A Minnesota Angle on Health Care

In all the current hubbub about health care around the Graham-Cassidy bill, there's one Minnesota-centric story that should be more widely known. You know how Republicans are all about local control and how they want the states to be laboratories of solutions?

Well, that's not really true. Shocking, I know.

Here's the story, but it requires some background. One of the few things the Minnesota legislature did right in its last session was pass a truly bipartisan bill that partially bailed out Minnesotans (like me) who get their insurance on the individual market, because our rates went up — literally — 50 to 70 percent for 2017. And they also passed a reinsurance provision for 2018 to head that problem off in future years.

This type of reinsurance is one of the "fixes" that people in the know often mention, including Republicans, and it was Minnesota Republicans who were the majority when this was passed last spring. I've heard this bill hailed as an example for other states to follow. Great idea, right?

But guess what: In order to do the reinsurance, the state has to apply to the federal Department of Health and Human Services for a waiver. Our governor has been waiting to hear for months, and finally got word that, while the waiver would be approved, it would mean a cut in federal money that currently is used to partially fund MinnesotaCare.

MinnesotaCare is a state program providing health coverage to people who don't have employer coverage, but who make too much money to qualify for Medicaid and not enough to pay for insurance, even with the subsidies available under the ACA. It was implemented about 20 years ago, well before the ACA, with funding through fees on health care providers, and it's currently a great boon to 120,000 people in our state. (I think its numbers used to be higher before the ACA expanded Medicaid coverage to people with incomes up to 133 percent of the poverty rate.) It's our gap coverage, basically, and every state should have something like it.

Under the ACA, Minnesota has been receiving the dollars that would otherwise have gone to these individuals to subsidize their insurance payments. So if a person would have gotten $500 a month to bring their insurance payments to an affordable rate, instead that $500 is going to the state to offset the cost of the person's MinnesotaCare coverage. Makes sense to me.

According to the Star Tribune, HHS plans to cut those payments to the state, $369 million, which blows past the $208 million increase the state will automatically receive because premiums are going up. The net loss is $161 million.

This is the same HHS, under its insider-trading, private-jet-chartering secretary Tom Price, that would be responsible for interpreting the provisions of Graham-Cassidy, such as the vaguely worded section on pre-existing conditions.

So great, let's trust the people who want to make sure poor people have no health coverage, and penalize states that have managed to come up with a bipartisan solution. Sounds like a plan.