Exchange sees continuing surge in enrollments, political complications
All eyes in the political scene have turned to the state health insurance exchange, it seems, and most are casting either a skeptical glance or a withering glare in the direction of MNsure. Earlier this week, the exchange began its own “end-to-end” review of its work process, while simultaneously holding a first meeting with Office of theLegislative Auditor (OLA) head Jim Nobles.
In a Thursday afternoon hearing before the MNsure Legislative Oversight Committee, interim CEO Scott Leitz told legislators the agency had experienced a “productive opening conference” with Nobles.
The MNsure oversight committee members include Rep. Joe Atkins, DFL-Inver Grove Heights, and Sen. Tony Lourey, DFL-Kerrick, who carried the enacting legislation in their respective legislative chambers. According to Thursday’s hearing, even they are concerned about recent reports of problems with MNsure’s performance since the beginning of open enrollment on Oct. 1.
When it came time for Nobles to take a turn at the microphone, he exhibited a stern demeanor and told the assembled lawmakers that his staff’s pending review of MNsure has grown from a duty handed down by the federal government to a major opportunity to explore what went wrong. Nobles’ warning of a thorough investigation was welcomed by both Democratic and Republican legislators.
“This year is going to be the year of MNsure for us, in terms of oversight and accountability,” Nobles said.
Review is obligatory with federal funds
Nobles explained that a formal review by his office is standard operating procedure in conjunction with any substantial federal grant award to the state – such as those received by MNsure, which has taken in more than $150 million from the federal government toward the creation of its website. But legislators from both parties expressed interest in whatever Leitz, Nobles and their respective staffs could churn up to explain how MNsure had gotten to the present point.
Republican committee members praised Leitz for taking a more transparent approach to MNsure’s leadership post than his predecessor, April Todd-Malmlov, who resigned unexpectedly in mid-December. But GOP legislators still argued that the exchange needed to revisit its decision process in order to determine who had signed off on key decisions that might be at the root of software and operating flaws in the exchange website.
“I hope that we’re seeing a culture change at MNsure,” said Sen. Michelle Benson, R-Ham Lake, who described her own difficulty in getting answers out of the agency during Toddd-Malmlov’s time in charge.
Also chiming in during Thursday’s hearing was Rep. Tara Mack, R-Apple Valley, who said she was particularly concerned with how much new customers would pay to buy insurance on MNsure. Committee co-chair Rep. Joe Atkins, DFL-Inver Grove Heights, made the point that Minnesota’s insurance premiums were, on average, the lowest of any state insurance exchange in the country. But Mack countered that customers did not care about how much they were paying relative to other states, and would instead be worried about their premium costs compared to past years. She said numerous constituents had contacted her to say they were paying more in 2014 than before.
Those relatively low premium costs have a significant downside, as addressed by MNsure board chairman Brian Beutner Thursday afternoon. Beutner told lawmakers the exchange, which is supposed to fund itself through a small withholding tax on private customers, could eventually find itself without the necessary resources to continue operating at its current level.
“It is not our intent to come to the Legislature and ask for additional funds,” said Beutner, who added that the exchange would explore its funding options in the coming months.
Enrollment surge continues
Thursday’s hearing followed a round of comparatively good news for MNsure, which announced earlier in the week that total enrollment had approached 72,000 through Jan. 4. That includes more than 26,000 consumers buying insurance on the private market, a large uptick over the slight interest seen in the exchange’s first few months.
Despite the significant increase in insurance purchases through late December and early January, University of Minnesota professor Steve Parente said the state exchange numbers are “still pretty anemic.”
The minimal sign-up can be partly attributed to the new state agency’s attempts to expand Medicaid coverage under the state’s Medical Assistance program while, at the same time, trying to reach new private customers who might be interested in Qualified Health Programs (QHPs).
“Most people would have expected Minnesota would have been better at this,” Parente said. He added that the true impact of MNsure and its technical difficulties won’t be known until late April, at least, when final figures will reveal how many residents have decided to enroll in the exchange rather than facing a federal tax penalty of $95 or 1 percent of one’s income, whichever is larger. Consumers have until March 31 to sign up for coverage, and those who do not would be subject to fines that are set to escalate in coming years.
Parente floated the possibility that the state could admit failure and turn administration duties over to the federal government, though he said he had not heard much discussion of that nature to this point.
“I think that type of thing will start coming up more as we get closer to the election cycle,” Parente said.