Minnesota officials say they will press ahead with new health care system

Gov. Mark Dayton's administration and state lawmakers have been preparing for life under President Barack Obama's health care law for some time. But their efforts got a new push Thursday when the U.S. Supreme Court upheld virtually all of the federal law.

Several Republicans, however, are holding out hope the law can still be abolished.

Minnesota's efforts to implement the Affordable Care Act have been a political tug-of-war so far, with Dayton aiming to enact its provisions while Republicans in the Legislature push back against him.

Now that the Supreme Court has ruled, the constitutionality of the law is settled, Human Services Commissioner Lucinda Jesson said.

"This clarity provides us an opportunity for a fresh start to reach out to others who have been skeptical about the good things in the affordable care act," Jesson said. "And I hope they'll join us in trying to implement it for all Minnesotans."

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Minnesota and the other states are responsible for delivering a large part of the health insurance coverage created under the law. The first piece, an expansion of Medicaid, was initially delayed by former Republican Gov. Tim Pawlenty. But Dayton, a Democrat, put it in place in early 2011.

About 85,000 Minnesotans have since been enrolled in the government program for people with low incomes. The other cornerstone of the federal law is a state-based health insurance exchange.

State Commerce Commissioner Mike Rothman has been working to create an exchange that would allow businesses and consumers to shop for health insurance. Expecting the court to reject the law, the Republican majority in the Legislature balked at providing ideas for an exchange and argued the governor cannot create the exchange without legislative input.

Rothman said he hopes to submit the state's plan for federal approval by Jan. 1.

"With the decision of the Supreme Court today, it makes it all the more important that we are focused on the choice to make and design our exchange in Minnesota, or the federal government option will be made for us," he said.

If Minnesota doesn't submit a plan, the federal government will create an exchange on the state's behalf. Several groups, including the Minnesota Chamber of Commerce and Minnesota Citizens Concerned for Life, have urged state lawmakers to create a state-based exchange, rather than submit to federal control.

State Rep. Jim Abeler, chairman of the House Health and Human Services Finance Committee, said he doesn't like the federal health care law but said the court's decision means it's time to start implementing one.

"We're going to have to move along and do our best to implement what the demand has been from the federal government whether we like it or not," said Abeler, R-Anoka. "Or worse things are going to happen."

Republican Sen. David Hann, chairman of the Senate Health and Human Services Committee, is willing to wait a few more months. Like many other Republicans nationally, Hann of Eden Prairie, hopes Republicans will win the White House, the U.S. Senate and the U.S. House in November.

Hann said he won't offer any legislation to create an exchange until he sees the outcome of the election.

"If the political response to this is what I believe it will be, the law will be overturned in the next session, and we will be remiss to go too far down the path of implementing something that would get repealed," Hann said.

House Minority Leader Paul Thissen said Hann's approach is bad for Minnesota. He said failing to create a Minnesota based-exchange means the state will run the risk of weakening its nation-leading health care system.

"Sen. Hann's approach to this bill is always finding another excuse to not go along with the direction that that country is going," said Thissen, DFL-Minneapolis. "To find another excuse to become the no, the gridlock, the block as opposed to working together to solve problems, and that certainly is going to be something that will be at the heart of the next election."

The Legislature won't be able to take up any health care legislation until it returns in January for the 2013 session. By that time, voters will have chosen which party will decide the health care debate.

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