Keep MinnesotaCare: Here's Why

I learned today from the Pioneer Press that Minnesota is unique within the national rollout of the Affordable Care Act. Where most states have a bunch of people who receive Medicaid (called Medical Assistance in Minnesota) and another bunch who can purchase private plans through an exchange (with tax credits if their incomes are below a certain level), Minnesota has a group of people in between.

They're covered by MinnesotaCare, which was started back in the 1990s as the beginning of universal health care in our state. Unfortunately, the forward movement toward full coverage stalled out, but at least we have the beginning of it.

Funded by a tax on health services, it covers people who generally have jobs, but make only between 138 and 200 percent of the poverty level. (That's $16,242.60 to $23,540 for an individual or $33,465 to $48,500 for a family of four -- your typical minimum- or close-to-minimum-wage worker.) When the program started, these were the people who made too much for Medical Assistance, but not enough to afford to pay for insurance without a subsidy, and their employers didn't provide coverage either.

MinnesotaCare has been a tremendous success. It covers 100,000 people at a cost of just over $5,000 each -- a lot less than my private insurance, let me tell you. And the state only pays half of that; the feds pick up the rest, though that subsidy will decrease in the future. (Medical Assistance has a significantly higher cost per person, since it covers many people over 60 and who have disabilities.)

Now our Republican-led House of Representatives wants to kill MinnesotaCare and dump those 100,000 people onto our state exchange. It seems maybe reasonable if you don't think about it too hard... If they can get coverage with tax credits that work out to a net amount of payment similar to their MinnesotaCare premiums, why not?

I'll tell you why not: First, there's no guarantee that the amount they have to pay for premiums (after their credits) will be as low as their current MinnesotaCare premiums, which range from only $15 to $50 a month (that range is based on income).

Second, and probably most important, their coverage under MinnesotaCare covers 98 percent of their health care costs, while the plans under MNSure cover at most 90 percent (for the platinum level). The most popular plan, silver, covers only 70 percent. Where are these folks with their minimum-wage incomes supposed to come up with the difference? If you break your ankle like I did, for instance, you end up paying a whole lot of money out of pocket before you hit your deductible. Under MinnesotaCare, you don't.

So in a state where we have a significant budget surplus, the Republicans are using their new majority to immediately stick it to the working poor in a really obvious and outrageous way. It may not be quite as bad as Kansas and Missouri's changes to their SNAP and TANF rules, but it's bad.

MinnesotaCare should be expanded, in my opinion, not cut back.