) was signed into law March 23rd, 2010. A lot of things didn’t make it into the law—anyone remember the public option?—but a lot of things did. A simple way to think about the ACA is as an interwoven set of changes to our current health insurance system:

  • We won big-time insurance reforms, like no more pre-existing condition denials or life-time limits.
  • More or less in exchange for reforms, the bill passed an individual mandate, requiring (almost) everyone to have health insurance.
  • Because the bill requires everyone to have insurance, we had to make insurance more affordable, through subsidies for private insurance and a huge expansion of Medicaid.
  • To help people access private insurance, public programs, and all these new benefits, we required states to set up Health Benefits Exchanges - websites where individuals and small businesses can compare apples to apples and easily enroll in quality, affordable health insurance plans.

In Minnesota, over a million people are expected to enroll through our Exchange, including 300,000 who currently don’t have insurance. According to an independent actuarial analysis, Minnesota families can expect to save $500 to $700 a year on insurance through the Exchange. So what’s the big deal? Exchanges are a pretty bi-partisan, if not Republican, proposal by origin. Current opposition to them is largely part of the “anything related to Obamacare is dirty” pandemic, not based on real policy concerns. But not all Exchanges are, or will be, created equal. Minnesota gets to decide, for example:

  • Will our Exchange be a public or private entity, or something in-between, and should insurance companies who stand to profit from the Exchange be allowed on its Governance Board?
  • Will our Exchange be held accountable to health-improvement goals, including reduction of health disparities, and if so how should that disparity be measured?
  • Will just any insurance products be sold on our Exchange, or only those that meet high standards for affordability and quality? In other words, can our Exchange negotiate with insurance companies?
  • Will Minnesota offer a Basic Health Plan, basically a continuation of MinnesotaCare, to provide stable, quality coverage to low-income working families, or should they be dropped into the private insurance market?

These and other decisions are in front of us. Currently, the Dayton administration has been leading the Exchange development process. The Department of Commerce, which oversees insurance, appointed an Exchange Advisory Task Force to guide this development. The GOP majority refused to appoint legislators to that Task Force, and last year they didn’t grant a hearing to any Exchange bill, including their own from Representative Gottwalt. This year they say will be different, and that’s where the calls for compromise and bi-partisanship come in.

Governor Dayton has said that his administration has the authority needed to “get to the starting gate:” to develop our Exchange enough over the coming year to get approval from the feds that we are on track to have our Exchange up and running by 2014. He has also said they want legislative participation if they can get it, and that makes sense. Now it’s important for the public (that’s us) to understand enough about what kind of an Exchange will serve our families, businesses, and communities. That way we can tell our legislature and our administration not just to “compromise,” but to move forward an Exchange that will really work for Minnesota. We may not want them to be partisan, but we do need them to be particular.

Sarah Greenfield is the Health Care Program Manager at Take Action Minnesota. To learn more, or get involved can contact her directly at 651-379-0751.

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