Commerce, Health Department and insurers outline Minnesota process for reviewing health insurance mandates and warn of premium pressure

The Minnesota House Commerce, Finance and Policy Committee heard presentations Feb. 27 from the Department of Commerce and the Department of Health on how the state evaluates health insurance benefit mandates, including how it measures costs that may be borne by the state and by health plan enrollees.

Ashley Sedalan, health policy director in the insurance division at the Minnesota Department of Commerce, told the committee that Commerce conducts mandate evaluations in partnership with a contractor and with technical input from the Department of Health and Minnesota Management and Budget. “We work with a vendor, American Institutes for Research on those evaluations,” she said, describing a process that can include a feasibility review, literature review, a claims analysis using the Minnesota All Payer Claims Database (APCD), a public comment period and a calculation of any federal “defrayal” payments the state must make.

The committee was briefed on two separate cost concepts. Sedalan said defrayal (payments from the state to carriers under federal Affordable Care Act rules) is a direct state payment when a new mandate expands the federally defined essential health benefit (EHB) benchmark. By contrast, she said, per‑member‑per‑month (PMPM) estimates describe projected impacts on premiums paid by enrollees and employers and are not direct state outlays. Sedalan noted some mandates are judged to require full defrayal, others partial, and some none at all. She said Minnesota has completed 34 mandate…