House to vote on whether or not MinnesotaCare can offer healthcare to all

[MUSIC PLAYING] CATHY WURZER: Today, the Minnesota House is set to vote on a sweeping health bill. It's the chamber's big health care budget bill. And among many of the provisions in it is one that includes a public option for MinnesotaCare. Right now, people who make less than about $27,000 a year are eligible for that public insurance option. But this bill would let anyone opt in to get coverage as long as they pay premiums.

Representative Tina Liebling is the DFL chair of the Minnesota House Health Finance and Policy Committee, and she is on the line. Madam Chair, thanks for taking the time.

TINA LIEBLING: Good afternoon, Cathy. Thanks for having me.

CATHY WURZER: There's a lot tucked in this bill because it is an omnibus bill so, we'll tease out some of the provisions. Let's start with the MinnesotaCare buy-in option. How would that work, exactly?

TINA LIEBLING: Well, there is a lot of information that needs to be gathered, numbers that need to be crunched before we can really answer that question. But what our bill does that's really never really been able to be done before is move ahead to try to answer those questions. So we're looking to give people a better, more affordable option in health insurance, because our goal is that people should be able to access the care they need without going broke. And too often, the insurance options available to them just don't meet that.

And so we're going to be-- one of the pieces of this is to do the real analysis to see if we can do a better job for people and give them a real option, whether it's buying into the existing MinnesotaCare program or designing it a little bit differently. And so right now, it's kind of MinnesotaCare buy-in, slash, public option. We're not really set on a design yet.

CATHY WURZER: I see. So you'll study this. As you look at this, who could be eligible for the buy-in? Does it include the self-employed, undocumented residents? Who exactly?

TINA LIEBLING: Well, let's talk for a second about undocumented residents. So one of the things we are doing is opening up MinnesotaCare to people who are undocumented. So right now, if you don't have legal status, you're just barred from applying for the program. We are going to be opening that up, if the Senate agrees-- it's in our bill, and I think there's willingness to do it-- to allow people to apply. And this would be people who meet the same income eligibility standards as they have to meet right now.

So we are definitely wanting to move forward with that. And that's not a difficult thing to do in terms of any study design. It's just letting more people in under the same program we have now. Another thing that we will be doing, I think, pretty safe to say, is taking some steps to reduce out-of-pocket costs for people who are just above the current limit for being able to get MinnesotaCare but are still under 250% of the federal poverty level.

So the plans that people can buy now on MNSure, our state's market exchange for insurance, they still have pretty big out-of-pocket costs. So people could have an insurance plan and still not be able to afford health care. So we're going to try to address that. And that one we can address pretty quickly.

CATHY WURZER: I was listening to a little bit of the debate in committee, and the chamber, Minnesota Chamber of Commerce, and the MHA, Minnesota Hospital Association, were not in favor of this bill, saying that it would not pay health care providers in hospitals enough. It could drive them out of business since public programs tend to reimburse providers less than private insurers. What's your response to that?

TINA LIEBLING: Well, my response to that is we don't know yet what those payments would be. And of course, it's not our intention to drive anybody out of business. We very much want there to be care for people. That's a big piece of our goal here. So we're going to be looking at that.

And so as we move forward and really crunch the numbers, the question is, how do these things balance out? What kind of premiums would we have to charge? What kinds of reimbursement would we give to providers? So it's pretty early to be against it, but it's moving it forward. And to really get the answers to this is what makes this really exciting.

CATHY WURZER: Is Nurses at the Bedside-- the Nurses at the Bedside Act in the omnibus bill? If so, could you explain more about that provision, how it could address conditions in hospitals?

TINA LIEBLING: Yeah, the Keeping Nurses at the Bedside Act has been cooking, I would say, for many, many years because we've had these issues with staffing in many of our hospitals. And so this year, we have a very serious proposal that allows-- fundamentally, it allows staff to have a little more say over making sure that hospitals are staffed appropriately.

And our author of it, Representative Sandra Feist, has been working very hard with hospitals, with nurses to get to something that everybody can live with. So it's a little bit of a work in progress, but we are getting down to where we think we'll have a really good product. Because let's face it-- if hospitals are understaffed, no patient is safe.

And nurses are leaving the bedside. The pandemic was extremely hard on people who work in hospitals. We've heard horror stories from nurses about having to work in unsafe, understaffed conditions and having to do things that really went against their professional ethics because of understaffing.

At the same time, we understand that qualified people don't grow on trees, so we are also approaching it with things like loan reimbursement, other measures to try to recruit more health care workers. So it's really a complex problem, and this is just one piece of it. But we're really hoping that this is the year that we're going to get to something that everybody can live with that will, most importantly, help patients so that when they go to the hospital, they get the great care that they need and deserve.

CATHY WURZER: I was also going through this-- of course, it's a big bill. It's an omnibus bill. It looks like the bill includes a creation of a prescription drug affordability board. What would that do? What authority would it have under this measure?

TINA LIEBLING: So that actually is in a different bill. That's being carried in the commerce bill. But, of course, I'm familiar with it. It tries to take a look at the extremely complex drug marketplace where all the big players-- the prescription PBMs, the prescription benefit managers, and the drug companies and everybody points fingers at everybody else and says, no, he's the problem. They're the problem.

So this board is experts who get together and get the data. And when they see that there's some excessive increases going on, they would have the power to cap those increases. So I think that it'd be great for us to try to understand as a state where these excessive price increases are coming from but also to have some power to say, hey, enough. Because you can't really get health care if you can't afford the drugs that are prescribed for you.

You go to the doctor, and the doctor says, here's what you need. And then you leave, and you go to your pharmacy, and you can't afford to pick up your prescription. That just should never happen in Minnesota.

CATHY WURZER: All right. And that, of course, is in a different bill. There's just so many bills, as you know, at the end of session. It's hard to keep track of everything.

TINA LIEBLING: Oh, yes, absolutely.

CATHY WURZER: All right, Madam Chair. Thank you so much for your time.

TINA LIEBLING: You are very welcome. Anytime.

CATHY WURZER: Representative Tina Liebling is the chair of the Minnesota House Health Finance and Policy committee.