At the national level, the very constitutionality of President Obama’s healthcare law is being debated.
Here in Minnesota, Democratic Governor Mark Dayton is pushing ahead to create something that the Patient Protection and Affordable Care Act requires — the establishment of a state healthcare exchange where small businesses and individuals can buy health insurance. By executive order, Dayton has established the Minnesota Health Insurance Advisory Task Force, whose 15 members were appointed by State Commerce Commissioner Mike Rothman. The Task Force adopted some initial high-level recommendations earlier this year, including the size of the governing board that will oversee the exchange.
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But even people involved in the effort say there is a question mark about how far Dayton can progress before he is required to seek legislative approval. On Monday, one bill that was introduced by a Democrat who heeded some of the Task Force recommendations died in the state Senate Health and Human Services Committee, when its progress was thwarted by a 7-5 vote.
“Governor Dayton and the Minnesota Department of Commerce still hope state lawmakers will continue a dialogue to pass legislation this session that will establish a Minnesota-made health insurance exchange,” said Commissioner Rothman, in a statement after the bill was defeated. “Our position is clear: Any exchange-related legislation must closely adhere to the broadly supported, consensus recommendations of the Exchange Task Force.”
There are several other bills, including one that instead of an exchange seeks to create an insurance premium pool to help people buy insurance.
The state has received a $26 million federal grant to help in the initial design of the exchange and since November, there have been several task force meetings to discuss a variety of topics. They include adverse selection; the role of navigators and brokers, and their compensation; and designing a user experience to help in enrollment among many others.
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“This issue has become political and so you got an administration that really believes that this is something we should do in Minnesota and they are moving forward with planning,” said Dannette Coleman, vice president and general manager of Individual Businesses and Families at nonprofit health insurer Medica. “There is a little bit of a question right now on how far the administration can take this before requiring legislative approval.”
Coleman, who is the lone representative of the insurance industry on the task force and acknowledged to feeling “overwhelmed” at times, said that the high-level recommendations were easier to agree on. But down the road, as the task force gets into the details of how the exchange will function, how the brokers/navigators and others with a conflict of interest will play a role and be compensated, achieving consensus would be a challenge.
For instance, instead of viewing brokers/navigators with suspicion because of the conflict of interest they have, the “Task Force has to recognizes that brokers are individuals in the community that both employers and individuals can utilize and trust to help them make decisions about what insurance they should buy.” Coleman said.
Meanwhile, task force members such as Phillip Cryan, a health policy specialist with the Service Employees International Union in St. Paul, are bent on prohibiting anyone working for or affiliated with insurers or brokers to be on the exchange’s governing board, the Star Tribune reported.
Still, Coleman believes that task force members are united in wanting to continue the Minnesota tradition of providing high-quality healthcare to citizens. She said Minnesota is unique in that most of the health insurers are nonprofit and domiciled in the state, and more of its citizens are insured compared with other states.
Coleman added that task force members need to remember that if they fail to create the exchange by Jan. 1, 2013, (and the law is not struck down in the Supreme Court) that the federal government will create an exchange for the state.
“We have to constantly remind ourselves when we disagree that this will be done and none of us believe that the federal government can do this better than what we – its citizens – can do for ourselves,” Coleman said.
It was a thought that was echoed by Commissioner Rothman, who said that Minnesota needs a Minnesota-made exchange and not a one-size fits all federal solution.
