Key decisions for Minnesota's health insurance exchange now have to be settled by a legislative conference committee, after House and Senate bills established different financing, board membership and regulatory provisions.
With federal planning grants and an IT contract signed last July, the Minnesota HIX is sprinting towards October enrollment with its website and IT design like other exchanges, but without a regulatory framework for the exchange market or a long-term financing stream.
In a bill passed earlier this month, Minnesota's Democratic majority House established a premium fee of up to 3.5 percent to cover exchange operational expenses, estimated at $60 million a year, while the Senate bill, passed after 11 hours of debate and some 122 proposed amendments Thursday, funds the exchange through the state's tobacco tax (which some critics said essentially taps the state's general fund, something other states are explicitly avoiding).
The House bill guarantees that insurers participating in the exchange meeting certain requirements will be able to sell at least two health plans in each of four product categories, with exchange officials having authority to permit or exclude additional health plans. The bill's sponsor, Democrat Joe Atkins, said he wanted to ensure there would be a large number of health plans participating in the exchange.
The Senate bill grants the exchange board broader authority to select and deny plans, facing criticism from both Democrats and Republicans. "We're saying we're going to limit your choices for your own good because we know better than you how to spend your money," Republican Senator David Hann said, as Minnesota Public Radio reported.
The Senate bill's sponsor, Democrat Tony Lourey, responded saying "The question before us is whether that value in the competition is driven better by having more plans or by having better plans on the exchange. This is about getting plans that are in the interest of consumers."
The Senate bill also specifically excludes anyone on the payroll of healthcare or insurance organizations from the seven-member board, another fractious issue for the reconciliation committee.
Also in the Senate bill, Republican Dave Brown, an insurance agent with the Breitenfeldt Group, was able to add an amendment that requires lawmakers to buy their insurance through the exchange, instead of the state employees plan.
"I don't like the exchange bill," Brown said, as the Saint Cloud Times reported. "But I feel that if we're going to impose it upon a certain group of Minnesotans, that we ourselves should be willing to live under the same laws."
Along similar strains of limited government ideas, several amendments added to the Senate bill address consumer privacy concerns stemming from Health and Human Service's data hub, which will be linking with state Medicaid databases and the Department of Homeland Security's databases, for identity verification.
One amendment establishes a state preemption of federal policy where Minnesota provides greater privacy protections, and another requires the exchange to explain its data sharing arrangements on its website.
The state exchange faces a March 31 deadline from the federal government to establish a legal HIX framework. Democratic Governor Mark Dayton helped bring $110 million in federal exchange grants, after establishing the HIX via executive order. It is currently in the hands of a stakeholder advisory group and task force, co-coordinated by the Department of Commerce, the Department of Health and the Department of Human Services.
Dayton has not weighed in on either the House or Senate bills yet, and the makeup of the legislative conference committee has still has to be determined.