ACA repeal would leave many Minnesotans without health insurance

Handing out information
Fidela Trevino, a clinic coordinator from HealthFinders Collaborative, distributes information sheets about MNsure before an info session.
Alex Kolyer | For MPR News 2013

As the "repeal and reform" effort stalled this week in the Senate, Majority Leader Mitch McConnell, R-Ken., and President Trump floated an alternative strategy: repeal the Affordable Care Act (ACA) without a replacement.

Although Republicans have promised to repeal Obamacare for years, it appears there are not enough votes in the Senate to do it. Why? Because of the effect it would have on people who currently have health insurance under the ACA.

"Ninety-six percent of Minnesotans have health insurance, which is the highest ever in state history and we want to keep that trajectory going," said MNsure CEO Allison O'Toole. "Straight repeal jeopardizes health care for at least a half a million Minnesotans."

Obamacare funding pays most of the health insurance costs for about 200,000 Minnesotans enrolled in Medicaid-funded Medical Assistance through the ACA expansion of the program. The ACA also foots almost all of the bill for roughly 100,000 Minnesotans who have subsidized health insurance through Minnesota's state-sponsored MinnesotaCare program.

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This year $330 million dollars in federal Affordable Care Act tax credits are helping more than 66,000 Minnesotans pay for individual market health insurance plans.

The Minnesota Hospital Association says a repeal would cost the health systems it represents tens of millions of dollars. Spokeswoman Wendy Burt says many people who would lose coverage would still need care.

"If there's a straight up repeal of the bill we anticipate that uncompensated care and charity care would increase again like it was before the Affordable Care Act."

Under the ACA, Burt said uncompensated care has decreased almost 25 percent, a repeal would allow health insurance companies to sell plans with significantly fewer benefits, which would also increase charity care.

"Bad debt will go up because people won't have enough insurance," said Burt.

Without the ACA's mandate that people buy insurance, Minnesota Human Services Commissioner Emily Piper said many people who think they don't need coverage will opt out, leaving people with health problems who need insurance facing higher premiums.

"You take away the subsidies, you take away the mandate for healthy people to have insurance and you just exacerbate problems that we are already seeing on the individual market," said Piper.

A full-out repeal would leave thousands of Minnesotans uninsurable, according to Jim Schowalter from the Minnesota Council of Health Plans. Many people with pre-existing health problems would not be able to afford premiums, if plans would be willing to cover them at all.

"So in that situation what would the state have to do? How would it have to step in? And really, how would it have the money?," Schowalter wondered.

Republicans are in a tough political position said University of Minnesota health policy professor Ezra Golberstein.

"There's a lot of pressure to repeal the Affordable Care Act from Republican constituencies, but on the other hand there's evidence that the public increasingly understands that the Affordable Care Act really has delivered some important benefits to people," Golberstein said.

DFL Sen. Al Franken predicted the measure McConnell is expected to put forth next week will fail, but said ultimately a bipartisan approach will work out.

"I think we're going to be able to work together and leader McConnell has talked about that — us working together."

Gov. Mark Dayton told reporters this week a repeal would threaten some Minnesotans' lives. He said he's hoping Republicans will finally bring Democrats into the health care debate.

"It's not about letting Obamacare die, that would be unconscionable and have devastating, life-threatening affects for thousands of Minnesotans," Dayton said. "It's about working together and saying, what's best for the people of Minnesota? What's best for the people of this country?"