AP News

Health care ruling may not sway Minn.'s direction

ST. PAUL, Minn. (AP) — Minnesota Gov. Mark Dayton was such a big supporter of the federal health care overhaul that his first act when he took office last year was extending Medicaid coverage to 84,000 vulnerable adults, taking up the push to expand health care coverage.

His embrace of the law included pursuing more than $28 million in federal dollars to create a state-crafted health insurance marketplace, a centerpiece of the Affordable Care Act.

With a U.S. Supreme Court ruling on the overhaul expected Thursday, the first-term Democratic governor hasn't said what he will do under various scenarios. But Dayton told The Associated Press on Wednesday that he stands by the Medicaid expansion.

"I hope and pray that the Supreme Court has the wisdom to know that they need to continue to be covered on a continuing basis," he said.

The state agencies that deal with the law wouldn't speculate on the court's decision either. That leaves unanswered questions about the fate of the adults Dayton switched to the joint federal-state Medicaid program from less generous state-funded programs and the work the state has already put into a health insurance exchange designed to go online in 2014.

Dayton's enthusiasm for the law's changes was a full reversal of his Republican predecessor, Tim Pawlenty, who ordered state agencies to limit involvement in what he called "a misguided piece of legislation."

Instead, Dayton saw nothing but upsides.

"This is the step that benefits all the people of our state at no, and I repeat, no net cost to the state of Minnesota," the new governor said while ordering the Medicaid expansion in January 2011.

Minnesota passed its own health care revamp under Pawlenty in 2008, including an emphasis on prevention, a push toward electronic medical records, the development of coordinated "medical homes" for patients and payment restructuring to discourage wasteful spending. But even as those measures were begun, the number of uninsured people jumped from 374,000 in 2007 to 490,000 in 2011 as employers dropped coverage.

Minnesota still has one of the lowest uninsured rates in the country, just under 10 percent, but has fallen behind states such as Massachusetts, Hawaii, Maine and Wisconsin.

A leading Republican lawmaker on health issues, Sen. David Hann of Eden Prairie, said a full overturning of the health care law wouldn't necessarily invalidate Minnesota's Medicaid expansion, which covers adults with yearly incomes of about $8,400 or less.

But Hann said if federal money for that population were to go away, the state likely would have to go back to the previous bare-bones state program, which included a residency requirement and asset testing.

"It would put some pressure on our budget to then deal with a program that was not going to get Medicaid support," Hann said.

Huntley said the state portion of the program's funding could continue, but the loss of federal dollars would squeeze medical providers and ultimately be passed on to those with insurance.

The people Dayton moved into Medicaid had started out on a state-funded program called General Assistance Medical Care until Pawlenty nixed state funding in 2009. He and lawmakers replaced that program in 2010 with a pared-back version that limited state payments to providers and got mixed reviews on the ground. Dayton said the move to Medicaid helped both the patients and health care providers, who get better reimbursements from the federal-state program, called Medical Assistance in Minnesota.

Democratic Rep. Tom Huntley, a top Democratic lawmaker on health issues, downplayed the possibility of a court ruling that would threaten the Medicaid coverage for the group. Huntley judged the court more likely to strike down the mandate requiring people to purchase health insurance, while leaving the rest of the law intact.

"If they threw the whole thing out, that's the one extreme, then Minnesota will just have to go ahead with the reforms that we passed in 2008," said Huntley, who also serves on the task force developing the health insurance exchange.

Huntley also said he would be interested in pursuing a health insurance mandate for Minnesota residents if the court overturns the national mandate, although conservative fury with the federal law has focused on the mandate and it would be difficult to get Republican support. Huntley said such a requirement would prevent people from signing up for insurance only when they need it.

One of Dayton's top advisers, Commerce Commissioner Mike Rothman, said the decision — whichever way it goes — won't derail the state's focus on covering more people with affordable health care. That view was also expressed in a letter last week signed by Rothman, Human Services Commissioner Lucinda Jesson, Health Commissioner Ed Ehlinger and 18 Democratic legislators.

"We all want to stay focused so we can meet those goals for Minnesotans," Rothman said in an interview.

Minnesota has been promised $28.4 million for its health insurance exchange and spent $1.9 million so far on planning, information technology and market research.

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