The Minnesota Senate on Thursday night followed the House in passing legislation to create an online health insurance marketplace under the federal health law. A legislative conference committee will meet in coming days to resolve differences between the House and Senate bills. More than one million Minnesotans are projected to find health coverage through the exchange, which is slated to be up and running in October.
The Senate bill passed on a mostly party line vote of 37 to 28 after more than 12 hours of debate.聽 The longest and most contentious battles centered on the small but powerful seven-person board of directors that will govern the exchange鈥檚 operations.聽 Republican Sen. Paul Gazelka from Nisswa wanted to eliminate a provision disqualifying anyone on the payroll of a health care organization or insurer.聽 He said it would be difficult to find experts who aren鈥檛 currently working in health care.
鈥淚n this particular industry, like a lot of industries, your expertise, if you鈥檙e out of it for a year, yeah, you still have a lot of wisdom and expertise, but you are missing whatever is currently changing both technology and otherwise,鈥� said Gazelka.
Mound Republican David Osmek, who鈥檚 employed by the nation鈥檚 largest health insurer, UnitedHealth Group, agreed.
鈥淯nitedHealth Group, they鈥檙e into the millions of people, they are the largest in this nation,鈥� said Osmek.聽鈥淎nd that we would not use that level of expertise, that level of knowledge leverage our health system to be the best that it is, is an abomination.鈥�
The Senate bill鈥檚 chief author, Tony Lourey, a Democrat from Kerrick, defended the restrictions.
鈥淵ou don鈥檛 have to get a check from industry to be an expert on know how the industry works,鈥� Lourey said. 鈥淲e are not trying to exclude the experience or the perspective. We鈥檙e trying to exclude the direct financial conflict of interest.鈥�
Like most amendments the GOP offered, the proposal failed to win a majority in the Demcratic majority Senate.
The board鈥檚 power to exclude plans from selling on the exchange also was an issue. This topic has been a speed bump for legislation that鈥檚 otherwise moved swiftly through previous committees.聽Last week, the chief author of the bill secured an amendment allowing companies to sell at least two products on the exchange.
Senate Republicans, including Michelle Benson from Ham Lake, asked to go further: to allow any plan that meets state requirements to be available on the exchange.聽 Otherwise, she said, the board is limiting consumer choice.
鈥淚f the board decides that there are only two plans of value at each level in this state, the consumers get no more say in the exchange; end of discussion,鈥� Benson said.
Senate Minority Leader David Hann from Eden Prairie said allowing the board to exclude plans is giving too much power to the government.
鈥淭his is what we鈥檙e doing here, people,鈥� Hann said. 鈥淲e鈥檙e saying we鈥檙e going to limit your choices for your own good, because we know better than you how to spend your money. That鈥檚 what Sen. Lourey and this bill and the Democrats and the Democrats in Washington鈥� that鈥檚 what they鈥檙e saying.鈥�
Chief author Tony Lourey said the board鈥檚 power to choose plans would make sure that the coverage offered on the exchange serves the public interest.
鈥淭he question before us is whether that value in the competition is driven better by having more plans or by having better plans on the exchange.聽This is about getting plans that are in the interest of consumers,鈥� Lourey said.
The amendment to strip the board鈥檚 power to deny certified plans ultimately failed.聽
Several GOP amendments beefing up privacy protections passed. One provides that state law will prevail when Minnesota law聽provides greater privacy protection than federal law. Another successful amendment聽 requires the exchange to have a list and descriptions of its data-sharing agreements on its website.聽
And the Senate agreed to require all state聽legislators to buy their health coverage on the exchange.
During debate, Republicans frequently recalled Gov. Mark Dayton鈥檚 recent comment that the exchange is a gamble. Dayton, a supporter of a single payer system, clarified Thursday that he didn鈥檛 want to get the public鈥檚 hopes up that the exchange would work smoothly from day one.
鈥淭here are going to be some glitches initially, and it will take some time to iron that out,鈥� Dayton said.
A conference committee will have to聽reconcile several material differences between the House and Senate bills, abortion coverage among them. The House version forbids health plans to cover abortions, except to save the life of the woman or if the pregnancy results from rape or incest.聽 The chambers also differ on how to fund the exchange鈥檚 operations: The House bill would impose a user tax of up to 3.5 percent of the premiums on plans sold on the exchange; the Senate would use an existing tobacco tax.聽聽
If lawmakers fail to pass exchange legislation by March 31, the federal government will play a much stronger role in how an exchange will run in Minnesota.
This story is part of a collaboration that includes , and Kaiser Health News.