ST. PAUL, Minn. -- Heading into Thursday's debate of health insurance exchange bill in the Minnesota Senate, it was clear that the DFL majority had enough votes to pass it.
That didn't stop Republican senators, who are now in the minority, from doing their best to reshape it with scores of amendments. And it was clear part of the strategy was to wear down the Democrats who proposed the legislation.
Per legislative tradition each amendment is debated and voted on separately. By 8:00 p.m. more than 70 amendments had been offered and discussed, some at great length.
The House of Representatives debated its own version of the insurance exchange bill for five hours on Monday before passing it. But Senate Republicans clearly found more to object to, and more ways to express those concerns.
The exchange has been described as an online market place, where 1.3 million Minnesotans will be able to shop for health coverage using federal subsidies available in 2014 through the Affordable Care Act.
Sen. Tony Lourey of Kerrick, the chief author of the bill in the Senate, said at least 300,000 uninsured working people are expected to take advantage of the exchange. He said an additional 600,000 persons currently enrolled in other public health plans in Minnesota would be able to buy coverage through the exchange.
Enrollment would begin October 1 of 2013, and coverage would start Jan. 1 of 2014. But Minnesota faces a March 31st deadline to submit a plan to federal regulators, one that is passed by the legislature and signed by Governor March Dayton.
"If we fail to adopt a Minnesota health insurance exchange the feds will impose a health exchange on the state of Minnesota," Sen. Lourey told his colleagues, pointing out that a Minnesota exchange will give the legislature more control over what's available to the state's consumers.
Much of the debate Thursday concerned the proposed makeup of the seven-member board that will oversee the insurance exchange. That panel will be appointed by the governor and legislature, but opponents of federal healthcare reform say they're worried the board will have too much say over patient care.
"We can't even have anybody that has a license or has got a connection to the insurance industry on this board, not even one," Sen. David Hann, an Eden Prairie Republican who has been an ardent opponent of federal health reform, said.
"It's odd and it's peculiar and I think it raises huge red flags about this whole project."
Carla Nelson, a Rochester Republican, suggested the conflict-of-interest rule would lead to the creation of a board that lacks necessary experience in medical insurance matters.
"We cannot afford to eliminate this expertise from Minnesotans. This is bad medicine!"
Sen. Lourey said the rule was meant to guard against someone with a financial conflict of interest, i.e. someone on a health insurance company payroll, from overseeing the health insurance exchange.
"You don't have to get a check from the industry to be an expert on how the industry works," Lourey said.
"There's a whole set of them in academia. There are accounting firms with actuarial experts."
The Citizens Council for Health Freedom, an organization opposed to the Affordable Care Act, has erected four billboards along interstate highways in the Twin Cities metro area. The billboards features seven silhouettes wearing suits, with the headline "Your Health in the Hands of Seven Strangers."
Lourey pointed out repeatedly that the board is creation of the legislature and can be changed by the legislature if it appears to unresponsive to problems and issues that arise.
Another point of contention in the Senate debate was over who has the power to select the plans that are offered through the exchange.
Republicans raised the specter that some of the state's largest health plans may not be approved to participate in the exchange.
"If Blue Cross and Blue Shield are not chosen to participate in the exchange, how would that affect Blue Cross and Blue Shield of Minnesota and the people who have a preference to having a plan with Blue Cross?" Sen. David Brown of Becker asked Democrats.
Sen. Jim Carlson, an Eagan Democrat, called that a hypothetical question that didn't reflect reality.
"This is the business they're in. And they will make a product that meets the criteria of the board," Sen. Carlson replied.
"The board is not there to deny people healthcare and deny these businesses participation. It's there to make sure there's a good value. And I think Blue Cross Blue Shield will give good value."
Lourey said he believes existing insurance carriers will have an incentive to participate, and offer plans that are affordable and meet with the minimum coverage standards that will be required by the exchange.
"There are federal subsidies totalling hundreds of millions of dollars, making this low-income, working Minnesota population valuable to them for the first time ever," Lourey said of the carriers.
"It's in the best interest of the state of Minnesota that we make sure that the insurance products they put on the market, to sell to these individuals, are in the best interest of the individuals as well."
At one point in the debate Republicans pointed out that high-deductible insurance plans are the most affordable, as part of an argument those types of policies should be offered by the new Minnesota exchange.
Lourey took exception to the use of the term "affordable" in that description, saying people who can't afford the higher out-of-pocket costs end up in hospital emergency rooms incurring bills that aren't covered.
"They're paying good money for products that don't cover their needs when they actually have to utilize the healthcare system," he said.
"And it also leaves our provider network seriously exposed to uncompensated care costs."
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