Other view: MNsure, so far, largely a subsidy exchange
In a look behind the numbers at MNsure, a few clear themes emerge, representing some timely challenges as Minnesota’s health insurance exchange under the federal Affordable Care Act prepares for its second “open enrollment” period in November.
Most of those enrolled through the exchange are on public subsidies. As of last week, nearly a quarter-million Minnesotans had enrolled. Of those, 88 percent — 218,615 out of a total of 249,369 — are receiving a public subsidy.
That leaves 30,754 Minnesotans who purchased a plan on their own via MNsure.
The ratio of subsidized to “commercial” enrollees “needs a long, hard look going forward,” said Julie Brunner, executive director of the Minnesota Council of Health Plans.
Unless they “ramp up significantly,” she wonders if the low numbers on the commercial side will provide “the financial support that MNsure needs to have a balanced budget.”
It’s a concern apparently shared by the MNsure board, which this spring voted to increase to 3.5 percent a fee on those buying policies from private health insurance companies through the exchange.
The system is preparing to absorb still more public enrollees. MNsure has delayed until August a major transition of public insurance beneficiaries to the system. About 800,000 Minnesotans will be renewing their current coverage.
MNsure CEO Scott Leitz said in June that the agency “wanted the system to be stable” to handle the influx.
MNsure’s technology and systems still don’t work as they should. “Tough questions need to be asked about the functionality of MNsure as we move into the new open enrollment season,” Larry Jacobs of the Humphrey School of Public Affairs at the University of Minnesota said.
“We need the kind of platform that was promised, and we are a long way from that,” he said, noting that the state’s health plans have been “exemplars in their willingness to put up with a very faulty system.”
A consultant’s report to the MNsure board this month noted significant work ahead: 41 of 47 flawed or missing system components should be addressed before open enrollment this fall.
Website problems and an overwhelmed call center resulted in increased traffic at health plan call centers, Brunner said. “People who weren’t willing to wait to get through the MNsure system went directly to the health plans. That was not supposed to be the design of MNsure.”
Part of the problem, Leitz said, was that the system was created on a tight timeline that didn’t leave room for development of backup procedures and contingency plans in the event of problems. The objective now, he said, is to “learn from what happened” and make progress on the overall goal of getting people covered.
We don’t yet know enough about whether MNsure will achieve one of the Affordable Care Act’s most important goals — to get more people covered. Earlier this month, MNsure announced that the rate for Minnesota’s uninsured population is at its lowest point since records have been kept, dropping by 40 percent. The September-to-May reduction was from 8.2 percent to 4.9 percent.
A key point, however: The report couldn’t say exactly where the uninsured found coverage, that is, whether insurance was obtained through public programs, private insurers available through MNsure or commercial plans sold outside the health exchange.
Pushback from legislative Republicans — including the contention of Sen. Michelle Benson of Ham Lake that, to the extent the reduction came from people enrolling in the state’s Medical Assistance and MinnesotaCare insurance programs — suggested the state “didn’t need MNsure at all.”
Costs are in doubt, now and in the future. The starting point here, Jacobs said, is that Minnesota has, on average, the lowest premiums in a state exchange in the nation. “We’re offering an incredible deal to most Minnesotans.”
It won’t last, though. It’s reasonable to expect MNsure’s rates to increase in 2015. The plans, competing in a free market, priced their offerings competitively in preparation for the exchange’s launch. New rates will reflect experience, although it’s limited to only about three months of actual billings, Brunner said, because of cycle time required for statements and processing.
What’s needed, Jacobs said, is “genuine legislative oversight on the cost issue.” That will require a serious bipartisan effort to “figure out how much is being spent, what is it being spent on, and where dollars can be cut.”
It matters what gets measured, how, and to what end. Assessing the results will require continually burning through the fog of politics.