Saturday, June 7, 2014

MNSure: Where the Candidates Stand (Today)

In the Republican race for Governor, we have so far seen very few areas where there are substantive policy differences between the candidates.  One area where we have seen some distinction is on the topic of MNSure.

To be sure, all of the remaining candidates for Governor would prefer that we could scrap the Affordable Care Act (aka Obamacare). But as the ACA is a federal law, there's very little a Governor can do to actually make that happen.

So, considering that the ACA will most likely be the law of the land until at least 2017, our next Governor will need to operate under the parameters of the existing law.  If Dayton is re-elected, the path is clear- we'll stay the course.  But what would the ACA look like in Minnesota under a Republican governor?

States are required under the law to either operate their own health care exchange, like Minnesota does with MNSure, or use the federal exchange, like the majority of states have done.  That means a Republican governor only has one of two options: 1) Ditch MNSure entirely or 2) Keep MNSure and tweak it.

Ditch It

The candidate who has the most defined position on MNSure is Scott Honour. In February Honour came out in support of the idea of shutting down MNSure and moving Minnesota to the federal exchange. 

Since February a number of states who originally opted to create state exchanges have chosen this path, including Oregon, Massachusetts and (kind of) Maryland. Nevada just made the move to dump their state exchange last week.

I said back in February that Honour's position clearly showed his background in business. Scrapping MNSure makes fiscal sense, and Honour's arguments that it's time to stop throwing good money after bad and that we should end the duplicitive efforts are what I would expect to see from a guy with a business background.  If MN were a business, getting out of MNSure would be a "no-brainer" decision for the CEO.

Honour's position is not without political risk, however. MN is not a business and Honour needs to get elected before he can implement his plan. Minnesotans (and specifically Republican primary voters) may bristle at the idea of joining a federal program. But if Honour can successfully sell his position as the best among our many bad options when it comes to MNSure, he could make some headway here.

I should also note that if elected, Honour would most likely have some trouble pushing a repeal of MNSure through the legislature. However, a GOP-led house combined with a few nervous DFL Senators may ultimately make a repeal possible.

Keep It

Kurt Zellers and Marty Seifert are both firmly in the "Keep it/Fix it" camp on MNSure.  Again, this shouldn't be interpreted as an embrace of MNSure, but both Zellers and Seifert argue that since we are required to have an exchange, Minnesota is better off with a state-run exchange than with the federal exchange.

This is a position that is not shared widely among sitting Republican governors.  The only state with a Republican governor to adopt its own exchange in 2014 was Nevada, and as I mentioned above they are now abandoning that plan.

Seifert told the Austin Daily Herald this week that "The bottom line is you have to have MNsure." In February, Zellers told the Associated Press that he was not "running to be Scott Walker-lite or Rick Perry-esque" when asked about other GOP Governors using federal exchanges.

Seifert has mentioned some specific changes he would like to see to MNSure including "some dramatic changes to how its board is set up and how the agency’s budget is allocated."

Zellers has been less specific, but has mentioned he wants to open MN up to more insurance companies in the hopes competition would drive costs down.

Seifert's tweaks to the board and budget would face the same challenge as Honour's repeal, in that they would have to make it through the legislature, so securing a GOP-led house is crucial to any efforts for reform.

The ? Position

While Honour, Seifert and Zellers have been clear about their MNSure intentions, Jeff Johnson has been less so.

In February Johnson criticized Honour's position in a Facebook post, so you may infer that he holds the "Keep it/Tweak it" position. (link via Politics.MN)

However, on his website, Johnson says he "will work to eliminate MNsure". It's unclear if Johnson has changed his mind and now favors the "Scrap it" position, or if he is just making a generic argument against MNSure.

A request for clarification from Johnson's campaign was, perhaps unsurprisingly, not returned.

The Bottom Line

All of our candidates for Governor would prefer to have a healthcare system that is free from federal intervention and mandates, but that's not reality.  There are only two positions that candidates for MN Governor can hold on MNSure: they either want to keep it and work to fix it, or end it completely.

I'm glad we have some clarity from (most of) the candidates on where they stand on this important issue.