Lawmakers are trying again to pass health insurance relief. Here’s what it would do:

Jan. 06--Thousands of Minnesotans are facing a similar crisis this year: skyrocketing health insurance rates.

After failing to reach agreement on a relief package last year, Minnesota legislative leaders on Thursday rolled out a new plan that includes immediate relief as well as some longer-term changes.

But this proposal from House and Senate Republicans differs in some key ways from what DFL Gov. Mark Dayton wants to address the problems in the state's individual health insurance market.

Premiums are going up for everyone on Minnesota's individual market, but many people qualify for federal tax subsidies that blunt most or all of the increase. Around 120,000 Minnesotans don't qualify for subsidies because they earn too much money -- but don't earn enough to pay thousands of dollars a month in premiums alone.

Others are forced to switch plans because some health providers have dropped out of their counties or capped enrollment.

Here is what you need to know about what Republicans and Dayton are proposing, what it would mean for Minnesotans, and whether this latest proposal will become law:

WHAT ARE LEADERS PROPOSING?

The House and Senate bills each have several provisions concerning health care, though some differ in important ways from Dayton's preferences:

Premium relief: The GOP bills would set aside $285 million to give rebates to Minnesotans buying individual health insurance without federal subsidies. For the first few months, everyone affected would get a rebate from the state equal to 25 percent of their premium.

But after that, the rebates would be stratified by income. People earning more than $95,040 for an individual or $194,400 for a family of four wouldn't qualify for further discounts. Everyone else would get discounts between 20 and 30 percent of their premiums, with higher incomes getting lower subsidies.

Dayton's plan is simpler: a flat 25 percent rebate for all eligible Minnesotans, with no income variation. That's a tradeoff: It makes the program simpler and possibly faster to administer, but also means more taxpayer money will go to people who are wealthy enough to afford even very high premiums. Dayton would also have the health plans directly administer the rebates, while Republicans want the state to verify incomes and distribute checks.

Continuity of care: People facing certain major medical conditions, such as life-threatening illness or advanced pregnancy, would get state subsidies to keep seeing their current medical providers even if those providers are now out-of-network because of a change of health plan. This would expire in June 2018, and would cost a total of $15 million. Dayton says he's all for this if it can be implemented.

For-profit insurers: Currently only nonprofit companies are allowed to sell health insurance on MNsure, the state-run health exchange. The GOP bills would delete that requirement, letting for-profit companies like UnitedHealthcare offer products on MNsure. The rationale is to add more options and competition, but it's unclear if any for-profit insurers will enter the Minnesota market where existing providers have suffered major losses. Dayton on Thursday declined to take a position on this measure, but said he was interested in adding more insurers to the market.

HOW WILL THIS AFFECT MINNESOTANS?

Most of the roughly 5.5 million Minnesotans will see no direct impact from these measures, because they get their health insurance through an employer or a government program. Similarly, about half of the 250,000 people buying individual insurance won't be directly affected either, because they already get federal subsidies and aren't currently undergoing urgent treatment.

But more than 100,000 Minnesotans will see a huge benefit from the bill. Unsubsidized premiums for an individual can range from 5 percent to as high as 30 percent of annual income, depending on age, location and income. That's just the premium and doesn't include any actual cost of care. The $285 million in premium relief would cut their bills by 20 to 30 percent -- saving thousands of dollars per year.

Continuity of care would help people with acute conditions keep seeing their current provider even if they've been forced to change networks, though this exemption would last only for a little over a year.

All Minnesotans would be indirectly affected because these relief efforts would be paid for by taxpayers. Taxes wouldn't rise under this measure because the money would be taken from the state's rainy-day fund. But the move would mean that money -- about $55 per Minnesotan -- won't be available and could mean eventual tax increases or spending cuts in a future budget crisis.

WILL IT BECOME LAW?

Minnesota's top leaders all agree that the state should offer rebates to Minnesotans struggling with high, unsubsidized premiums. But they don't yet agree on the details.

The Minnesota Council of Health Plans is still examining the details of the bills released Thursday, but its president Jim Schowalter said Thursday that the state's carriers have no major objections so far to the big picture of either the GOP or Dayton proposals.

Dayton, whose signature is needed for the relief to become law, criticized the GOP proposals for including reform measures that won't affect the 2017 insurance market. Those proposals should be discussed and maybe passed, Dayton said, but over the next two months and not in a rush next week.

Bridging that gap and their other differences about income-testing and rebate administration will test the ability of Minnesota's divided leaders to reach a compromise.

They've been wrestling with how to structure premium relief for months and have yet to strike a deal. Dayton first offered a rebate plan in late October, kicking off eight weeks of talks that ended in a public blowup between Dayton and House Speaker Kurt Daudt.

"We know that for it to happen we have to have agreement with the governor, and we intend to have that," said Senate Majority Leader Paul Gazelka, R-Nisswa.

WHEN WILL THE RELIEF HAPPEN?

Time is important because Minnesotans are already paying 2017 health premiums. The 2017 open-enrollment period ends Jan. 31, so lawmakers want to pass a law by then so Minnesotans can pick a 2017 plan knowing what kind of subsidy they'll get.

Lawmakers on Thursday said they hope to put a premium relief bill on Dayton's desk within two weeks -- around Jan. 19. If Dayton signs it, it could become law shortly after that.

Dayton called for lawmakers to pass a measure this week, but Republicans wanted to add more reforms to the bill and to give the public a chance to weigh in.

House Republicans tried to fast-track their bill Thursday afternoon, but Democrats objected to voting for a bill they got only that morning. Without DFL support, the measure didn't get the two-thirds majority it needed to skip the normal legislative precess.

That House vote was only symbolic because the Senate is sending its bill through committees and full floor debate. The law can't reach the governor until both chambers have passed it.

If and when lawmakers do pass a bill, people undergoing treatment for acute conditions would immediately benefit from the law letting them stay with their old doctors.

The health rebates could take longer to set up. If Dayton gets his wish and the health plans administer the relief, it could take eight to 12 weeks to develop the technology to get the money to the right people, Schowalter said.

Under the GOP proposal, the state would have several months to develop software to process the income-based payments. Budget Commissioner Myron Frans said Thursday that it would take that time and perhaps more to create such a system. Adding to the complication is that it would need coordination from the Department of Revenue to verify income from tax returns -- coordination made during tax-filing season when Revenue Department staff are already busy. A spokesman for Minnesota Management & Budget said the office doesn't know how long it would take to develop the simpler system to send out non-income-based checks for the first part of this year.

WHAT DON'T THE PROPOSALS DO?

Though the Republican proposals contain some measures that would affect the insurance market only in 2018 or later, they don't contain the biggest potential reform Minnesota leaders are discussing: a way to protect the individual health insurance market from cost spirals caused by its sickest members.

Called "reinsurance," such a measure would see costs of the most expensive patients either absorbed by taxpayers or spread across the entire commercial insurance market. The intended result would be to slow or reverse the growth of premiums in the individual insurance market, where just 2.2 percent of patients account for 50 percent of all costs.

The total cost to either taxpayers or the insurance market could be $500 million per year.

Republican senators had pushed to include this measure in the immediate relief bill, but agreed to put it in a separate bill. Those packages will proceed more slowly, but lawmakers hope to pass some form of 2018 market changes by March so insurers can take that into account when proposing their 2018 rates this spring.

Dayton says he will propose his own long-term health insurance fixes this month.

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