By Tom Steward
Watchdog Minnesota 

MN counties brace for 'not so Affordable Care Act'


ANOKA, Minn. — After years of rhetoric and rulings out of Washington, D.C., reality is hitting home as Minnesota counties scramble to implement and pay for what one frustrated county board leader calls the “not so Affordable Care Act” for local property taxpayers.

“Locally, we are just beginning to fully realize how unaffordable the Affordable Care Act will be to carry out, specifically the publicly-funded medical assistance (Medicaid) portion of this law,” said Rhonda Sivarajah, chair of the Anoka County Board, in a recent op-ed. “After years of identifying efficiencies, streamlining services and reducing the county levy, we will now be hit with unfunded costs estimated to be as much as $1.4 million over the next three years to pay for the additional staff and overtime needed to administer the “Affordable” Care Act.”

While the contentious debate over the health care law played out largely at the national level, the administration of the 2,800-page federal law will be carried out at the county level here. Some county officials anticipate a 25-percent to 30-percent increase in workload as they ramp up to begin enrolling new and existing recipients of Medicaid and Minnesota Care in MNsure, the state healthcare exchange.

By Oct. 1, individuals not covered through employers, Medicare or other plans must be able to sign up for medical coverage to begin on Jan. 1, 2014.

“We are in conversation with a number of counties who are also attempting to try and figure out what they’re doing and how they’re going to approach their boards in order to anticipate what is happening,” said Janet Goligowski, a Stearns County official, at a recent board meeting.

While many counties still are struggling to estimate the number of new government employees and associated costs of implementing the health care mandate, a Watchdog Minnesota roundup indicates there will be a broad impact on local resources and taxpayers.

“We will have to pass those costs on to our local citizens through tax increases or budget cuts to make room. And in our particular case, the current county board has made it clear that tax increases are not a realistic option,” said Bruce Mellert, Chisago County administrator. “So we will have to adjust our budget elsewhere and cut services or programs to make room to make room for these additional costs.”

Statewide, the Minnesota Department of Human Services estimates that about 108,000 new participants will be added to county health care rolls. Approximately the same number will be transferred by county staff from Minnesota Care to the new system. In addition, existing Medical Assistance cases must be converted “using the new eligibility rules and management information system, MNsure”.

“We as a county this year are going to be spending over $1 million to address some of this issue,” said St. Louis County Commissioner Chris Dahlberg. “As a county, we try to run on a policy for having a surplus for tough times but Washington is putting us on a path to jeopardizing our financial security as counties.”

The federal government will pay just under half of county costs to administer the medical coverage program, leaving it up to local taxpayers how to fund millions in implementation costs. The heavy lifting will last 18 months or more as thousands converge on county offices to sign up for the program.

“Being poorly thought through, rushed through with some Congress members stating ‘they need to vote for it to understand what is in it’, we are finding out at the local level, the byproduct of their wishful thinking,” said Anoka County Commissioner Matt Look, who opposed the health-care mandate.

Counties anticipate another surge related to the Affordable Care Act’s coming of age with some officials predicting up to 40 percent of health-care enrollees will sign up for food assistance at the same time.


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