Star Tribune

Distributed by Tribune Content Agency, LLC.

A preview of 2018 health insurance costs will soon serve notice to Minnesotans that political teamwork and innovation are still necessary to provide accessible coverage across the state. Those now breathing a sigh of relief that President Barack Obama’s Affordable Care Act remains the law of the land after Friday’s historic U.S. Senate vote should be leading the efforts to ensure that these worthy reforms leave no one priced out of the market.

On Monday, the state Department of Commerce is expected to release insurers’ proposed rates — an increase is widely expected — for those who buy their health insurance on their own. This is a narrow slice of consumers, about 5 percent of Minnesotans who are not covered through an employer or public program such as Medicare. But this small market is where the Affordable Care Act has fallen painfully short in living up to its promise.

The law made new financial aid available that instantly discounted monthly premiums for individual market buyers. But the aid was generally for those with incomes not exceeding a certain threshold — 400 percent of the federal poverty level, which translates to about $64,900 for a household of two. As the insurance market adjusted to the reforms’ impact, expected price hikes ensued in Minnesota and elsewhere. Maneuvers by congressional Republicans to undercut federal programs intended to cushion insurers and consumers through this transition contributed to soaring costs.

The result was situations like that described by U.S. Sen. Ron Johnson in a floor speech this past week. The Wisconsin Republican told of a hardworking couple in their late 50s from River Falls who made slightly too much for the Obama law’s new aid. They’re unable to keep up with costs and are thinking of going without — a decision that could devastate them financially.

Friday’s U.S. Senate vote thankfully staved off massive Medicaid cuts and kept premium payment assistance in place. Republican Sens. Susan Collins, Lisa Murkowski and John McCain merit loud thanks for safeguarding the nation’s medical safety net. That the trio prioritized care for the elderly, disabled and 30 million kids over tax cuts speaks volumes about their character.

But the Republican health plan’s defeat still leaves flaws in the Obama reforms to be addressed. The 2010 law reduced the uninsured rate to historic lows in Minnesota, but it left some behind, as Johnson’s floor speech outlined. Pragmatic steps are needed to help those who don’t qualify for the new law’s premium assistance but face rising costs.

While state legislators and Gov. Mark Dayton enacted a “reinsurance” measure this year to hold down Minnesotans’ costs, other factors may have blunted this program’s impact. Specifically, uncertainty about congressional action and the Trump administration’s unwillingness to commit to funding “cost-sharing reductions” (CSRs) may drive up rates. CSR aid is an Obamacare component that helps eligible consumers pay out-of-pocket medical costs. Insurers provide it in advance, and the federal government is supposed to reimburse them.

There should be bipartisan support in Congress for helping families like the one Johnson highlighted. Raising financial eligibility levels for premium payment assistance — rather than reducing them, as the GOP plan called for — would ease their plight. Launching a national reinsurance program like Minnesota’s would also help stabilize the market and hold down consumer coverage costs.

Fully funding CSRs is especially important for Minnesota. These federal dollars are uniquely funneled here into the state-run MinnesotaCare program, which covers working families who still struggle with private insurance costs. In 2016, MinnesotaCare funding from CSRs totaled $94 million. The state’s three Republican U.S. representatives — Erik Paulsen, Tom Emmer and Jason Lewis — especially must wield their clout with President Donald Trump. Too much is at stake in Minnesota to let Trump withhold CSR dollars in fit of pique over the Senate bill’s defeat.

Federal and state leaders also must weigh long-term strategies on rising medical costs, the main driver of coverage prices. This is a complex undertaking that will require political teamwork, expertise and time. The blow the Senate vote dealt to Obamacare repeal efforts gives hope that this hard work can now begin. It was magical thinking, at best, that the law’s demise would solve health care woes. It’s time for a reality-based reset.