The head of the largest business group in Minnesota has a message for both Democrats and Republicans as the state attempts to plan a health insurance exchange: We need answers, fast.
"We don't like poking fights with the administration or commerce commissioner or any of those people. They're hardworking, well-meaning people,” said David Olson, president of the Minnesota Chamber of Commerce. “But the bottom line is that our members have no clue what this exchange is going to look like or how they're going to buy their insurance."
About 1 million Minnesotans are expected to get health insurance through the state's exchange starting in 2014. But there are already deadlines coming up. Minnesota and other states have fewer than 90 days to submit a detailed plan to the federal government about how their exchanges will work.
The deadline is Nov. 16. But last month, Gov. Mark Dayton, a Democrat, announced the administration would make no final decisions for developing Minnesota's insurance exchange until after the election on Nov. 6. That leaves a window of a week and a half between the election and the application deadline.
Olson is also unhappy with the GOP-controlled Legislature, which has refused to authorize an exchange for the state. And he's frustrated that, with the November deadline looming, the Dayton Administration hasn't settled basic questions such as: who will run the exchange, how much it'll cost, and how the state will pay for it.
Commerce Commissioner Michael Rothman says the department is working hard with all stakeholders, including the Chamber. But he says the state doesn't have to make final decisions on those big questions yet. The state can submit an application with preliminary answers to those questions to meet the deadline. And the Legislature can make changes later.
“The application is to show the federal government that we have the plans, the designs in place at a minimum, to have a state-based exchange,” Rothman said. “There's flexibility there. There could be changes.”
Even so, business groups like the Chamber are going public with complaints that major policy decisions remain to be made and that the state Commerce Department, which is developing the exchange, is unresponsive to requests for information.
The Chamber sent a letter to Rothman about six weeks ago outlining its questions. Rothman met with Olson in person in mid-August, but Olson says he came away from the meeting unsatisfied. As of last week, the Chamber was still waiting for a letter back from the commissioner.
Minnesota insurance agents and brokers are also lodging complaints about the exchange planning process. Worried that state officials are implementing the law in ways that will hurt their business, the agents and brokers sent a letter to Rothman in May seeking answers about the exchange would affect their compensation. Rothman says he later called but waited until after until after the Supreme Court upheld the law on June 28 to respond in writing. His reply is dated August 2.
Robert Hanlon, a member of the insurance exchange advisory task force representing brokers and agents, said the response was vague and light on specifics.
Hanlon complained about the lack of transparency.
“If we don't see anything, then decisions are being made without us or no decisions are being made,” Hanlon said. “Which one is it?"
The brokers and agents met with Rothman on Tuesday and submitted a list of questions they want answered by the Dayton administration.
While business groups press for answers, the GOP controlled legislature has actively resisted the exchange development. GOP lawmakers refused to participate in the exchange advisory task force, and even a Republican bill creating an exchange failed to pass.
One of the GOP leaders of the opposition, state Sen. David Hann of Eden Prairie, chairman of the Health and Human Services Committee, says Dayton's delay of decisions until after the elections makes sense. He says there may be nothing to decide at that point.
"If the president loses and Gov. Romney is elected, then that will immediately stop. I think that's pretty clear," Hann said.
For now, Rothman said the administration is working to keep the exchange's development on track.
"Most importantly, the governor and the administration want to keep the door open to have that productive conversation with legislators about what an exchange would look like," Rothman said.
But if the election doesn't change control of the White House or the Legislature, Rothman will have to confront a sticky constitutional question: Can the Dayton administration launch a health insurance exchange without the Legislature's approval?
This story is part of a partnership that includes Minnesota Public Radio, NPR and Kaiser Heath News.