|By Mark Sommerhauser, St. Cloud Times, Minn.|
|McClatchy-Tribune Information Services|
There's one point on which fans and foes of the controversial act agree: Getting Minnesota's exchange functioning in a matter of months, as is required, will be a Herculean task.
"This is an incredibly tight timeline," said
The exchanges often are analogized as something like
Each state must have an exchange in place by
Before the November elections, it wasn't a sure thing which route
The Dayton administration has called for
Last month's election of DFL majorities in the state
But in the next few months, lawmakers and Dayton must fill in the many blanks of the exchange, including how it will be governed, how its considerable operating cost will be covered and what coverage options and other tools it will offer.
Jacobs says the discussion in
"Now there's going to be an even more heated debate about how to do the exchange," Jacobs says.
The time crunch will limit what the exchange can look like at the outset, Pollard said. The October deadline actually understates the urgency because some key elements of the exchange, such as its governing structure and financing mechanism, must be identified by the end of March.
To meet deadlines, Smith says the exchange should start out as a no-frills model. What Smith calls "add-ons" -- items that could add value to the exchange but aren't required, such as putting provider quality ratings on the exchange website to help guide coverage decisions -- should be postponed until later, she says.
"I'm not saying don't do those things ever," Smith said. "I'm just saying, by October, have the essentials running smoothly."
Borgert also says determining how to pay the operating cost of the exchange will be crucial. It's expected to cost about
Borgert and other providers hope the state's health care access fund, fed in part by a tax on health care providers, won't be tapped.
"It's a target," Borgert said of the fund, "and it shouldn't be."
'Rushing this ahead'
Under the federal law, states may choose to permit all plans that meet minimum standards to be on their exchange. Or they may take a more active role in negotiating coverage options with health plans.
Borgert says those governing the exchange should give consumers as many options as possible.
"The more choices consumers have, the better," Borgert said.
The possibility of a exchange that heavily regulates coverage is one of many concerns about the issue voiced by Rep.
Gottwalt chaired the House committee on health care policy, a likely starting point for any potential exchange legislation, when Republicans controlled the House for the past two years. He will remain the lead Republican on that committee in 2013.
The exchange issue already has given Gottwalt no small amount of heartburn. He was blasted by conservative activists and by some in his own party for joining the
Gottwalt says there are examples of how an exchange can function without imposing what he considers too heavy a hand. He cites the state of
But under the so-called Obamacare law, Gottwalt predicts the cost of running the exchanges will increase the cost of health coverage. Some could even establish what Gottwalt calls "government-run health care," he says.
"We have to start painting a picture for average Minnesotans of what this will mean for them," Gottwalt said. "We're rushing this ahead so fast with so many unanswered questions."
Pollard doesn't dispute that there are many exchange-related questions that lawmakers and Dayton must resolve in the coming months.
"A lot of this is up to
"That debate needs to play out, and people need to engage."
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