The Big Story Blog

Minnesota officials divided on effects of Court decision

Posted at 4:29 PM on June 28, 2012 by Paul Tosto
Filed under: Health, Politics

Here's MPR News reporter Elizabeth Stawicki's story on the Supreme Court's decision to uphold much of the Affordable Care Act.

Steve Knutson has spent his career trying to get health care for those who can't afford it. He runs the Neighborhood Health Source, four community primary care clinics in north Minneapolis. Forty percent of the patients have no insurance.

"Right now so many of our uninsured patients delay care or avoid care altogether because there's just no ability to cover even a portion of the costs of that."

Knutson says the court's ruling lifts the financial barrier for people to get health care and get it earlier.

One of the main goals of the federal health care law is to expand health care coverage to those who don't have it.

While Minnesota's 9 percent uninsured rate is low compared to the national average of 16 percent that still amounts to nearly a half million people in the state. And that number has been growing.

"So this is a significant step for Minnesota in terms of moving to cover uninsured in the state," said University of Minnesota economist, Lynn Blewett. The law's reforms, she added, should cut the number of uninsured residents in Minnesota by more than half.

One of the ways the law will help fill in that coverage gap is by expanding the joint federal/state program for low-income people known as Medicaid. While the court ruled that states may opt out of the expansion, Minnesota has already signed on.

The Medicaid expansion allows Minnesota to get federal matching dollars for providing health insurance for residents previously covered solely with state dollars through GAMC and MinnesotaCare programs. The expansion is expected to deliver more than $2.8 billion in federal funding to the state over the next several years.

The Department of Human Services says currently 84,000 Minnesotans are enrolled under the Medicaid expansion. Of those, approximately 30,000 were from the former GAMC program; 50,000 from the MinnesotaCare program.

"What the Affordable Care Act does is give us additional federal dollars so that we can do our job quicker and faster and with less additional impact on Minnesota taxpayers," said Human Services Commissioner Lucinda Jesson:

The Medicaid issue is also important to insurance giant UnitedHealth Group, a major employer in Minnesota. The Minnetonka-based company has a subsidiary serving Medicaid patients in 23 states, which brought in nearly $14 billion in revenue last year.

The law is expected to bring health insurers an influx of new customers.

Geoff Bartsh of the Medica health plan says the court's ruling brings a little more certainty that until now has been non-existent. Insurers have had to plan for new customers and new regulations.

But while the Supreme Court's ruling provides more certainty, it isn't the final word. Depending on the outcome of the November elections, Bartsh says Congress could substantially change the law.

"So while this gives us some clarity in terms of the constitutionality of the law as it stands today, it certainly doesn't give us any clarity in terms of how the law might look, or how the law might change, between now and 2014 when the law goes fully into effect."

Health Partners released a statement calling for adjustments in the law to make sure that coverage is affordable, saying under the current law, individuals and small employers will pay for coverage.

Mayo Clinic, which had been held up by the Obama Administration as an example of how the health care law could function in reality, says it won't see major changes. The world-renowned clinic has been a pioneer of a centerpiece of the law ... so-called patient-centered care and regardless of the ruling, officials there say Mayo will continue to innovate.

Lawrence Massa of the Minnesota Hospital Association, which represents most of the state's hospitals, says the ruling means fewer patients will be unable to pay their medical bills.

"Minnesota has been a leader in the country in terms of providing coverage," he said. "So we're not going to see as many new people covered as some of the other states under the law. But it certainly gives our state some advantages in terms of the Medicaid expansion and some of those provisions."

On the other hand, there's still the question for insurers over the future of Minnesota's health insurance exchange.

The state-based exchanges are a cornerstone of the federal health care law.

Envisioned as online marketplaces where individuals and small groups can comparison shop for health insurance, these are supposed to be operating by early 2014.

But GOP state lawmakers led by Sen. David Hann of Eden Prairie have rallied against it. Hann, who chairs the Health and Human Services Committee, says the High Court's ruling doesn't change his mind that a Dayton-created exchange will be bad for the state. He says the Obama health care law is the law of the land now, but he says that could change after the November elections

"Depending on how that election goes," he said, "if the political response to this is
what I believe it will be the law will be overturned in the next session and we would be remiss in going too far down the path of implementing something that would get repealed."

A lingering question is whether the Dayton administration has enough legal authority through its executive powers to commit the state to an exchange or will need legislative buy-in to do so.

The ruling doesn't change much for Minnesota's big medical device companies. Analysts say most people getting pacemakers and other implantable devices were already insured through Medicare and that companies have taken actions to offset the impact of the a tax on devices. Nonetheless, there have already been moves in Congress to repeal the tax with bi-partisan support.

In any case, today's ruling is only a way station in the law's history. The Supreme Court's decision provides certainty that the federal health care passes constitutional muster, but it remains to be seen whether it passes muster with the voters and their elected officials following the election.


About Paul Tosto

Paul Tosto

Paul Tosto writes the Big Story Blog for MPR News. He joined the newsroom in 2008 after more than 20 years reporting on education, politics and the economy for news wires and newspapers across the country.