Landmark health insurance legislation is on its way to the Minnesota Senate after the House approved it shortly after midnight on Friday.  The House passed a conference committee’s proposal to reconcile the differences in House and Senate bills enacting a Minnesota health insurance exchange.  The ever-controversial exchange bill had a bumpy ride in the House, as anti-abortion legislators tried to revive an amendment that would have banned coverage of the procedure for any insurance policy sold on the exchange.

The House voted largely along party lines, 72- 61, on what the bill’s sponsor called a vote that made history. At times the process seemed erratic with procedural problems and abrupt schedule changes.  At first, members suspended their own rules and began debate mid-afternoon instead of waiting until the evening.

House Minority leader Kurt Daudt, a Republican from Crown, wanted to send the bill back to the conference committee, because he said it erred in removing House provisions that members from both parties had supported. “One of those in particular was the pro-life provision. I know that that particular issue had broad bipartisan support. We had 12 Democrats and all the Republicans supporting that provision to go into the bill, and obviously that was removed in conference committee,” Daudt said.

Unlike the Senate, the House approved a ban on abortion coverage except to save the life of the woman or in cases of rape or incest. Daudt also said the bill fell short of the needs of employers and the state’s economy.

“Is this bill going to make Minnesota more competitive? Is this going to help job creators in Minnesota do what they do best? Create jobs?  Unfortunately I think the answer to that question right now is ‘no,'” Daudt said.

That drew fire from Democratic Rep. Joe Atkins of Inver Grove Heights, who is the bill’s sponsor and a member of the conference committee.

“Rep. Daudt, you gave a nice speech.  It just kind of lacked one thing, which is facts,” Atkins said.

According to Atkins, the exchange would remove $150 million in business taxes that help fund the state’s safety net insurance for high-risk Minnesotans that health plans currently won’t cover. He added that the exchange would eliminate $150 million in uncompensated care.

“So that’s $300 million.  That’s impact on the business community, on the insurance carriers, not to mention the fact that the average Minnesota family is anticipated to save over $490 a year,” Atkins said.

The exchange is expected to cost between $50 million and $60 million a year to operate. The conference committee decided to fund the exchange through a kind of user fee, a 1.5 percent fee withheld from premiums sold on the exchange in 2014, and up to 3.5 percent in 2015. The exchange is expected to provide government health coverage to about 700,000 Minnesotans and at least another 300,000 Minnesotans in the individual and small group markets.

After about 90 minutes of debate, Majority Leader Erin Murphy, a St. Paul Democrat, called for a recess until 9:30 pm to allow for committee meetings.  When House members returned, the passion from opponents such as Delano Republican Glenn Gruenhagen had not subsided.

“This bill, it’s going to damage one of the best health care systems in the world with stinkin’ growth of government!  That’s a bunch of nonsense!” Gruenhagen said.

Lake Elmo Republican Kathy Lohmer echoed those thoughts, after explaining how the current health system helped members of her family when they were ill. “So the whole idea of the exchange to me is a monumental bait and switch,” said Lohmer. “I hope I’m wrong but I see 2014 and the federal government taking over this exchange.”

A federal exchange is exactly what supporters of the Minnesota exchange say is in the state’s future if the state doesn’t meet a deadline of March 31 to establish its own.

Before the House vote, Gov. Mark Dayton, a Democrat who had recently called the exchange a gamble, said he thought the conference committee’s compromises were reasonable and that he’d sign the bill enthusiastically.   He was already thinking about whom he would appoint to the seven member board.

“[I] pushed hard for this to have to go through the open appointments process so that we would allow for everyone in Minnesota who has expertise and wants to be involved in this to come forward and be considered for the board.  And I’m going to appoint the best qualified board I possibly can and make this a success in Minnesota,” Dayton said.

Right now, Minnesota is one of at least 17 states that aims to operate its own insurance exchange instead of opting for the federal government’s version. More than a million Minnesotans are projected to obtain health insurance through the online marketplace.  Among them are 300,000 who would otherwise lack insurance.

This story is part of a collaboration that includes Minnesota Public Radio News, NPR and Kaiser Health News.