Sen. Dave Thompson, R-Lakeville, sought a rule clarification during the early proceedings of a Senate hearing. As the committee of origin for a bill, Thompson asked, were legislators not entitled to ask questions about any aspects of the bill?
Thompson was informed by the committee chair, as well as the bill’s chief author, that he was welcome to ask whatever came to mind, time permitting. It was a rare moment of politeness, and probably had more to with respect for the institution of the Senate than the bill itself.
For years, Republicans have not hesitated, let alone asked permission, before criticizing any and every piece of the the Affordable Care Act, aka Obamacare, or its Minnesota offshoot, the MNsure health insurance exchange.
Do not expect this to change.
To wit: “MNsure is fatally flawed, and has failed,” said Rep. Greg Davids, R-Preston, who said he looks forward to serving his new appointment as the House Republican leader on the MNsure Legislative Oversight Committee.
After some questioning, mostly from GOP members, the Senate State and Local Government Committee voted to pass the MNsure “fix” bill from Sen. Tony Lourey, DFL-Kerrick, on Wednesday morning. The vote sets the stage for another spin cycle of committee proceedings for Lourey, who chief-authored the original MNsure legislation in 2013, and is expected to have a similarly grueling committee lineup before that bill could reach the floor.
Lourey’s legislation would accomplish a number of things intended to bring simplicity and accountability to the state insurance exchange. MNsure’s much-maligned board, a governor-appointed body with budgetary and rulemaking authority, would be dissolved entirely, and MNsure would become a single-issue state agency, subject to the same rules as any other department.
In the House, that bill has not even been introduced, but is already the target of withering criticism from a peanut gallery that happens to include the leaders of two key committees. Rep. Tara Mack, R-Apple Valley, chair of the House Health and Human Services Committee, said she appreciates Lourey’s admission that MNsure has fallen short of expectations, but said the Senate bill fails to recognize “systemic problems” with the exchange.
Davids, chair of the House Taxes Committee, has been appointed by House Speaker Kurt Daudt to join Lourey as a co-chair on the oversight committee, and has asked Lourey to convene a meeting of that body in the first half of this month. Davids’ concerns include how the state is handing a $34 million federal grant from the federal government.
MNsure’s announcement stated that the new funds, which bring the state’s total federal investment to just shy of $190 million, would go toward technology needs and consumer assistance. Davids is more worried about counties, which have suffered with their own technology and enrollment gaps related to the expansion of public programs under the ACA, and said “a portion” of the federal grant could go toward that need.
Davids said his plea to Lourey was met only with a letter welcoming him to the committee. As Lourey’s letter explained, according to Davids, other oversight members would receive updates on MNsure as part of their duties on health and human services committees. Davids is not on either of two house committees with that purview.
Lourey’s tone was hardly defiant during Wednesday’s hearing. Rather the opposite: The DFL senator expressed contrition that MNsure had not succeeded in the ways he had hoped, and was prepared to make changes after some “hard soul-searching.” Lourey explained that part of the original planning of the board structure was to shield the exchange from partisan attacks.
“I actually don’t think it insulated us from politics very well, either,” Lourey said. “This has been a very difficult political issue, for the 18 or so months this has been operating.”
In answer to questioning from Republicans, Lourey argued that reclassifying MNsure as a state agency would add accountability, and not bureaucracy, pointing out that the reform legislation would not result in the hiring of any new employees.
Timing was another topic of debate for Senate Republicans, who pointed to a pair of major and overlapping deadlines in the coming weeks. MNsure’s current open enrollment period ends Feb. 15, after which point legislators would know the level of participation in private insurance plans on the exchange. (Enrollees in public plans such as MinnesotaCare or Medical Assistance, the state’s Medicaid program, may join the exchange at any time during the year.)
Due at the same time, by apparent coincidence, is a report from the Office of the Legislative Auditor (OLA), which was tasked with a full program evaluation of MNsure last session. A move was made to lay Lourey’s bill on the table until release of that report, but was overruled on a roll call vote.
Davids and Mack are also eager to get the OLA report, which, the taxes chair guesses, will not reflect well on the first year of MNsure’s enrollment and insurance activities.
“I can’t imagine there’s going to be any good news in it,” Davids said.
Mack has her own MNsure reform bill, though its passage could actually usher in the dwindling, if not demise, of the state’s exchange. Mack’s proposal, among the first five House bills introduced by the Republian caucus, calls for the state to seek a federal waiver allowing consumers to seek federal subsidies for the purchase of private insurance outside of MNsure. Without the exclusive incentive of subsidies, Mack said, insurance products on MNsure would have to compete with the open market.
While Lourey’s bill has already started moving — it passed the committee on a party-line, roll call vote — Mack’s bill is not even scheduled for a committee hearing yet. She said she would prefer to see the OLA report, and the final enrollment figures, before entering the bill for committee review.
“My bill is a starting point,” Mack said. “I am more than willing to tweak, and make adjustments, based on the findings, and how things come out in the next couple weeks.”
The DFL Senate bill will appear next in the Senate Health, Human Services and Housing Committee, though it has yet to be placed on any upcoming agenda. Davids said Lourey’s proposal is a non-starter with the House, and did not have a ready answer on how a reform package might emerge for MNsure.
“I don’t know that it does,” Davids said. “I don’t know if there’s any way to fix it. And I’m an optimist.”