Minn.'s health care left largely intact by high court's ruling

The U.S Supreme Court's decision on the federal health care law leaves the status quo largely intact in Minnesota.

If the law survives the November elections, the high court's decision will have far reaching effects on patients, employers and insurers in Minnesota.

Steve Knutson has spent his career trying to obtain health care for those who can't afford it. He runs the Neighborhood Health Source, four community primary care clinics in north Minneapolis. Forty percent of the patients have no insurance.

"Right now so many of our uninsured patients delay care or avoid care altogether because there's just no ability to cover even a portion of the costs of that," Knutson said.

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The court's ruling lifts the financial barrier for people to get health care and get it earlier, he said.

One of the main goals of the federal health care law is to expand health care to cover those who don't have it. While Minnesota's 9 percent uninsured rate is low compared to the national average of 16 percent, it still amounts to nearly half a million people in the state. And that number has been growing.

The law's reforms should cut the number of uninsured residents in Minnesota by more than half, said University of Minnesota economist Lynn Blewett.

"This is a significant step for Minnesota in terms of moving to cover uninsured in the state," Blewett said.

One of the ways the law will help fill in that coverage gap is by expanding the joint federal and state program for low-income people known as Medicaid. While the court ruled that states may opt out of the expansion, Minnesota has already signed on.

The Medicaid expansion allows Minnesota to get federal matching dollars for providing health insurance for residents previously covered solely by state dollars through GAMC and MinnesotaCare programs. The expansion is expected to deliver more than $2.8 billion in federal funding to the state over the next several years.

The Department of Human Services says currently 84,000 Minnesotans are enrolled under the Medicaid expansion. Of those, approximately 30,000 were from the former GAMC program, and 50,000 from the MinnesotaCare program.

The Dayton administration called the ruling an affirmation of the reform efforts currently underway in Minnesota.

"What the Affordable Care Act does is give us additional federal dollars so that we can do our job quicker and faster and with less additional impact on Minnesota taxpayers," Human Services Commissioner Lucinda Jesson said.

The Medicaid issue is also important to insurance giant, UnitedHealth Group, which is a major employer in Minnesota. Minnetonka-based UnitedHealth has a subsidiary serving Medicaid patients in 23 states, which brought in nearly $14 billion in revenue last year. The law is expected to bring health insurers an influx of new customers.

Geoff Bartsh, vice president of public policy and government relations at Medica, said the court's ruling brings certainty that until now has been non-existent.

While the Supreme Court's ruling provides more certainty, it isn't the final word. Depending on the outcome of the November elections, Bartsh said Congress could substantially change the law.

"While this gives us some clarity in terms of the constitutionality of the law as it stands today, it certainly doesn't give us any clarity in terms of how the law might look, or how the law might change, between now and 2014 when the law goes fully into effect," Bartsh said.

Health Partners released a statement calling for adjustments in the law to ensure that coverage is affordable, saying under the current law, individuals and small employers will pay for coverage.

Mayo Clinic, which had been held up by the Obama administration as an example of how the health care law could function in reality, says it won't see major changes. The world-renowned clinic has been a pioneer of patient-centered care, which is a centerpiece of the law. Regardless of the ruling, officials there say Mayo will continue to innovate.

Today's ruling also means fewer patients will be unable to pay their medical bills, said Lawrence Massa of the Minnesota Hospital Association, which represents most of the state's hospitals, says

"Minnesota has been a leader in the country in terms of providing coverage, so we're not going to see as many new people covered as some of the other states under the law," Massa said. "But it certainly gives our state some advantages in terms of the Medicaid expansion and some of those provisions."

On the other hand, there remains for insurers the question over the future of Minnesota's health insurance exchange. The state-based exchanges are a cornerstone of the federal health care law. Envisioned as online marketplaces where individuals and small groups can comparison shop for health insurance, these are supposed to be operating by early 2014.

But GOP state lawmakers led by Sen. David Hann of Eden Prairie have rallied against it. Hann, who chairs the Health and Human Services Committee, said the high court's ruling doesn't change his mind that a Dayton-created exchange will be bad for the state. He said the Obama health care law is the law of the land now, but that could change after the November elections

"Depending on how that election goes, if the political response to this is what I believe it will be, the law will be overturned in the next session and we would be remiss in going too far down the path of implementing something that would get repealed," Hann said.

A lingering question is whether the Dayton administration has enough legal authority through executive powers to commit the state to an exchange or will need legislative buy-in to do so.

The ruling does not change much for Minnesota's big medical device companies. Analysts say most people getting pacemakers and other implantable devices were already insured through Medicare and that companies have taken actions to offset the impact of a tax on medical devices. Nonetheless, there have already been moves in Congress to repeal the tax with bipartisan support.

In any case, today's ruling is only a way station in the law's history. The Supreme Court's decision provides certainty that the federal health care passes constitutional muster, but it remains to be seen whether it passes muster with the voters and their elected officials following the election.

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