Congressional ACA mandate repeal could roll back health coverage gains

Two weeks later, the car accident victim's first words still stun state Sen. Scott Jensen, R-Chaska.

Jensen, a physician, came upon a freshly rolled-over vehicle near his western suburban practice on the morning of Dec. 13 and stopped to help the woman still inside. As he approached, worried about head injuries and her heart rhythm, the woman stammered out: "I don't have any health insurance. I don't want to go to the hospital. I don't want to take an ambulance ride."

"It just struck me and it has stayed with me to this day,'' Jensen told an editorial writer this week. "The first three sentences she shared with me had nothing to do with well-being and everything to do with she just couldn't be saddled with a $5,000 bill."

Thankfully, the woman Jensen aided was not seriously injured. And the state senator merits praise for embodying the best of his home state in stopping to help and then offering follow-up care "on the house."

But the harrowing experience spurred Jensen to think even deeper about how vulnerable people without health insurance are and how best to help them. His colleagues in the Minnesota Legislature need to swiftly join him in seeking prescriptions for this because Congress just took a regrettable step that will roll back coverage gains here and elsewhere.

As part of the tax reform package passed last week, the Republican majority in the House and Senate effectively repealed the Affordable Care Act's individual mandate to carry insurance. The change takes effect in 2019. It's a political victory the party has sought since former President Barack Obama's signature health law passed in 2010. Those celebrating ignore the troubling consequences.

According to a November Congressional Budget Office report, repealing the mandate will result in 13 million fewer people nationally choosing to go without coverage by 2027 and 10 percent annual premium increases over the same time period for people buying insurance on their own. A state-by-state analysis by the Washington, D.C. -based Center for American Progress estimates that the repeal will result in 227,000 fewer Minnesotans with health insurance over the next decade.

States, however, can enact their own mandates to stop the backward slide. Several are considering doing so — California, Maryland and Washington. Massachusetts already has one. Minnesota should take a hard look at this as well. During the last legislative session, lawmakers passed a "reinsurance" measure authorizing $542 million over two years to stabilize the individual market. The mandate repeal will create upheaval. A state mandate would blunt this without a costly price tag.

But reality needs to be acknowledged. Both chambers of the Legislature are controlled by Republicans who are unlikely to reimpose the ACA mandate, especially during an election year. A check-in with key Republican health policy leaders last week confirmed the long odds against a state-level mandate.

Still, doing nothing is not an option given repeal's serious consequences. Jensen's experience drives home the human cost. If you need emergency medical care, should your first thought involve avoiding a hospital bill? If you or a loved one develop a serious illness, shouldn't recovery be the focus?

Thankfully, Jensen is still wrestling with the questions his roadside assistance raised. He does not back simply reinstating the ACA mandate but wants to explore all options. Is there critical care coverage that could be provided to all Minnesotans, for example? Are there other incentives the state could enact to get people to sign up for coverage? How much would these cost? How much can the state afford?

His legislative colleagues ought to applaud his passion and join him in searching for innovative, doable ways to keep Minnesotans covered. Said Jensen: "If we're not going to go after this and try to solve this as aggressively as I would a patient's appendicitis or diarrhea, if we're not going to do this, then I'm wasting my time in the Senate."