Task force calls for health care changes, balks at HealthCare.gov switch

A state task force on health care finance adopted a long list of recommendations Friday, including expansion of the MinnesotaCare health insurance program, maintaining a tax collected by health care providers, and a review of the state's MNsure exchange.

Those three proposals were among the more contentious in a package of more than 30 recommendations approved by the task force on a 20-5 vote. Four people abstained.

The recommendations go to DFL Gov. Mark Dayton and the Legislature in a report later this month, but Friday's vote showed a clear partisan divide.

All three DFL lawmakers on the panel supported the plan, while the two Republican legislators who voted were against it.

"I'm going to be carrying these to the Legislature, and hope that we can get a good start on implementing some of these," said Sen. Tony Lourey, DFL-Kerrick, a task force member."

"I think the fiscal model is pretty clear that it's a good deal" to expand MinnesotaCare, said Lourey, whose party controls the state Senate. "I think it might have legs."

Rep. Matt Dean, R-Dellwood, also a task force member, said the biggest proposals wouldn't fly in the Republican-controlled House.

"The committee voted to add more cost to just about everywhere …," Dean said. "I wish we had made some tougher choices and actually tackled how are we going to pay for MinnesotaCare, without simply saying: 'Well, we're going to raise taxes.' "

Dayton called for creation of the 29-person task force last year as lawmakers debated changes to MNsure and MinnesotaCare, in particular.

On MNsure, the panel didn't embrace a proposal from House Republicans to dump the state's online marketplace and move to the federal HealthCare.gov exchange. MNsure has had technology problems and lower-than-expected enrollment since it was launched in 2013 as part of the federal Affordable Care Act.

On MinnesotaCare, the task force backed a proposed expansion of the program to cover another 41,200 people. House Republicans have called for directing enrollees to private coverage.

MinnesotaCare provides subsidized health coverage to a group that's often described as the "working poor" — people who don't qualify for the state-federal Medicaid program and don't get coverage from an employer, either. MinnesotaCare currently covers about 120,000 people.

The program is funded in part by a tax that health care providers collect, which is currently scheduled to sunset in 2019.

The task force called for continuing the provider tax, which would generate $972 million for state health care programs over a two-year period ending June 2021.

Lourey said a study developed for the task force showed that MinnesotaCare coverage could be expanded without adding costs to the state budget, and might actually generate savings. He argued that the proposed expansion is actually a restoration of the program, because those who would be added to MinnesotaCare were previously eligible for the program.

"The feds have some new, really interesting options [in 2017] that allow us to restore MinnesotaCare," Lourey said during Friday's meeting near the Capitol in St. Paul.

But task force member Molly Jungbauer, chief executive of Hollstadt & Associates, said expanding public health insurance coverage would shift costs onto the private health insurance market, because programs like MinnesotaCare pay doctors and hospitals significantly less for providing health care services.

The study done for the task force suggested that doctors and hospitals might get paid about 50 percent more for providing the same services to people with private individual health insurance policies, than for those in public programs.

"I don't know where else that expense can go, because our providers have fixed costs that have to be reimbursed somehow," said Jungbauer, who voted against the task force's recommendations.

Task force member Lynn Blewett said any savings generated through the MinnesotaCare expansion could be put toward improving reimbursement rates to doctors and hospitals through the program.

Expanding MinnesotaCare would have implications for MNsure, because many people who might newly qualify for the program can currently purchase through the health insurance exchange.

The proposed recommendations do not support a move to HealthCare.gov because the switch would be costly and force the state to surrender control, said Blewett, who is a health policy researcher at the University of Minnesota and voted in support of the recommendations.

The task force also called for a review of MNsure's performance after the current open enrollment period.

Christopher Snowbeck • 612-673-4744

Twitter: @chrissnowbeck