Minnesota can lead on health exchange

Stopping the state from setting up a customized health care exchange website will not thwart "Obamacare" one bit.

Instead, obstructing or ignoring this key pillar of the 2010 Affordable Care Act (ACA) -- exchanges allow comparison-shopping for medical insurance -- would simply mean that the federal government will dictate a one-size-fits-all exchange two years from now.

That would be a step backward for state consumers, businesses and insurers, all of whom deserve an exchange designed by Minnesotans for Minnesotans.

There's strong consensus about this among the state's respected providers, insurers and its business community.

Among the leading advocates for a state-based exchange: the Minnesota Chamber of Commerce, whose position on this issue reflects the state's world-class health care expertise and the need for the exchange to work snag-free for the businesses that will rely on it beginning in 2014.

Minnesota lawmakers need to heed this groundswell of support. Delusions about defying "Obamacare" have contributed mightily to dithering this session on legislation needed to create a governance framework for a state-run exchange.

The lack of progress is stunning. As of Tuesday, none of the exchange bills had made it out of legislative committees or had even been given a hearing.

While progress on this type of legislation varies across the nation, a health care standout like Minnesota should be leading, not lagging.

States such as California, Maryland, West Virginia and Utah have already passed bills. Massachusetts' early adaptor exchange -- the Connector -- is up and running as part of that state's 2006 health reform.

Doing nothing to set up an exchange in Minnesota cedes authority for this to distant bureaucrats. The feds will provide a default plan in 2013 if the state hasn't acted. The state then will have a year to get an exchange up and running.

That would be a rush job given the complexities involved. What a default exchange would look like is a big unknown; the U.S. Department of Health and Human Services has not yet released details.

Minnesota can and should do better. How provider networks will be structured and how the state's high-risk insurance pool will be handled are decisions best made locally.

A state-run exchange should also take advantage of the leading-edge quality measures the state has put in place. Those measures will help improve care while saving consumers and businesses money.

Consumers especially should demand a state-run exchange. If something goes wrong with an insurance purchase -- an enrollment card doesn't arrive, for example -- who would you rather call: Someone in St. Paul or someone on the East Coast?

The ACA faces legal and political challenges, particularly if Republicans gain control of the White House in 2012. The work that comes with the exchanges can't wait until then.

"Minnesota over the years has done pretty good work on health care, and I think we can do good work on the health care exchange. I don't think we want the federal government telling us how to do it," said David Olson, president of the Minnesota Chamber of Commerce.

"If this thing is stuck down as unconstitutional, [legislators] can sunset the exchange. In the meantime, I think we ought to be getting ready."

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