Mark Dayton was seeking a public option for health insurance before his collapse

Jan. 24--Gov. Mark Dayton was seeking a more vigorous role for the state government and more requirements of the state's insurance companies in response to the state's health insurance crisis before he collapsed Monday.

In his seventh State of the State address Monday night, Dayton was to propose letting Minnesotans buy unsubsidized insurance coverage from the state's MinnesotaCare program, which could expand choice and save Minnesotans money. He did not get a chance to finish the speech, though, after apparently fainting. He was later seen revived and moving about.

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RELATED: Mark Dayton collapses during his State of the State address

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"This public option could offer better benefits than many policies, presently on commercial markets; more options for people to keep their doctors and clinics; and less expensive coverage than what is available today," Dayton was planning to say, according to an advance text of his remarks. "The public option will also guarantee that all Minnesotans have at least one good option available on the individual market, wherever they live."

His health proposals may meet stiff resistance from both insurers and from Republicans who now control both chambers of the state Legislature. The same is also true of many of other proposals Dayton -- who insisted despite a Republican Legislature he would propose and govern as he saw fit -- addressed Monday evening before his collapse ended his speech.

In his penultimate annual address to the state, the governor also gave a victory lap of sorts. He defended his tax increases on the wealthiest Minnesota. He would also brag that Minnesota's budget moved from a $6 billion deficit to a $1.4 billion surplus, added 255,400 jobs and increased education spending every year.

But, he noted that the gains have not been uniform across the state. He proposed spending more on K-12 education and child care and providing more help for college students struggling with tuition debt. He is expected to detail both of those proposals on Tuesday when he releases his budget plans. The governor's office said late Monday that Dayton will present his 2017 budget on Tuesday morning as planned despite his Monday collapse.

HEALTH CARE

The anchor of Dayton's speech was supposed to be his proposal to create a quasi-public option competing against health insurance plans on the individual market, though he collapsed shortly before making the proposal. It would be the first such plan in any state, Dayton administration staffers said.

Around 250,000 Minnesotans buy health insurance on the state's individual market, which has been plagued by high costs and skyrocketing premiums.

MinnesotaCare has for decades provided health coverage to Minnesota's working poor. Currently around 100,000 Minnesotans get subsidized coverage through MinnesotaCare which pays 94 percent of health costs with ranging from $0 to $80 per month.

The proposal would let Minnesotans buy unsubsidized plans where premiums would cover the full cost of care. This MinnesotaCare buy-in would compete with private insurance plans from companies such as Medica and HealthPartners on the individual marketplace.

His office predicted the average premium for this MinnesotaCare buy-in would be $469 per month, less than the average individual market premium of $538 per month.

"This public option could offer better benefits than many policies, presently on commercial markets; more options for people to keep their doctors and clinics; and less expensive coverage than what is available today," Dayton's prepared remarks said. "The public option will also guarantee that all Minnesotans have at least one good option available on the individual market, wherever they live."

Minnesotans who purchased such a plan would have access to any medical providers who accept MinnesotaCare. It could take effect in 2018 if lawmakers approve it by April.

Such a proposal would face obstacles. It would take an estimated in $12 million in startup costs and months of development. Minnesota would also need approval from President Donald Trump's administration to implement the plan. Trump recently signed an executive order telling the federal government to give states flexibility in implementing the Affordable Care Act.

The Legislature's Republicans have also pushed back for years against public options proposed by Democrats.

"(A) public option would reduce access," Senate Majority Leader Paul Gazelka, a Republican from near Nisswa, said in advance of the speech. "Your hospitals, doctors and clinics lose money at the reimbursement rates we give through our present public (plans). If they're losing more money you're going to reduce the care available."

Republicans have pushed for a different proposal, an attempt to subsidize the cost of the sickest patients in the individual market called "reinsurance".

Even as Dayton called for a public option in Monday's speech, he was also planning to tell lawmakers he was still willing to work with them to pass a reinsurance proposal -- though he urged them to "design it carefully" rather than passing it in a rush.

Besides the public option, Dayton was also proposing new laws requiring insurance companies to open up their providers networks somewhat.

One Dayton idea would require insurers to cover at least one primary care provider in each of Minnesota's counties, so people wouldn't have to travel too far for routine medical care.

Another is to require insurers to give a grace period to people with serious medical conditions if they change their provider networks. Under the governor's proposal, these people could keep their old doctor for 120 days into the new year even if the plan's new network didn't include that provider.

FAMILIAR THEMES

Aside from the health care proposal, much of the Dayton's speech trod familiar ground.

He again called for major new funding for roads, bridges and transit to fill a multi-billion dollar gap -- an issue that dominated the past two legislative sessions.

"Every year we delay in filling that gap, everything deteriorates further, and becomes even more expensive to remedy," he will say.

He contrasted the state's economic improvement over his tenure with people who have been left behind, noting that "the average Minnesota family is relatively poorer than sixteen years ago."

The governor emphasized cleaning up Minnesota water, an issue he has emphasized in his second term and will address more in a "water summit" at the end of the week.

With lawmakers obligated to pass a two-year state budget this year, the governor urged in his prepared remark lawmakers to "continue our state's fiscal prudence."

Dayton will propose his full budget Tuesday morning.

COOPERATION

Despite plotting his own path -- anticipated Republican objections aside -- the DFL governor was planning to ask lawmakers to work with him.

"We will never solve the problems facing Minnesota, unless we first resolve our own. That is, our unwillingness to work together," Dayton was planning on saying before his speech ended partway through. "The same is true for us today, in this state, in this Legislative session. Either we go up together, or we go down together."

In his first State of the State address in 2011, Dayton also faced a Republican Legislature. In that speech he implored lawmakers to join with him in pledging that they would not shut down government.

Six months later -- in the face of bitter budget differences -- Minnesota experienced its longest ever government shutdown.

This year, Republicans are also pledging cooperation.

"We're not going to accept anything just because it's the governor's idea, but we're also not going to reject anything just because it's the governor's idea," House Speaker Kurt Daudt, a Republican from near Crown, said before the speech.

In his speech, Dayton was going to acknowledge that challenge -- including for himself -- but said the state will be better if they can meet it.

"Each of us will ultimately be judged, not for the political points won in today's news cycle, but for how well we have achieved that goal, for now and for the future. That is how we should judge ourselves," he planned to conclude his speech. "So let's begin with where we can agree; then move ahead to where we must agree. If we do, there are no limits to what we can achieve for a better Minnesota."

This story has been updated to account for what proposals Dayton made in his speech before collapsing and which proposals Dayton didn't get a chance to discuss because he passed out.

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