David W. Hann Senate Republican Leader 147 State Office Building St, Paul, Minnesota 58155, Office Phone: 681-296-1749 = Senate October 31, 2016 State of Minnesota Governor Mark Dayton 116 Veterans Service Building 20 West 12th Street Saint Paul, Minnesota 55155 via electronic delivery Governor Dayton, 1 am writing to follow up after our meeting this morning with Minnesota Management and Budget (MMB) Commissioner Myron Frans and MNsure Board Member Lauren Gilchrist. We met to discuss the details of your recent proposal to provide short term relief to Minnesotans facing unaffordable health insurance premiums in the 2017 individual market. Senate Republicans found the meeting to be informative and look forward to working together to find a solution, Republicans are distraught by the stories we are hearing from our constituents, many of whom will be forced to forego health insurance next year due to unaffordable premiums and deductibles. We are determined to find solutions to the healthcare crisis; itis the most pressing issue facing our state. However, for some people, cost is the least of their concems. Even those who can afford increased premiums will encounter limited doctor networks and enrollment caps on insurance plans. In a town hall meeting in Bemidji last week, one Minnesotan expressed dismay at the fact that her choice of doctors for labor and delivery is limited to only one obstetrician 60 miles away from her home. This is alarming and unacceptable. ‘We must not be short sighted; we must work to restore a stable and robust health insurance market that provides more choices to patients and permanently bends the cost curve down, This will require long term solutions such as the ones proposed by Senate Republicans in our October 3 press conference. The proposal discussed today is a Band-Aid fix that will only provide short term relief for higher costs. Let me be clear: Your proposal will not stop 2018's premiums from being even higher, prevent more insurers from leaving the marketplace, increase plan options, or expand doctor networks. That being said, the damage is done and we must help the people facing these huge premium increases. ‘Committee: Rules and Administration ‘E-Mails een david hann@senate.mn Serving Eden Prairie and Minnetonka1 appreciate your recent candid comment that the Affordable Care Act i “no longer affordable for an increasing number of people.” Minnesotans have experienced this reality year after year, but their concems have been largely dismissed by Democrats. Likewise, Senate Republicans” ideas and solutions have been rejected for years. While Democrats sudden interest in fixing these problems could be viewed as purely political just days before an election, I sincerely hope your concern is genuine. We look forward to working in a bipartisan manner to restore the individual health insurance market. During the meeting, we asked for answers to the following questions: 2, Is there a fiscal note calculating the actual cost of the proposal? Has the federal government confirmed your proposal is legal, or granted approval in the form of a waiver? If not, when will we have an answer? Have you received confirmation from the IRS that rebates will not be considered imputed income and therefore not subject to federal ineome tax?” Have the affected insurers agreed to issue rebates to tens of thousands of customer accounts and cover those costs until reimbursed by the state? How will customers be audited to verify eligibility for rebates? Which state agency will take on this responsibility? Will the state incur additional administration costs? Whaat is the process by which customers will be assigned a rebate amount and receive a rebate? Please provide roles and responsibilities for each affected entity, including MNsure, MMB, the insurers, and customers. Please provide a detailed flow chart of the process from beginning to end, and a timeline of required updates to existing software and/or web tools necessary to achieve this. How often, and how long after rebates are provided to customers, will the state reimburse insurers? Which state agency is responsible for doing so? Will the state incur additional administration costs? If rebates are provided to ineligible customers, which state agency will be responsible for reclaiming the money? If they can’t reclaim it, will the insurers still be reimbursed, and will there be a delay in reimbursement? ‘Are you and your administration committed to restoring the individual health insurance market to a robust, stable, free market system that is not dependent on future government bailouts? Will you support Republican proposals to increase choices in plans, expand provider networks, and encourage competition in the marketplace to drive down costs? We look forward to your response and working with you on solutions to this problem, Respectfully, Tattle Senator David Hann Senate Republican Leader Ce: Myron Frans, Commissioner Minnesota Management and Budget Lauren Gilchrist, MNSure Board Member