Insurance health care exchange legislation clears for legislative committee

by T.W. Budig
ECM Capitol reporter

Insurance health care exchange legislation cleared its first legislative committee with Democratic leaders wanting the complex bill signed by the governor and out the door by the end of March.

A Senate committee on a party-line vote Thursday (Jan. 17) advanced Sen. Tony Lourey’s exchange bill, touching off a flurry of committee hearings in the Senate on the state’s alternative to a federal insurance exchange.

Senators Bruce Anderson, R-Buffalo Township, Alice Johnson, DFL-Spring Lake Park, and Bev Scalze, DFL-Little Canada, listen to insurance exchange testimony in committee. (Photo by T.W. Budig)

Senators Bruce Anderson, R-Buffalo Township, Alice Johnson, DFL-Spring Lake Park, and Bev Scalze, DFL-Little Canada, listen to insurance exchange testimony in committee. (Photo by T.W. Budig)

The House is expected to hold its first exchange committee hearing this week.

Minnesota is one of 18 states that has conditional approval from the federal government to launch its own insurance exchange.

Speed is part of the bargain.

Because insurance companies must be allowed six months to prepare products to sell in the exchange, a one-stop marketplace where consumers can browse for the best buy, the state exchange must be state law by the end of March.

Enrollment is scheduled to begin Oct. 1, with plan coverage starting the first of the year.

The exchange is expected to serve more than a million Minnesotans.

Lawmakers flatly say they need to bone up on the legislation.

“I think other than (Republican Rep.) Jim Abeler and a couple of others, (House Health and Human Services Finance Committee Chairman Tom) Huntley, that have worked on this for a long time, I would wager most people don’t have a clue,” said Rep. Jerry Newton, DFL-Coon Rapids.

Senate Commerce Committee Chairman James Metzen, DFL-South St. Paul, held up a diagram of the workings of the exchange — a diagram at a distance resembling the guts of a computer — as evidence of complexity.

Does he fully understand it?

“I don’t, but I’m learning,” said Metzen, speaking after the committee hearing.

“I think we can do a thoughtful, good job in the time frame we have,” he said.

Minnesota Exchange Executive Director April Todd-Malmlove will become a fixture at the State Capitol in upcoming weeks as insurance exchange legislation working through House and Senate may require stops in a dozen or more committees. (Photo by T.W. Budig)

Minnesota Exchange Executive Director April Todd-Malmlove will become a fixture at the State Capitol in upcoming weeks as insurance exchange legislation working through House and Senate may require stops in a dozen or more committees. (Photo by T.W. Budig)

Minnesota Exchange Director April Todd-Malmlov appeared before two Senate committees, detailing the form and function of the exchange.

“It’s not just a $110 million website,” she told one committee with a smile, referring federal grants for developing the exchange.

The exchange is ushering in fundamental health insurance reform, she explained.

Todd-Malmlov depicted the exchange — soon too have a new name, because no one likes what it’s currently called, she said — as providing consumers with apples-to-apples comparisons of insurance products, with “navigators” to assist them, all with high-tech access.

Consumers can browse among “gold” plans, or “silver” plans.

Eligibility for a given plan can be confirmed in as little as 30 minutes on the exchange, she explained.

Individuals and people on Medical Assistance will make up the bulk of the 1.3 million Minnesotans the exchange is expected to serve.

“The exchange is there to make things simple for people,” Todd-Malmlov said.

All Americans, under the federal Affordable Care Act, must have health insurance.

The exchange budget is estimated at $40 million to $50 million a year.

The entity is proposed to fund itself by collecting 3.5 percent of total premiums for individual market and small group market health benefit plans sold through the exchange.

By federal law, the exchange must be self-funding by 2015.

Legislation calls for the creation of a seven-member board of directors to operate the exchange.

Sen. Dave Thompson, R-Lakeville, an exchange critic, likened the proposed board to a “Met Council on speed.”

He expressed concern over insufficient legislative oversight.

This concern has been voiced by others.

“I favor a lot of detail (in the legislation),” said Abeler, former Republican House Health and Human Services Finance Committee chairman.

Abeler is working with Democrats on the exchange in the spirit of crafting the best bill possible.

But he believes the current proposal has basic flaws.

“This is set up to be so simplistic you don’t even have to think about,” Abeler said of using the exchange.

All that technology costs a lot of money.

“I think we can do it for much less,” Abeler said.

But Abeler, like other Republicans and Democrats, agrees the state is much better off designing its own exchange than having a bureaucrat in a Washington cubicle pulling the wires.

It’s much better Minnesotans can call a phone number with a “651” prefix than a “202,” the latter being one for Washington, many lawmakers say.

“We all believe it,” Abeler said.

Health care consultant Dr. Roger Kathol, president of Cartesian Solutions of Burnsville, served on Democratic Gov. Mark Dayton’s health care exchange task force.

He views the proposed exchange as a proper public/private partnership.

It makes sense the government is involved, as so many exchange customers will be people on government health care programs, Kathol noted.

“Some do, some don’t,” he said of lawmakers wanting more control.

Kathol views the proposed board model as offering stability.

One worry for task force members, he indicated, was that exchange funding would be raided by lawmakers during times of state budget woes.

Getting the exchange up and running is a challenge.

“It’s a massive undertaking just to put the infrastructure together,” Kathol said.

Other criticisms of Lourey’s bill includes concerns over conflict of interest provisions for board members.

Some find them too stringent, chasing away professional with in-depth, timely knowledge of the health care industry.

“This just seems to be eliminating a class of people,” Thompson said in committee.

Other criticisms were voiced by the health care industry.

“There’s something for everyone to love in this bill — even you, Sen. Thompson, I believe,” Lourey, DFL-Kerrick, said in committee.

But Lourey conceded there was also something to hate.

Republicans in the Senate State and Local Government Committee — the first committee to advance an exchange bill — cautioned against hastiness.

“I think it’s moving way too fast,” said Sen. Bruce Anderson, R-Buffalo Township.

Sen. Dan Hall, R-Burnsville, agreed.

“It takes some time to digest it,” Hall said.

Sen. Bev Scalze, DFL-Little Canada, said discussions had been going on for almost two years.

“It’s time that we take actions on this,” she said.

On a party line vote, the bill passed the committee.

House Commerce Committee Chairman Joe Atkins, DFL-Inver Grove Heights, is carrying the House health care insurance exchange bill.

Tim Budig is at tim.budig@ecm-inc.com.

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