In 49 states, there are basically two options for public health insurance programs: Medicaid for the very poor, and subsidized private health insurance on the Affordable Care Act’s exchanges for everyone else.

Minnesota is the exception. Unlike every other state, it has a third option in the middle: MinnesotaCare.

Created in the 1990s, MinnesotaCare covers people who earn too much money for Medical Assistance (Minnesota’s Medicaid program) but not enough to qualify for MNsure, the state’s health insurance exchange.

But MinnesotaCare’s future is uncertain.

Under the federal Affordable Care Act, people currently on MinnesotaCare could get subsidized health insurance on MNsure if policymakers decided to scrap MinnesotaCare. That’s the case in every state but Minnesota.

State Rep. Matt Dean, R-Dellwood, has sponsored a bill to abolish MinnesotaCare and move its remaining customers to MNsure plans. That idea faces opposition from the Department of Human Services and Democratic-Farmer-Labor Party lawmakers, but it remains an active proposal in the final weeks of the legislative session.

Here’s what you need to understand about MinnesotaCare:

What is it?

MinnesotaCare is a public health care program created in the 1990s to provide health coverage for people who earn too much money to qualify for Medical Assistance, Minnesota’s Medicaid program. Federal changes as part of the Affordable Care Act have left MinnesotaCare smaller than it used to be, but in 2013 policymakers chose to keep it around.

Who does it cover?

Today, people are eligible for MinnesotaCare if they earn at least 138 percent of the federal poverty line — $16,242.60 for an individual or $33,465 for a family of four. They can stay on MinnesotaCare as long as they earn less than 200 percent of poverty. People who earn more than that — $23,540 for an individual or $48,500 for a family of four — have to get subsidized private insurance on MNsure instead.

How many people are on MinnesotaCare?

About 100,000 people were signed up for MinnesotaCare last month, far less than the 1 million enrolled in Medical Assistance.

How much does it cost?

In 2015, MinnesotaCare cost $546 million. Of that, $254 million came from the federal government, $268 million from the state of Minnesota, and $24 million from member premiums.

Those costs are projected to increase dramatically, up to a total of $824 million and state share of $439 million in 2017.

With about 105,000 members, MinnesotaCare costs about $5,200 per enrollee per year in 2015. That’s about half the cost for Medical Assistance, which partly reflects differences between the programs but also that Medical Assistance covers senior citizens and people with disabilities, both groups with high medical costs.

How is MinnesotaCare different from Medicaid and MNsure?

Like Medical Assistance, Minnesota’s Medicaid program, MinnesotaCare is a public health program for low-income people. But Medical Assistance covers poorer people earning less than 138 percent of the poverty line, as well as people with disabilities, senior citizens in nursing homes and children from low-income families. MinnesotaCare largely covers the “working poor,” Human Services Commissioner Lucinda Jesson said. Unlike Medical Assistance, MinnesotaCare requires monthly premiums from members, ranging based on income from about $15 to $50 each month. Medical Assistance is also available retroactively, while MinnesotaCare requires advance signup.

People of slightly higher incomes than MinnesotaCare’s threshold can buy private health insurance on MNsure and receive federal tax subsidies based on their income. These private plans differ in how much they cost per month and how much they cover. The most popular MNsure plans are “silver” plans that cover 70 percent of medical costs, while MinnesotaCare covers 98 percent.

What would happen if MinnesotaCare went away?

MinnesotaCare enrollees wouldn’t be left on their own if the program were abolished, though policymakers disagree about whether those enrollees would be better or worse off.

The federal Affordable Care Act makes subsidized private health insurance available for people earning more than 138 percent of the poverty line — unless a state creates a “basic health plan,” which Minnesota did with MinnesotaCare.

So if Minnesota abolished its basic health care plan, the people currently on MinnesotaCare still would be eligible to get tax subsidies on MNsure.

Because those tax subsidies are covered entirely by the federal government, Minnesota’s budget would benefit. A fiscal analysis of Dean’s proposal to abolish MinnesotaCare found it would lower state expenses by close to $500 million per year.

Jesson said the state “would save money” if MinnesotaCare were abolished but said that’s ignoring “the impact on people” of moving to less-generous private plans.

“These are people who are barely making it paycheck to paycheck,” Jesson said of MinnesotaCare enrollees.

Dean said that the state needs to help low-income people with health costs but “can’t afford” MinnesotaCare when a cheaper option is available. And he argued MinnesotaCare’s enrollees would benefit from the change, too, by getting out of a “one-size-fits-all” model.

“They’d have a choice of plans (on MNsure),” Dean said. “Most consumers like choice. … I think people, by and large, do better with their health care decisions than the government does.”

Dean would direct about $100 million of the annual savings from abolishing MinnesotaCare to extra subsidies for people on MNsure earning less than 200 percent of poverty. These state subsidies would amount to half the premium remaining after the federal subsidy.

Will lawmakers abolish MinnesotaCare this year?

The Republican-controlled House is set to include Dean’s proposal to abolish MinnesotaCare in its budget. But Senate leader Tom Bakk has said the DFL-controlled Senate will never agree to scrap MinnesotaCare.

House and Senate leaders will hash out their differences in May.

David Montgomery can be reached at 651-224-5064. Follow him at twitter.com/dhmontgomery.