Business groups frustrated over lack of information on health exchange

Commissioner Rothman
Minnesota Department of Commerce Commissioner Michael Rothman discusses the health insurance exchange program at the Capitol in St. Paul, Minn., on Monday, Jan. 30, 2012.
MPR Photo/Jeffrey Thompson

Officials representing health insurance agents and brokers in Minnesota will have their first meeting on Tuesday with state Commerce Commissioner Michael Rothman to discuss concerns they have raised.

The brokers and agents are worried that state officials are implementing the federal health care law in ways that will hurt their business. They and other Minnesota business groups also say they are frustrated by what they call a lack of transparency as Rothman's department develops one of the foundations of the law: a health insurance exchange.

About a million Minnesotans will receive health insurance through the state's exchange starting in 2014. But deadlines are already looming. Minnesota and other states have less than 90 days to submit a detailed plan to the federal government about how their exchanges will work; the deadline is Nov. 16.

But last month, Gov. Mark Dayton announced that the administration would make no final decisions for developing Minnesota's insurance exchange until after the Nov. 6 election. That leaves a window of a week and a half between the election and the application deadline.

David Olson, head of the Minnesota Chamber of Commerce, the state's largest business group, was not pleased with the delay. But his displeasure is bipartisan: He is unhappy that the Republican-controlled Legislature has refused to authorize an exchange for the state, and he is frustrated that as the November deadline looms the Dayton administration hasn't settled basic questions. Those questions include who will run the exchange, how much it will cost and how the state will pay for it.

"We don't like poking fights with the administration or commerce commissioner or any of those people," Olson said. "They're hardworking, well-meaning people. But the bottom line is that our members have no clue what this exchange is going to look like or how they're going to buy their insurance."

Rothman said the department is working with all stakeholders, including the chamber. But he says the state doesn't have to make final decisions on those big issues yet. The state can submit an application with preliminary answers to those questions to meet the deadline, and the Legislature can make changes later.

"The application is to show the federal government that we have the plans, the designs in place at a minimum to have a state-based exchange," Rothman said. "There's flexibility there; there could be changes."

Even so, business groups like the Chamber of Commerce are going public with complaints that major policy decisions remain to be made and the state Commerce Department, which is developing the exchange, is unresponsive to requests for information.

The chamber sent a letter to Rothman about six weeks ago outlining its questions. Rothman met with Olson in mid-August, but Olson said he came away from the meeting unsatisfied. As of last week, the chamber was still waiting for a letter back from the commissioner.

Minnesota insurance agents and brokers sent a letter to Rothman in May seeking answers about how the exchange would affect their compensation. Rothman said he called but waited until after the Supreme Court upheld the law on June 28 to respond in writing.

His reply is dated Aug. 2. Even then, the letter was vague and light on specifics, said Robert Hanlon, a member of the insurance exchange advisory task force representing brokers and agents.

"They feel, [and] I feel, that if we don't see anything then decisions are being made without us, or no decisions are being made," Hanlon said. "Which one is it? We don't know."

Sen. David Hann, R-Eden Prairie
State Sen. David Hann, R-Eden Prairie, is the chairman of the Senate Health and Human Services Committee.
MPR Photo/Tom Scheck

Hanlon hopes to learn more in the meeting on Tuesday afternoon. While business groups press for answers, the GOP-controlled Legislature has resisted establishing the exchange. Republican lawmakers declined to participate in the exchange advisory task force. And even a Republican bill creating an exchange failed to pass.

One of the leaders of the opposition, state Sen. David Hann, R-Eden Prairie, the chairman of the Senate Health and Human Services Committee, said Dayton's delay of decisions until after the November election makes sense. He said there may be nothing to decide at that point.

"If the president loses and Gov. [Mitt] Romney is elected, then that will immediately stop," Hann said. "I think that's pretty clear."

Even if Romney wins the presidential election, the health care act will remain the law of the land. But a change in the White House would create substantial uncertainty about the law's future.

For now, Rothman says the Dayton administration is working to keep development of the exchange on track.

"Most importantly," he said, "the governor and the administration want to keep the door open to have that productive conversation with legislators about what an exchange would look like."

But if the election doesn't change control of the White House or the state Legislature, Rothman will have to confront a sticky constitutional question -- whether the Dayton administration can launch a health insurance exchange without the Legislature's approval.

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