November 21, 2016

Governor Mark Dayton

116 Veterans Service Building
20 West 12th Street
St. Paul, MN 55155
via electronic delivery

Dear Governor Dayton,

Our caucus remains committed to providing Minnesotans with both short-term relief and long-term
solutions for the health insurance crisis. On Friday, we again met with Commissioner Frans, your
staff, and counterparts in the Senate. This was a productive meeting with a robust discussion of the
short-term proposal from your administration, potential alternatives, and the need to start long-term
reform that benefits the 2018 insurance market.
Daily messages from constituents are a sobering reminder that unaffordable premiums are only the
tip of the iceberg. Deductibles, out-of-network costs and lack of access to trusted providers are also
weighing on families as they make health insurance choices for next year. Those affected including
many small business owners who purchase in the individual market are also making long-term
plans to avoid enormous future financial costs. This means people are scaling back businesses,
making difficult personal financial choices, and considering relocation to other states.
We can do better for Minnesotans. Toward that goal, our caucus has sought greater flexibility and
assistance from the federal government. On November 1, we requested guidance from the acting
director of the Centers for Medicare and Medicaid Services on potential waivers that will help our
state develop short and long-term solutions. Any assistance your office can provide in obtaining this
guidance would be appreciated.
Further, to expedite the use of federal financial assistance owed to Minnesotans, Speaker Daudt
requested support from Senators Klobuchar and Franken last week in obtaining some or all of the
unused federal advanced premium tax credits as a block grant for premium relief administered by
the state. This would avoid Minnesota taxpayers being asked to pay twice for the same assistance.
Our goal from the onset has been to address both cost and choice issues for families in Minnesota.
With that in mind, as well as constructive ideas offered by members of both parties last week, our
outline for moving forward is as follows:

1. Immediate Premium Relief. We believe a one-month 20 percent premium cut for all
policies purchased without an advanced premium tax credit (APTC) in the individual market
will provide time to establish a broader and more targeted relief program. While we work
through the legislative drafting process, we will review any detailed individual market data
or modeling used by your agencies in developing your existing proposal.
2. Targeted Assistance for Premium, Deductible & Out-Of-Network Costs. For the
remainder of 2017, we propose a targeted financial assistance program - which can be used
for premiums, deductibles, in-network or out-of-network costs - based on three income tiers
between 300 and 800 percent of federal poverty guidelines. Relief would be staggered among
those three income groups so that those with less means and no access to any federal
assistance receive the greatest share of any state subsidy.
Our intention is to provide some assistance for those in the lowest tier without duplication of
federal subsidies. This type of program could be administered jointly by the Department of
Revenue and Minnesota Management and Budget, in cooperation with the health plans, or
through a third-party administrator. We look forward to reviewing information requested at
the meetings on November 4 and 18 and received this afternoon in order to fully develop this
proposal.
3. Continued Ability To See Current Doctors. We propose a one-time expansion of the
continuity of care statute (Minn. Stat. 62Q.56) so that everyone in the individual market can
continue seeing their physician for up to 90 days. Unlike the existing continuity of care
statute, this would not be not limited to those who are currently in a course of treatment.
4. Prevention of Future Health Care Crises. In addition to the immediate relief measures
listed above, we propose further reform with near and long-term implications. The following
are initial steps toward increasing certainty and affordability for consumers, eliminating
unnecessary costs to the state, and restoring market stability. These are not partisan ideas. In
fact, many were previously authored by DFL members and others have received broad bipartisan support in the legislature.

Eliminate surprise billing where people are unknowingly stuck with an out-of-network
charge for one provider during a surgery or hospital stay.
Create a financial penalty for knowingly falsifying a Special Enrollment Period
application, to be enforced by plans and the Minnesota Department of Health (MDH).
Require the Department of Commerce and MDH to draft a transition plan from MNsure
to a federal-state partnership exchange, where the Department of Commerce retains rate
review authority, the state manages a call center and in-person assistance, and we use the
better-performing Healthcare.gov site for commercial enrollment.
Reduce the stop-loss limit from $20,000 to $10,000, making it easier for small businesses
to offer affordable health insurance.
Allow for-profit HMOs to participate in the individual market.

We look forward to discussing these proposals further with you to deliver relief for Minnesotans
who are in dire need of assistance.
Sincerely,

Representative Greg Davids

Chair, House Taxes Committee
Co-Chair, MNsure Legislative Oversight
Committee

Representative Matt Dean

Chair, House Health & Human Services
Finance Committee

Representative Joe Hoppe

Chair, House Commerce & Regulatory
Reform Committee

Representative Tara Mack

Chair, House Health & Human Services
Reform Committee

Copes (via electronic delivery):

Speaker Kurt Daudt
Senator Jim Abeler
Senator Michelle Benson
Senator Ann Rest
Senator Tony Lourey
Senator Jeff Hayden
Commissioner Myron Frans, Minnesota Management and Budget