Expand MinnesotaCare

The number of Minnesotans who lack health insurance coverage is back on the rise after reaching a historic low of 4.3 percent in 2016. Rising health insurance premiums and lack of quality insurance options in many parts of Minnesota are contributing to the situation, which pushed the number of uninsured in the state to 6.3 percent in 2017. The uninsured population is almost sure to increase again this year.

All of which makes the case for Gov. Mark Dayton’s proposal to expand MinnesotaCare eligibility, essentially creating the public option that should have been part of the Affordable Care Act. The governor introduced this measure last year, but Republicans who control the Legislature have been unwilling to consider it. That’s unfortunate and foolish.

Republicans who now control the Legislature are well aware of the problems in the individual insurance marketplace in Minnesota. That’s why they supported an emergency fix last year that provided a 25-percent subsidy for Minnesotans who earned too much to qualify for the federal subsidies under the Affordable Care Act, but not enough to afford the sharply rising premiums in the individual market.

They also pushed a reinsurance program under which the state agreed to pick up a portion of the costs incurred by health insurance companies operating in the individual market, to help keep premium increases in check.

Yet both of these options cost the state hundreds of millions of dollars a year. Gov. Dayton’s plan would cost nothing, other than a small amount of initial start-up funding. That’s because the governor’s plan would allow Minnesotans who don’t otherwise meet the income guidelines for MinnesotaCare eligibility to buy-in to the insurance program for a market-rate premium.

MinnesotaCare would become, in effect, the public option that the Affordable Care Act should have created.

The refusal of the Republican Legislature to go along shows the degree to which traditional GOP talking points have been turned upside down when it comes to the health insurance debate. Under the governor’s plan, Minnesotans would have additional choice, for a substantially lower premium. Indeed, the average premium under MinnesotaCare would be about 28 percent cheaper than equivalent private plans, according to the governor’s office. Thanks to large pools of beneficiaries, low administrative costs, and no need to siphon 20 percent off the top for profits and big executive pay packages, premiums for such public plans are naturally less expensive.

The GOP claims to like competition, which is exactly what the governor’s proposal would offer. In St. Louis County, for example, there are only three private sector health insurance providers serving the individual market, and that number is likely to continue to fall. In several Minnesota counties, only one provider exists. That’s not competition, and the lack of choice provides little incentive for providers to improve their offerings

Because MinnesotaCare is substantially cheaper, Minnesotans of higher incomes wouldn’t need the emergency state-funded subsidies or the costly reinsurance program. They could pay their own way, which one might think would be pleasing to Republican legislators who like to tout personal responsibility. At the same time, Minnesotans who do meet the income guidelines to qualify for federal subsidies, would still qualify, which would further reduce the out-of-pocket impact of their premiums.

And, in most cases, the MinnesotaCare provider network is far better than what’s offered by the private sector. The MNsure exchange is currently overloaded with high deductible plans, which are little more than catastrophic coverage. These are asset protection plans, intended to (hopefully) stave off bankruptcy in the event of a major illness. They don’t provide the affordable day-to-day health care access that many families desire. MinnesotaCare does have a deductible, but it’s so low ($2.95 per month- and that’s not a typo) that it’s no deterrent to health care access, even for low-income Minnesotans. And forget about staying within your network or getting referrals to specialists. Virtually any provider in the state, including the Mayo Clinic, is “in-network” under MinnesotaCare. 

The advantages of the governor’s proposal are significant. It would provide better health care choices for Minnesotans at a lower price. And it would potentially save the state hundreds of millions of dollars a year. What’s not to like? The Legislature should put aside politics and do the right thing for Minnesota.