What's in Senate Republicans' health care cost plan – and why Democrats don't like it

Republicans are celebrating the first major step toward some type of relief for Minnesotans who are facing expensive health insurance – while Democrats say the proposal is off-target.

The Minnesota Senate, which is controlled by Republicans, approved a bill that would spend $285 million of Minnesota's backup rainy day fund to provide rebates for certain health insurance consumers. It passed 35-31, with one Democrat voting for it.

Who does this affect? The 125,000 or so Minnesotans who bought health insurance through the individual market (so through MNsure, or directly from an insurance company for example) but make too much money to qualify for tax credits that significantly bring down the cost.

The Senate Republicans' plan would initially cover 25 percent of the costs for people who make more than 300 percent, but less than 800 percent, of the federal poverty line. But starting April 1, people who make on the low end of that could get up to 30 percent, while people who make on the high end could get just 20 percent. (See pages 3-4 here.)

It also provides $15 million in funding so extremely ill patients will be able to continue their care no matter what, and some other changes to the state's insurance market (including a reinsurance program to help insurers with costly consumers, plus changes to how HMO plans can operate here).

Democrats' response

Democrats quickly responded by questioning how well the bill was scrutinized, and pointing to comments from the state's budget office about how unwieldy it may end up being.

Sen. Greg Clausen called it "an unvetted mix of paperwork and delay."

In addition, Democrats are pointing to comments from the state's top budget chief, Myron Frans – he said this week the bill that was passed is too complicated, could cost the state another $20 million to implement the requirements, and might take a year to put into place, MPR News reported.

What that means is the Minnesotans eligible for a rebate might not see it until 2018, for health insurance they bought and paid for in 2017.

There's also a looming MNsure deadline. You have to buy coverage by Jan. 31 if you want health insurance to kick in this year.

In an email statement, Sen. Jeff Hayden called the bill "a mess," adding: "we do not have proper accounting of the spending, the reinsurance pool only has funding for one year, and the additional red tape and bureaucracy will create more problems than it will resolve.”

So is this going to become law?

In order for a bill to become law, identical versions have to pass the House and Senate – and then the governor has to sign it.

This bill passed the Senate, but hasn't gone to the House. A vote in the House is expected next week, but that version of the bill is a little different from the one the Senate passed.

That means there would have to be what's called a conference committee – that's when a handful of lawmakers from each chamber get together to hash out the differences in two bills.

Then there's Gov. Mark Dayton, who has expressed concerns about the Republicans' plan in the past. The bill that comes out of the conference committee would have to also appease his DFL sensibilities.

If he vetoes it, the House and Senate could override him only by getting two-thirds of their members to vote in favor of it. And while the Republicans have an advantage in both chambers, it's not enough to guarantee two-thirds support.