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Health insurance No. 1 Minnesota issue

Rep. Matt Dean talks to reporters while he was House majority leader, position he held in 2011 and 2012. (Forum Communications photo by Don Davis)

Preferred One dropped out. So did UCare. Blue Cross Blue Shield stopped offering its regular policies. Medica says it no longer will supply insurance for a state-run health insurance program. "We almost lost all of the private insurers over the summer," Democratic Gov. Mark Dayton said. Minnesota Commerce Commissioner Mike Rothman says the trend may continue, offering the prospect of no health insurance policies being available for private purchase late in 2017 unless state legislators take action. It is an issue that has risen to the top: Premium prices for individual health insurance policies, those that are available, are up to 67 percent more than last year and deductibles sometimes reach several thousands dollars. State leaders agree it is a crisis. It is especially bad in greater Minnesota, where many western and southern residents have just one option, a Blue Cross health maintenance organization policy much more expensive than regular insurance and including fewer health-care providers in its network. Rothman said insurers stayed in the Minnesota individual market only after he pleaded with them to keep offering policies. People do not understand the impact they will feel, Rep. Matt Dean, R-Dellwood, said. "They are going to be really shocked that they have to drive by their doctor and their hospital and the hospital in the next town to get to a doctor in their network," said Dean, a key health-care legislator. "People not being able to get into their doctor or their own hospital is a big deal," Dean added. "It may mean the economic viability of the hospital, long term, could be at risk." Dean called for quick action this legislative session, which begins this week. "This is a real crisis across Minnesota ... but particularly in greater Minnesota," Dean said. The governor and most legislators make fixing the health insurance problem their top priority even though only about 5 percent of Minnesotans buy policies from the individual market. Most of the rest are insured through employer or state plans, which legislative candidates report they heard great concern about all health insurance while knocking on voters' doors this fall In the past two months, more than 100,000 Minnesotans applied for individual insurance through MNsure, the state-run health insurance sales program. An unknown number bought policies from private sources. More than 60 percent who get individual policies are eligible for federal premium aid, available only through MNsure. Officials say many of those who received the assistance are paying just a little more than a year ago, but those who are not eligible are facing massive increases for the same coverage. Dayton and legislative leaders agree that the state needs to help those who do not get federal aid. They could not agree on specifics to pass during a special legislative session, but key lawmakers say an insurance assistant bill will be the first out of the chute in the Minnesota House and Senate. "The first priority is to provide emergency relief to people, who through no fault of their own have got caught up in this mess," Dean said. Legislative leaders suggest the insurance premium relief could be made retroactive to Jan. 1 even if lawmakers pass it weeks from now. Even though there has been no agreement after weeks of negotiations on providing aid, that is the easy part of the insurance problem. A tougher action, which may not happen in time for 2017 policies, is opening up access to doctors, hospitals and other health-care providers. That is the situation Dean mentioned about patients passing their own clinics and hospitals to reach one included in their insurance policy, perhaps 60 miles away. That access issue may have to wait until later in the legislative session, when lawmakers try to fix the situation for 2018 policies. House Speaker Kurt Daudt, R-Crown, said he aims to pass a 2018 fix by mid-March. One unknown that will affect Minnesota policy makers is what President-elect Donald Trump and the GOP-controlled Congress will do on the subject. While Republicans want to get rid of the federal health-care law popularly known as Obamacare, they have yet to spell out a replacement. Since federal law governs what states can do, whatever happens in Minnesota may need to be rehashed once Washington changes the law. Republicans who will draw up Minnesota legislation, which would need Dayton's approval, are considering several changes, including: -- A requirement that insurance policies are kept in force for people with serious illnesses. -- Create more competition, such as allowing for-profit companies to sell insurance in Minnesota (it is limited to non-profits now) and allow out-of-state companies to sell insurance as long as they comply with Minnesota law. -- Expand the insurance pool for individual insurance. The number of people is small and they are sicker than other segments of the population, a combination that drives up costs. Folding other types of health insurance, perhaps including a state-subsidized insurance program known as MinnesotaCare, into the pool could spread out the cost. -- Allowing insurance companies to sell different policies than they can now, such as a low-cost, low-coverage option for young people unlikely to need a full policy. Republicans also would like to get rid of MNsure, saying that allowing a federal insurance sales program that operates in many states would be cheaper.

Don Davis
Don Davis has been the Forum Communications Minnesota Capitol Bureau chief since 2001, covering state government and politics for two dozen newspapers in the state. Don also blogs at Capital Chatter on Areavoices.