Change is coming to health coverage in Minnesota, but until Donald Trump takes office and reveals how he and the Republican-controlled Congress plan to overhaul or replace the Affordable Care Act, it's unclear what that change will look like.
A repeal or replacement of the health law could pose problems for the more than 1 million Minnesota residents on public programs and could dismantle the state and federal health insurance exchanges. Meanwhile, the Republicans who now control both chambers of the Minnesota Legislature are plotting their own health care changes as all Minnesota officials remain mostly in the dark.
"We have really no idea what form it will take," Democratic Gov. Mark Dayton said Friday.
Minnesota's health care system stands out across the nation — for reasons good and bad. Not only did the state set up its own health insurance exchange and expand the low-income health care program Medicaid, but Minnesota offers another subsidized program called MinnesotaCare for those who make too much to qualify for Medicaid, which is called Medical Assistance in Minnesota. But premium rates for individuals who buy insurance on their own are set to jump as much as 67 percent next year, the fourth-largest increase in the nation.
Emboldened by taking control of the Legislature after campaigning on those high costs, Minnesota Republicans won't necessarily wait for the federal government to act before they start making changes. House Speaker Kurt Daudt has called it a mandate.
Rep. Matt Dean, a Dellwood Republican and leader on health care issues, faulted MinnesotaCare for exacerbating the high costs that have driven up rates — House Republicans tried to axe that program in 2015. Dean said Minnesota should replace the Affordable Care Act with its old approach, a high-risk pool to cover ill and expensive consumers who previously couldn't get health insurance.
He said the old model could serve as a guide for Trump as he and Congress consider how to fix the Affordable Care Act. But in the meantime, Dean said Minnesota should dump MNsure and move to the federal exchange.
"I think we need to kill it and bury it and move on," he said, echoing other leaders in both the state House and Senate. "The sooner the better."
Allison O'Toole, MNsure's chief executive, is assuring consumers that no matter what happens, the health plans they select for 2017 are guaranteed through the end of that year. She said the exchange is focused on signing up enrollees for coverage through open enrollment — 22,000 Minnesota residents who aren't covered by employers or public programs had purchased coverage through MNsure as of Friday, smashing previous records.
"We have the lowest uninsured rate in state history. I hope that any policy change they pursue doesn't change that. That's good for all of us," O'Toole said.
Outnumbered by a GOP-controlled Senate and House, Dayton said he is ready to fight against drastic changes. He said his priorities will hinge on what happens at the federal level, but cautioned lawmakers against scrapping MNsure, saying the sticker shock has nothing to do with exchange but the health care overhaul as a whole.
"It's a great political slogan. I think it had a major impact on some of the legislative races," Dayton said of Republicans tying Minnesota Democrats and MNsure to the rate increases. "But it's another thing to deal with the reality of what you put in its place."
"They better look before they push us over the cliff," he added.