Proposed MinnesotaCare expansion aims to aid undocumented immigrants, small businesses, families

Last year, small-business owner Dan Marshall’s 18-year-old son hit his thumb while chopping wood – but argued that he shouldn’t go to the emergency room, because he didn’t want his family to be hit with a high insurance deductible.

“As a parent, I feel pretty terrible that kind of message has come through to my kids,” Marshall said. “That: no, you don’t go to the hospital even if you’ve grievously injured yourself … because you have to worry about money. … But after 22 years as a small-business owner, that’s what they’ve taken in.”

Small-business owners are one of several groups who could gain access to health insurance through a “MinnesotaCare public option” that would be created by HF11, sponsored by Rep. Jennifer Schultz (DFL-Duluth).

The House Health Policy and Finance Committee approved the bill, as amended, 11-8 Tuesday. It now goes to the House Commerce Finance and Policy Committee. There is no Senate companion.

“This is a small bill but it does big things,” Schultz said. “The goal is to increase health insurance coverage across the state and improve affordability by giving Minnesotans the option to choose comprehensive coverage.”

The bill would increase access to MinnesotaCare in three different waves, she explained.

First, in 2022, coverage would be extended to people within the current income limits — 200% of the federal poverty guidelines — but are not currently considered eligible: undocumented immigrants and people impacted by “the family glitch,” which excludes the cost of an entire family when determining the affordability of employer-subsidized coverage.

The next wave, in 2023, would open MinnesotaCare to families even if they exceeded the current income limits, and allow employers with 50 or fewer employees to contribute towards their MinnesotaCare premiums.

The bill would be “a true game changer for us and thousands of other small-business owners,” said Marshall, who owns Mischief Toy Store in St. Paul. “It would offer predictability.”

He was one of several testifiers — including other small business owners and farmers — who spoke about the difficulty, uncertainty, or financial impossibility of getting health insurance coverage, given the current options.

“This poverty level is about $25,000 for a single person and $52,000 for a family of four,” Schultz said. “And these premiums would be based on an income-based sliding fee scale.”

Currently, people may qualify for MinnesotaCare one year, but be forced to forgo insurance entirely the next if they go slightly over the current limits.

“It makes no sense for a person to have to choose between quality income and access to quality health insurance,” said Jack Ramsland, a farm worker and Land Stewardship Project member.

The last phase of the proposed legislation would consider ways to increase access further across the state, Schultz said.

“We really want to evaluate whether this expansion is a good idea, and if it’s effective, and look at other delivery options and payment methodologies,” Schultz said.

The idea is to improve hospitals’ ability to negotiate by increasing competition in the marketplace; decrease out-of-pocket spending for individuals and families; decrease the number of people who are uninsured; and reduce the cost of uncompensated care “passed on to all of us through higher premiums,” Schultz said.

Testifiers — representing the Minnesota Council of Health Plans, The Minnesota Business Partnership, and the Minnesota Chamber of Commerce — expressed support for MinnesotaCare as it currently stands, but stated this sort of expansion could have a negative impact on other segments of the health insurance market.

Their concerns included increased premiums for people who do get insurance through their employers and unsustainably low reimbursement rates for health care providers that could force much-needed resources to close, especially in rural areas.

Amendments

Rep. Joe Schomacker (R-Luverne) offered, and then withdrew, two amendments he said he intends to work on further with Schultz and in future committee stops.

The first would require people to enroll in MinnesotaCare during the regular enrollment period, while the second would allow managed care providers to opt out of serving people so they wouldn’t be stuck with lower reimbursement rates.

An amendment offered by Rep. Glenn Gruenhagen (R-Glencoe) was voted down 11-8, but proposed a completely different approach to helping families with high costs: reference-based pricing that would shift responsibility for negotiating with medical providers to the consumer.