Democrats hit the ground running with insurance exchange legislation in 2013, shuffling enacting bills through several House and Senate committees in just over two months. This year, Republicans look like the ones who intend to make certain that the exchange, now known as MNsure, gets sufficient attention during the legislative session.
A group of senior Republicans with expertise in health and human services issues entered a bill, HF 2006, that would alter the operation and budgeting process of the exchange, which began its six-month open enrollment period in October. Under current law, MNsure sets its own budget through the use of a 1.5 percent premium tax on customers shopping on the exchange. Beginning in 2015, the tax, or “withhold,” can be increased to up to 3.5 percent of premium costs.
The Republican bill would force MNsure to seek legislative approval for any adjustment in the premium costs beginning in 2016, a change that would essentially bring MNsure’s budget under legislative authority.
Chief author Rep. Matt Dean, R-Dellwood, said the Republican proposal includes a number of ideas entered as amendments during the 2013 legislative process, and faulted DFL leaders for paying “no attention to Republican input” last year.
Despite Republican pressure, the odds of any substantive legislation during this session to change MNsure are slim, according to the chief DFL authors of the enacting legislation.
“In this highly politicized environment, the chances of passing a law that actually helps anything are fairly minimal,” said Senate Health and Human Services Finance Chair Tony Lourey, DFL-Kerrick.
MNsure budget submission
The fact that neither Lourey nor Rep. Joe Atkins, DFL-Inver Grove Heights, are planning to enter bills on MNsure does not mean they won’t be paying attention. The MNsure board must submit a provisional budget to the Legislature by March 15, a date that would allow the Legislature to approve additional funding, if necessary.
Enrollment numbers in commercial insurance plans have been a disappointment so far, and MNsure has been forced to dial back its expectations. During a Wednesday meeting, board member Tom Forsythe predicted the exchange could fall as much as $4 million short in operating revenue during 2015, if current enrollment trends hold.
Lourey, who points out that the MNsure budget will be a “detailed informational report” rather than a budget request, has met with MNsure officials repeatedly to discuss the exchange financing mechanism. In public and private settings, exchange administrators have assured Lourey that the March 15 report will not include a request for additional funds from the Legislature.
The mid-month deadline is a tricky one for the exchange: Open enrollment will continue for two weeks following that date, and interim CEO Scott Leitz has predicted that consumer interest will swell in the run-up to the final deadline. That date will serve as a key benchmark, said Atkins, who lamented the fact that MNsure would need to submit a budget before final enrollment numbers were available.
“I think you just need to be cognizant of that fact,” Atkins said. “That’s not to say that the document they submit for their budget on March 15 won’t have value, it obviously will.”
Republicans keep issue visible
On Wednesday, GOP leaders fell back on a favored tool in the MNsure debate, writing an open letter addressed to Gov. Mark Dayton. The message from House Minority Leader Kurt Daudt and Senate Minority Leader David Hann urged Dayton to call on President Barack Obama to delay the individual mandate penalty, which is set to hit all those who are uninsured after the March 31 deadline with a $95 tax penalty.
Daudt and Hann wrote that website glitches and poor customer service may have wholly prevented some consumers from being able to register through the MNsure site.
“It’s wrong to punish families who haven’t been given a fair shot to find health insurance,” they wrote. “Penalizing them for the failures of your program is not the right thing for our state.”
A spokesman for Dayton said that what the Republicans are seeking would take an act of Congress, and was not certain whether the governor planned to respond directly to their letter.
Atkins had not seen the letter and was unfamiliar with Dean’s bill to change MNsure’s budgeting, but said he was “open-minded” to proposals that would improve MNsure, though he had none of his own in the works. According to Atkins, the major work to be done to improve the exchange is largely a “matter of execution.”
Rep. Carolyn Laine, DFL-Columbia Heights, said she was unaware of any desire to alter MNsure from her fellow members on the Health and Human Services Finance Committee.
“We have a very short session, and our plate’s full,” Laine said. “The MNsure stuff is being handled by those who are responsible.”
Lourey notes that even one of the exchange’s most outspoken critics, Sen. Michele Benson, R-Ham Lake, has recently taken a more appreciative tone toward to the MNsure board, a change he credits to the board’s increasingly active role.
Lourey said he has also heard positive sentiments from health care industry figures as well, who have found MNsure and its board to be more engaged in the policy details than during earlier periods.
Dean argues that DFL lawmakers should want to make changes in MNsure now, especially if they have heard the same constituent complaints as he has: Some people found their old insurance plans no longer existed under MNsure, while others were hampered by technological and information failures.
“[Democrats] can, and obviously have the votes to pass it, and the votes to fix it, if they choose,” Dean said of his bill.
The idea of a session that focuses on MNsure early and often is no bother to Atkins, who said he would not shy away from espousing the value of Minnesota’s insurance marketplace, and how it produced the lowest average premium rates of any exchange in the country.
“I take every opportunity to talk about MNsure,” Atkins said, “and would be happy to visit about it all session long.”