Letter to Health and Human Services Secretary Kathleen Sebelius - Protect Coverage for More Than 140,000 MinnesotaCare Recipients

Letter

U.S. Sens. Amy Klobuchar (D-Minn.) and Al Franken (D-Minn.), and Reps. Collin Peterson (D-Minn.), Betty McCollum (D-Minn.), Keith Ellison (D-Minn.), Tim Walz (D-Minn.), and Rick Nolan (D-Minn.) have urged the U.S. Department of Health and Human Services (HHS) to help states like Minnesota meet the coverage needs of lower-income, working families.

In a letter led by Sen. Franken, the group pressed top Administration health officials to help protect health coverage for more than 140,000 Minnesotans expected to enroll in MinnesotaCare next year. The program provides comprehensive health insurance coverage to individuals and families who do not have access to affordable coverage through their employer and are not eligible for Medicaid or other public programs, such as the Children's Health Insurance Program.

Minnesota is leading the nation by offering this type of coverage to low-income, working families through a framework known as the Basic Health Program (BHP).

Last December, the Centers for Medicare & Medicaid Services (CMS) proposed a funding formula for the BHP that could jeopardize the future of MinnesotaCare. The formula does not consider unique conditions affecting health care costs within Minnesota, so the lawmakers have reached out to HHS to urge that the formula include state-specific data that will better inform funding decisions for programs like MinnesotaCare.

"Minnesota has been a pioneer in advancing solutions to help ensure Minnesotans have access to affordable health insurance, and we shouldn't be penalized for that track record of success," Sen. Klobuchar said. "That's why CMS needs to adjust its funding methodology to take Minnesota's innovative system into account so MinnesotaCare can continue to provide Minnesotans the coverage they need and deserve."

"Minnesota leads the nation when it comes to delivering health care to families that need it," Sen. Franken said. "I have made it one of my highest priorities to ensure that health reform supports MinnesotaCare, taking the concerns of Minnesotans to top officials, including the President. The Administration needs to be more flexible in how it takes into account state-specific factors to make sure Minnesotans can get the care they need."

"Minnesota's leadership in health care has showed us that providing a safety net for low-income working families can be cost-effective and receive strong bipartisan support," Rep. Peterson said. "MinnesotaCare's success should not be tampered with and it's imperative to keep this funding methodology in place."

"Minnesota has been ahead of the curve when it comes to delivering high quality, affordable health care to working families. The Administration needs to recognize the importance of MinnesotaCare in serving the health needs of Minnesota families and work with us to continue to build on that success," Rep. McCollum said.

"Minnesota should be rewarded for leading the way on increasing health care coverage for working families," Rep. Ellison said. "The expansion of insurance for poor families in the state could become unsustainable without enough federal aid, cutting off access to care for thousands of Minnesotans. The formula calculating federal funding should be changed to ensure working Minnesota families don't lose the health care coverage they need."

"The proposed rule for BHP is misguided because it does not take into account unique market conditions created by decades of innovative health care in Minnesota," Rep. Walz said. "CMS should partner with both Congress and the State of Minnesota to develop a revised rule that takes into account all aspects of health care costs, not just premiums, to give states flexibility."

"The federal government should be helping and supporting - not hurting - Minnesota's longstanding bipartisan effort to provide a health care program that reflects our unique state and population. That's going to require flexibility and creativity consistent with the intent of Congress and the needs of low-income working families and individuals who depend on MinnesotaCare to meet their important needs," Rep. Nolan said.

You can read the full letter here or below.

The Honorable Kathleen Sebelius
Secretary
U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201

Dear Madam Secretary:

We are writing to express our concerns regarding the proposed rule titled Basic Health Program: Proposed Federal Funding Methodology for Program Year 2015, issued by the Centers for Medicare and Medicaid Services (CMS) on December 23, 2013. Implementation of the Basic Health Program is very important to us, and we appreciate your work to develop an appropriate funding methodology. Such a methodology must recognize the distinctive features of Minnesota's health care marketplace; unfortunately your proposal currently does not do that. If finalized in its current form, this methodology would threaten the sustainability of Minnesota's long-standing, bipartisan MinnesotaCare program and would create significant barriers for a state like Minnesota to providing the best possible health coverage to our constituents.

Relying on your partnership, Minnesota became the only state in the nation last year to take the necessary legislative and administrative steps to provide more affordable health care to low-income working families through the framework of the Basic Health Program. This was particularly important for our state because of the many working families who depend on MinnesotaCare, our health program that currently supports many low-income individuals and families. Providing continuity of coverage is by far the best way to ensure current beneficairies' access to high quality, affordable health care. Appropriate funding for MinnesotaCare through the Basic Health Program, as envisioned by Congress, will allow Minnesota to continue its successful MinnesotaCare program.

Unfortunately, the future of MinnesotaCare would be jeopardized by CMS's recently proposed funding methodology that does not take into account the unique market conditions created by decades of health care innovation in our state. Specifically, this proposal fails to take into account the impact of MinnesotaCare on our reformed market or any state-specific factors except for our state's average premiums in our state health insurance marketplace. Our average premiums are the lowest in the nation, and an independent analysis showed that these low rates are in part due to our separate MinnesotaCare program. By failing to consider state-specific factors that contributed to these low rates, including our MinnesotaCare program, the proposed methodology could jeopardize the future of that program.

When determining new federal funding levels for MinnesotaCare, we respectfully request that CMS allow Minnesota to use actual state data retrospectively, so we can account for the unique factors in our health insurance market. We also ask that CMS provide a risk adjustment formula that allows Minnesota to reflect the cost and actual health status of our MinnesotaCare population, which has historically been different from our general population. We also recommend that states be allowed to account for expected premium trends in their markets to ensure fairer funding levels, including those related to population shifts and market competition effects. In Minnesota, this would include the projected costs to our individual market from the elimination of the state's high-risk pool for our sickest residents, which notably is the largest of its kind in the country.

It is critical that CMS be creative and flexible with this funding methodology to help states get through this period of market changes and fluctuation. If a state-specific solution is not available at this time, then states should be allowed the flexibility to use national data for the entire funding formula, including the average reference premium. This would at least allow for consistency in the funding formula so one state isn't unfairly disadvantaged compared to another.

It was the intent of Congress that the statute authorizing the Basic Health Program offer states a real opportunity to provide coverage for low-income working families and individuals. If the methodology does not take into account the distinctive health care markets of states like ours, it will not fulfil this intent. MinnesotaCare provides high quality, affordable health coverage for tens of thousands of hard-working, low-income Minnesotans and their families. We respectfully request your assistance in directing your staff to once again partner with us and with Governor Dayton's administration to create a fair and reasonable Basic Health Program funding methodology that reflects our shared commitment to providing affordable health coverage through MinnesotaCare.

Sincerely,

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