Thousands of Minnesotans rely on the Affordable Care Act (ACA) to access medical care — those who get financial help to buy health insurance on MNsure, those who depend on pre-existing condition protections and those covered by public medical programs thanks to the law's expanded eligibility.
If you're in one or more of those groups, here's an important message: You still have coverage and you can still sign up for a health plan for 2019 despite a controversial legal ruling issued late last week declaring the entire landmark health law unconstitutional. The ruling from a federal judge in Texas created confusion here and elsewhere but should not cause changes in the short term and hopefully will not in the long term, either.
The ruling, which weighed in on a challenge to the ACA led by Republican state attorneys general, is the beginning of yet another fierce court battle over former President Barack Obama's signature health care law. Legal challenges to it are expected to wind up before the U.S. Supreme Court, which has already twice rejected high-profile arguments about the ACA's constitutionality. Legal experts consider this run at the law's constitutionality to be far weaker than the previous two, with University of Michigan law school professor Nicholas Bagley calling it an "exercise of raw judicial activism."
In the meantime, Minnesotans who buy their coverage on MNsure continue to have through Jan. 13 to sign up for 2019 coverage. The estimated 63,280 MNsure customers who have qualified so far for financial aid to reduce premium costs — one of the ACA's cornerstone benefits — can feel confident this help will continue through the coming year. Nor should the 211,000 Minnesotans who get coverage through the law's expanded medical assistance eligibility expect changes. The same holds true of the consumers who buy private insurance but depend on the ACA's consumer protections to get coverage because they have a pre-existing medical condition.
State lawmakers, however, should not sit tight in the ruling's wake. The Jan. 8 start of the 2019 legislative session looms, and the ruling adds urgency to a critical health policy decision that must be made this session: whether to extend the state's 2 percent tax on medical providers. The tax was originally passed to pay for MinnesotaCare, a state-run health care program enacted in the early 1990s to cover working families. But as federal funding for MinnesotaCare improved under the ACA, lawmakers tapped these dollars to pay for the medical assistance program and other health care needs. One of these other needs: the two-year "reinsurance" program passed in 2017 to lower costs for consumers who buy on the individual health insurance market.
The provider tax is slated to sunset at the end of 2019, leaving the dedicated fund that the dollars flow into with a deficit of "more than $500 million per year," according to state budget officials. The fight to extend the tax, or some version of it, is likely to be one of the highest-profile issues of the coming session. The uncertainty created by the Texas ruling bolsters the already strong existing argument for the extension based on the state's reliance on these dollars for critical health care programs and the gaping hole the sunset will create. Adding to these concerns is the likely need to extend the expiring reinsurance program or find an alternative measure to help individual market consumers.
The Texas ruling, while considered a legal long shot, still has the potential to massively disrupt the nation's health care system. Minnesota not only needs to be prepared, but to forge ahead on its own with reforms to improve care and access.
Now would be an especially incautious time to do away with a dedicated health care funding stream that has covered Minnesotans and enabled health care innovation here for well over two decades.
