Dayton proposes major ‘buy-in’ expansion for MinnesotaCare

Star Tribune (Minneapolis, MN)

March 01--Gov. Mark Dayton and several DFL lawmakers are proposing a dramatic expansion of the MinnesotaCare health plan, creating what is known as a "public option" that would offer health insurance for any Minnesotan who is struggling to find and afford coverage.

Announcing the plan Thursday morning, Dayton said the buy-in option -- removing MinnesotaCare's income restrictions and allowing anyone to purchase coverage -- is "the single most significant step that Minnesota can take" to shore up its unstable insurance market for individuals.

"It's not working for Minnesotans," Dayton said. "Maybe it's working for the insurance companies, but it's not working for Minnesotans."

The governor estimated that 100,000 Minnesotans, especially in farming communities, would benefit from this public competition to private health plans.

Dayton's proposal follows a startling report last week showing that the rate of uninsured Minnesotans jumped from 4.3 percent in 2015 to 6.3 percent last year -- the first increase after years of decline -- despite strength in the state's economy and labor market.

While agreeing about problems in the individual market, Republican legislative leaders have strongly opposed the MinnesotaCare-for-all expansion, which was first proposed by Democrats last year.

Sen. Michelle Benson of Ham Lake, a leader in the Republican caucus, was not immediately available for comment Thursday morning. But in a November 2017 newspaper Op-Ed, she said that despite its appeal, the expansion could hurt doctors, clinics and other providers because MinnesotaCare pays them at lower rates. She also said it could hurt privately insured Minnesotans who might have to pay higher premiums and costs to make up the difference.

"Last time we tried something that merely sounded good and felt good," she wrote, "it almost destroyed our health care market and hurt hundreds of thousands of Minnesotans."

MinnesotaCare was created 26 years ago by then-Gov. Arne Carlson, a Republican, to cover working Minnesotans who made too much to qualify for low-income public plans such as Medicaid but too little to afford private plans. The income limit for enrollment is 200 percent of the federal poverty level, which is a household income of $49,200 for a family of four.

The program is funded partly through a tax on medical providers, which is set to expire at the end of 2019 unless lawmakers opt to renew it.

Rural Minnesotans, especially farmers, need new insurance alternatives if they can't acquire coverage from employers, lawmakers said Thursday. The introduction of the MNsure online market, as part of the federal Affordable Care Act, created new individual health options in 2014.

Since that time, insurers have increased prices, reduced benefits or withdrawn plans altogether in certain parts of the state, said state Sen. Tony Lourey, DFL-Kerrick.

"MinnesotaCare is a trusted source of health insurance for people all across this state and that's kind of rare right now," Lourey said.

Gary Wertish, president of the Minnesota Farmers Union, recalled a farmer who was paying $43,000 in premiums and deductibles and was under financial pressure to drop his insurance -- despite the physical dangers of farming.

"That's what's happening out there," Wertish said. "People are dropping health care (coverage), taking that gamble."

Minnesota's uninsured rate remains near its historic low -- last week's reported increase was the first in a decade. But the gains created by the initial creation of MNsure have eroded, partly due to health plans raising prices or withdrawing from the market.

Uncertainty about changes in federal health policy also appear to have discouraged some people from remaining insured. Both the state's Medical Assistance and MinnesotaCare programs are largely supported by federal funds.

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