Legislation establishing a health insurance exchange cleared the House on a largely partisan vote on Monday evening. The 72-58 vote followed more than five hours of contentious debate over the proposal to provide a marketplace for individuals and businesses to buy insurance products under the federal Affordable Care Act.
The bill made it to the floor after eight committee hearings vetting the proposal. The state is required to have legislation in place by the end of the month, or the federal government could impose a state exchange of its own making.
Rep. Joe Atkins, DFL-Inver Grove Heights, the chief author of the bill, raised this specter in explaining the need for the state to take action. “If you vote red, that’s the equivalent of voting for a federal exchange,” Atkins said. “That to me is untenable.”
The Senate is slated to take up health care exchange legislation on the floor Thursday. Then it’s expected to move to a conference committee.
There are two significant differences between the Senate and House versions of the bill. The House version of the bill relies on a fee of up to 3.5 percent on insurance plans purchased through the exchange to cover costs associated with the marketplace. By contrast, the Senate uses cigarette taxes that are part of the state’s general fund to pay for it.
In addition, Atkins amended his bill during its final committee stop to limit the authority of the seven-member board that will oversee the exchange to determine what products can be sold through the marketplace. The House version now guarantees that insurance firms that meet certain requirements will be allowed to sell products through the exchange. The Senate bill contains no such guarantee.
The change in Atkins’ legislation was designed, in part, to placate the Minnesota Chamber of Commerce and the Minnesota Council of Health Plans, which have been among the most vocal critics of the exchange proposals. But several DFLers, including Rep. Tina Liebling of Rochester, chair of the Health and Human Services Policy Committee, spoke out against the change in the board’s ability to limit products sold on the exchange. “I don’t believe it works,” Liebling said.
Republicans had filed nearly 100 proposed amendments, but many of them were pulled on the House floor. Atkins accepted some of the proposals as friendly changes. For instance, an amendment that would make breaches of data privacy a misdemeanor was adopted on a bipartisan vote.
Republicans raised concerns about the cost of the exchange, increased government bureaucracy and a lack of accountability for the exchange board. They also criticized conflict-of-interest language that prohibits individuals with financial ties to insurance companies and medical providers from serving on the exchange board.
“We’ve taken an extreme view on this,” said Rep. Matt Dean, R-Dellwood. “If the Mayo brothers were alive today, they could not be on this board.”
Rep. Patti Fritz, DFL-Faribault, offered a controversial amendment largely prohibiting coverage of abortions in plans sold through the exchange. The amendment passed on a 71-58 vote, with a dozen (mostly rural) DFLers joining all Republicans in supporting it. The DFLers voting for the anti-abortion amendment: Reps. David Dill of Crane Lake, Roger Erickson of Baudette, Tim Faust of Hinckley, Ann Lenczewski of Bloomington, Paul Marquart of Dilworth, Jay McNamar of Elbow Lake, Mary Murphy of Hermantown, Gene Pelowski of Winona , Joe Radinovich of Crosby, Mary Sawatzky of Willmar, and John Ward of Baxter.
Rep. Jim Abeler, R-Anoka, was the lone Republican to vote in favor of the bill. He has consistently criticized the proposal, but supporting it allows him to serve on the conference committee. “This bill has a ways to go to get me excited about it,” Abeler said.
Rep. Laurie Halverson, DFL-Eagan, was the only member of her party to vote against the legislation. The first-term legislator formerly worked for Blue Cross Blue Shield of Minnesota, which is strongly opposed to the bill in its present form.