Two years after receiving federal planning grants and 9 months after inking an IT contract, the Minnesota Health Insurance Exchange's enabling legislation is being finalized by state lawmakers, amid competing visions for regulatory scope.
Facing a federal deadline of March 31 to pass state HIX legislation, the Democratic-led Minnesota House passed a heavily debated exchange bill late Monday, sending it to the Senate for consideration Thursday.
The House bill passed 72-58, mostly on party lines, and establishes a framework for funding, health plan participation and an oversight board. Under the House bill, the exchange will be able to levy a premium fee of up to 3.5 percent to cover its operational expenses, estimated at $60 million a year, and will have a seven-member board appointed by the Governor and approved by lawmakers.
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 Senate bill, meanwhile, would grant the exchange broader active purchaser authority (and would also fund the exchange with proceeds from tobacco taxes rather than a premium fee).
The House bill's sponsor, Representative Joe Atkins, a Democrat from from suburban Saint Paul, said that conditionally guaranteeing insurers product slots would ensure there'd be enough participating health plans.
Consumer groups like TakeAction Minnesota were riled by the House bill's reduction in regulatory power, along with several progressive lawmakers and the sponsor of the Senate legislation.
"I think the Senate version is much stronger in its ability to foster a competitive marketplace that really has the (products) that are in the best interest of consumers," Senator Tony Lourey, a Democrat from the rural town of Kerrick, told the Twin Cities Pioneer Press.
Tina Liebling, a Democratic Representative from the southeastern Minnesota city of Rochester, told Minnesota Public Radio that the exchange should "give Minnesotans the opportunity to select in much the same way that large employers are able to select plans that meet their needs. Without that I'm not really sure if it's worthwhile to have a Minnesota exchange."
The Minnesota Council of Health Plans supported the House bill after it was amended with the conditional two health guarantee. "It brings more choice for consumers, and it brings more competition," Julie Brunner, the council's executive director, told the Pioneer Press.
Minnesota Governor Mark Dayton created the exchange by executive order in October 2011, and last summer, the state signed a $41 million contract with MAXIMUS, Inc. to design and develop the IT for the exchange and Medicaid modernization
According to state estimates, the Minnesota exchange will cover 1.3 million people -- nearly 20 percent of the state population -- with about 300,000 becoming newly insured.
Though only one Republican voted for the House bill, GOP lawmakers unsuccessfully tried to pass amendments that would have made board members elected rather than appointed, would have required exchange officials to obtain their insurance through it, and would have removed marketing and education funding, as the Associated Press noted.