Changing power at the Minnesota Legislature puts the future of Minnesota's precarious health insurance system in new hands.
Republican Sen. Michelle Benson will chair a powerful health care committee in 2017 after the GOP won back control of the state Senate.
Together with a Republican-controlled House, Benson and the Senate GOP will debate drastic changes to Minnesota's health insurance system at a time of skyrocketing monthly premiums and concerns about access in the individual market.
That market -- for residents not covered by employers or through public programs -- is a small segment of Minnesota health insurance. But it's been turned on its head by President Barack Obama's health care law, with 50 percent to 67 percent rate hikes next year that have lawmakers discussing a special session to provide cost relief for those who don't get federal subsidies.
Benson spoke to The Associated Press about her thoughts on what's gone wrong in Minnesota's insurance market and how to fix it. Her answers were edited for length.
Q: What is the problem driving these cost increases and instability?
A: The market was destabilized through the Affordable Care Act reforms ... because we had a relatively small individual market. When they took away the reinsurance pool, I think that was a significant impact in the market too. Right now, people don't have good choices. A lot of people are going to go without insurance because the individual market is just too expensive for a family to afford.
Q: What are you expecting from the incoming Trump administration? He has promised to repeal and replace the law.
A: I don't know exactly what the Affordable Care Act rollback and framework will look like. I think we are going to have a lot more freedom and latitude.
Q: How much can the Legislature really do before the changes from the federal level become clear?
A: We have to put some solid things in place. I think we have to look at a reinsurance program (to help insurers pay for high-cost patients). How do we improve choice of competitiveness? I don't know if we've already gone too far. Can the individual market recover?
Q: What are your top three ideas for making the market healthier?
A: If we can focus on giving consumers more flexibility in their plan, it would be a more attractive market. If we can get the feds to ease up on some tax laws: employers can deduct those plans, but individuals cannot. If we were allowed to market plans that were more similar to the large group market, there might be more employers who can offer plans to their employees.
Q: Should MNsure, the state's exchange, exist in 2018?
A: We won't need a state exchange if the federal government doesn't want to collect that data. It might be of use for public program enrollment system. Most of the clients served by MNsure are actually public program enrollees. If the MNsure IT backbone works for that, let's just put it to good use. I don't like to waste things.
Q: How much of your health care agenda hinges on the state's budgetary health? Will signs of a budget shortfall when state officials release an economic forecast next week make it harder?
A: There are things that have just gotten too expensive. There's nothing like a scarcity of resources to get people to the table and focused on outcomes.
Q: Will there be a special session?
A: I am less hopeful today than I was even a couple of days ago. We're just not hearing anything from the governor that indicates he's interested in the bigger picture in health care. There needs to be some understanding from the governor's office that he wants to change things going forward. If we get that, I think we go a long way to opening the door to a special session.