The federal government giveth and the federal government taketh away.
With one hand the Trump administration approved $323 million for two years of an innovative Minnesota plan for a high-risk health insurance pool, designed to lower individual premiums by about 20 percent (compared to what premiums would be without it) for MNsure, the state's version of the Affordable Care Act.
But with the other hand it stripped away $369 million in funding for MinnesotaCare, an entirely different program which serves 91,000 people often described as the working poor.
To state officials, who had been assured MinnesotaCare would be held harmless, it felt like a stab in the back.
Emily Piper, Minnesota Human Services commissioner, told the Star Tribune newspaper recently that "the administration has been promising all throughout 2017 that they want to give states flexibility to innovate and control their own destiny. And it just doesn't feel like that is what they are doing, and that is incredibly frustrating." She could not be reached for comment Friday.
MinnesotaCare serves many entrepreneurs, farmers, part-time employees and other low-income workers who cannot afford premiums, deductibles and copayments in the private insurance market, even plans subsidized through MNsure.
The unexpected decision may have been partly due to the sudden resignation of U.S. Department of Health and Human Services Secretary Tom Price-under fire for spending up to $1 million unnecessarily on charter and military flights.
The Trump administration's decision will not eliminate MinnesotaCare entirely, but will cut $369 million over two years if the decision isn't reversed.
State leaders, including Gov. Mark Dayton, are working hard to get that reversal.
"This approach is contrary to the explicit guidance from the U.S. Department of Health and Human Services and the U.S. Department of Treasury staff this spring to Minnesota legislators and my staff during the drafting of the legislation and waiver application, which assured Minnesota that our Basic Health Plan (MinnesotaCare) funding would be unharmed," Dayton said in a letter to Acting Health and Human Services Secretary Don Wright. "For 25 years, MinnesotaCare has been a very successful, bipartisan coverage program for about 100,000 Minnesotans, who earn no more than $24,120 a year (or $49,200 for a family of four). This program today operates under federal law as a Basic Health Plan and offers low-cost coverage through MNsure, the State Exchange," Dayton added.
The Affordable Care Act itself is still alive and kicking, and enrollment runs from Nov. 1 to Jan. 15. People interested in enrolling in any government-funded healthcare plan should do it through the MNsure website to make sure they get all the subsidies available, and Mahube-Otwa Community Action Partnership can help, said Senior Program Director Karen Linius.
"We are still offering MNsure navigation services at our five offices," located in Detroit Lakes, Park Rapids, Wadena, Mahnomen and Fergus Falls, she said. "You can enroll in MinnesotaCare or Medical Assistance or a direct policy with an agent at slightly reduced rates. You might be eligible for credit (subsidies) based on income and household size."
The two Mahube-Otwa navigators can help people navigate the MNsure website and sign up for the plan that best suits their needs at the lowest cost. "The two are scheduled in each of our five offices at least once a week, they move around and make appointments," she said. "People can call any one of our five offices and make an appointment for after Nov. 1."
Mahube-Otwa is able to pay its navigators thanks to a partnership grant with a sister agency in southwestern Minnesota.. "We have a grant through June of 2018," she said.