By Rep. Tom Hackbarth
Part of the federal healthcare reform legislation – aka, the Affordable Care Act – asks each state to set up an Internet portal – known as an “exchange” – for the purchase of health insurance. This has been a major undertaking in the 2013 session.
Federal law will require every Minnesotan to have some form of health care insurance beginning Jan. 1, 2014. Our choices were to set up the Internet exchange or to accept a national exchange operated by the federal government. The option to sue under grounds of unconstitutionality evaporated when the U.S. Supreme Court upheld the federal health care reforms. As of this writing, 18 states were moving toward conditional federal certification to operate their own health exchange.
Minnesota’s exchange was being fast-tracked in the Legislature to become state law by March 31 in order to comply with federal guidelines. Some people believe the exchange was moved too quickly in our Legislature, without adequate time to flesh out key details, provide answers to crucial questions and make sure we are making the right decisions.
Under the exchange, insurance providers would have until October to design their marketplace offerings and get them approved by the Commerce Department. Providers of the selected plans would begin enrolling consumers Oct. 1, with the help of community navigators and brokers.
Proponents expect 1.3 million people – approximately 25 percent of Minnesotans – to use the exchange. Small businesses with 50 or fewer employees also could shop for plans on the exchange website. Businesses with more than 50 employees or companies that provide employee coverage by self-insuring them would not purchase insurance through the health exchange. Enrollees would pay premiums and, depending upon their income, they may be eligible for federal tax credits.
A new state agency within the executive branch would operate the health care marketplace. A seven-member board of directors would be appointed by the governor. That group would decide which insurance plans to certify and make available through the exchange. A number of legislators expressed strong concern over providing non-elected officials with such latitude.
Serious questions regarding privacy, choice and costs arose during the legislative process. Patient data could be accessed by the federal government, there is no guarantee patients will be able to see their preferred doctor at their convenience, and the system will cost hundreds of millions of dollars to simply operate.
Under the plan, the state would collect 3.5 percent from the premiums sold through the exchange. In addition, the health exchange would require around 85 full-time equivalent jobs when it’s fully implemented, according to projections. An estimated eight senior managers would earn up to $108,000 per year. There also would be support staff, business operations analysts and officers, information technology administrators, marketing and communications staff and a broker/navigator licensing division.
One notable amendment approved on the House floor prevents abortions from being covered through the exchange. That provision was later eliminated by a conference committee.
Many questions and concerns remained with the Minnesota proposal as this legislation moved through the Legislature around the time of this column’s deadline. Minnesotans deserved to have them resolved through the process.
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