MinnesotaCare

Gov. Mark Dayton’s proposal to expand MinnesotaCare eligibility is a reminder of how easy, and how beneficial, it would have been to include a public option under the Affordable Care Act. Indeed, it’s a reminder of how much easier it would have been to have made expansion of eligibility for Medicare and Medicaid the centerpiece of the ACA.

Unfortunately, the Republicans who now control the Minnesota Legislature are unlikely to go along with Dayton’s proposal, and that’s a shame— because it limits choice and affordability for consumers. If GOP leaders want to remain true to the talking points, and their professed desire to expand choice and make insurance more affordable, they will back the governor’s proposal.

From the GOP perspective, there should be a lot to like in the governor’s plan. Consider:

‰ It creates no new government bureaucracy. MinnesotaCare already exists, so there’s no need to create a new agency from scratch. Given the experience with MNsure, Democrats and Republicans can probably agree it’s best to stick with what’s working already.

‰ It expands competition. One of the biggest flaws of the ACA came from the Obama administration’s decision to forego a public option, which would have allowed residents in any state the choice of buying into a public insurance plan, like Medicare or Medicaid. 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 less expensive. In the case of MinnesotaCare, the average premium is about 12 percent cheaper than private insurance options presently available through the MNsure exchange. And Minnesotans would still qualify for the federal subsidies available through the ACA, which would further reduce the out-of-pocket impact of their premiums.

‰ MinnesotaCare insurance is better than most private plans. 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.

Indeed, if offered through MNsure, MinnesotaCare would almost certainly force private insurers to come up with more competitive offerings, or fade away. In other words, expanding MinnesotaCare eligibility to the entire individual insurance market would be the single best means of achieving what Republicans say they want— a truly competitive insurance market that will drive down costs and improve coverage for consumers.

For Republicans to oppose such competition would expose their arguments as mere talking points, and suggest they are more interested in serving the interests of the private insurance lobby than actually meeting the needs of the public. And that would be a potent argument for DFLers as they seek to regain the Legislature in 2018.