Rep. Matt Dean chairs the House Health Care Finance Committee. Alex Kolyer | For MPR News 2012

Days after saying they want to cut taxes and still spend money on key priorities, a key Republican in the Minnesota House is floating a proposal to end a popular health care program for Minnesota's working poor.

Pressured by their own party to return a $1.9 billion budget surplus to taxpayers, GOP leaders are looking for ways to do that while pursuing their agenda.

State Rep. Matt Dean, who chairs the House Health Care Finance Committee, would move the 95,000 people currently participating in MinnesotaCare coverage to MNsure, where they would buy a private plan. Dean estimates the shift would save about $900 million over two years, cash that could be used for Republican priorities that include nursing home funding, and mental and dental health programs.

When MinnesotaCare was created more than two decades ago, state lawmakers aimed to make sure people who made too much money to tap Medicaid but didn't make enough to buy their own insurance had access to health care coverage.

That's still a state goal today. But people now enroll in the plan through MNsure, the state's health insurance exchange.

Dean, R-Dellwood, thinks private plans will offer people more choice.

"They could shop and get a plan that better fit their particular circumstances, and ones that would provide better reimbursements for hospitals and physicians, and one that really fit people's choices," Dean said.

Liz Doyle, associate director of TakeAction Minnesota, a non-profit group that supports public health care programs, said Dean's plan would be bad for MinnesotaCare participants. It would land them in more expensive and potentially less comprehensive coverage, she said.

"Our concern is that it would end the guarantee of affordable coverage that MinnesotaCare currently provides and subject low-income working families to potentially much higher health care costs on the private market," Doyle said.

TakeAction Minnesota played a big role in making MinnesotaCare the state's so-called basic health plan under the Affordable Care Act. Aside from some benefit improvements and adding more people to the program, incorporating MinnesotaCare in the state's implementation of the law effectively allowed Minnesota to tap some federal money to help pay for it.

A tax on health care providers also helps pay for the plan, but that source of cash is due to end in the next few years.

Dean said his bill also would set aside money to help MinnesotaCare participants buy a private plan. But so far he hasn't said how much he has in mind.

Doyle, however, said Dean's bill would hit Greater Minnesota the hardest because that's where enrollment is the highest.

At least one of the state's leading insurance companies also opposes Dean's proposal.

Ghita Worcester, senior vice president of public affairs and marketing for Ucare, which covers about 30 percent of MinnesotaCare's participants, said the company's analysis of Dean's idea points to higher costs for Minnesotacare participants.

"We're talking about a couple of hundred dollars at least in differences in premium through the year, and deductible differences," Worcester said.

Dean's bill is scheduled to receive its first hearing this week.

While his approach to MinnesotaCare might suggest Dean wants to bolster MNsure, which has been the subject of criticism from Dean and other Republicans since it launched in 2013, Dean said that's not the case. He has another bill that would abolish MNsure and move Minnesota to the federal exchange in 2017.

"Folks who are qualifying will need to be able to purchase insurance," he said. "But what we're saying is this is not sustainable."

Dean's bills face challenges in the DFL-controlled Senate, where legislators say they're hesitant to dismantle MinnesotaCare or MNsure.