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MNsure study heralded by Democrats

When a health researcher at the University of Minnesota plugged the final figures into an analysis of how the Affordable Care Act has affected insurance coverage rates in Minnesota, Julie Sonier’s first response was to ask a colleague, “Could you please check my work?”

What popped out at her that day in mid-May was a striking figure: MNsure and the ACA had helped cut the state’s uninsured population by nearly 41 percent over the course of half a year. According to the study, released on Wednesday, the rate of uninsured Minnesotans dropped from 8.2 percent to 4.9 percent between September 2013 and May 2014. That historic low made an impression.

“When you see a number that big, the first thing you think is, ‘We’ve got to check this to make sure this is right,’” said Sonier, deputy director of the State Health Access Data Assistance Center (SHADAC).

The dramatic cut in the number of uninsured people in the state brought cheers from Democrats and those implementing the reforms. Much of the boost stemmed from public program enrollment, which has turned out to be significantly higher than projected.

Though Democrats have said they’re already highlighting the positive effects of health reform on the campaign trail, the dramatic drop in uninsured Minnesotans is a welcome bit of concrete data. But, despite the good news, don’t expect the Republican barbs about MNsure to stop.

The exchange and its partners acknowledge that there’s still work to be done to secure coverage for the 264,500 people who are still uninsured in Minnesota. The study’s authors also caution that their report is simply a snapshot of a dynamic measurement and more research needs to be done. But this week’s news prompted a victory lap of sorts.

“I’m delighted,” said Department of Human Services Commissioner Lucinda Jesson, who also serves on the MNsure governing board. “These are very encouraging numbers.”

 ‘We think it’s dramatic’

MNsure’s initially rocky rollout — technical roadblocks plagued consumers attempting to purchase coverage for months — made the significant reduction something of a surprise.

“I wish I could say I wasn’t, but yeah, I was really taken aback,” said DFL Rep. Joe Atkins, who carried the 2013 exchange bill in the House. “I didn’t expect this much of a drop this soon.”

The researchers said the report is the first look at how the ACA is affecting statewide measures of the uninsured.

“We think it’s dramatic,” Sonier said. “It definitely is unprecedented in Minnesota that we would see a change this rapid in the number of uninsured. … However, it is consistent with what some of the early national research is showing about changes in the percentage of people who are uninsured.”

Much of the coverage growth stemmed from the state-led expansion of Medical Assistance (Medicaid) to 138 percent of the federal poverty level and enrollment in public programs more generally. Enrollment in Medical Assistance and MinnesotaCare, a program for the working poor, grew by 20.6 percent.

Roughly two-thirds of those previously not insured were already eligible for public programs but simply hadn’t accessed coverage, which has long been a focus of the state Department of Human Services. Private individual plan consumption increased by 12.5 percent.

“We’ve known [of eligible non-enrollees] for 15 years,” said MNsure CEO Scott Leitz, a former Department of Human Services official, on Thursday.  “We weren’t ever able to make a dent in reducing that uninsurance rate … until now.”

Leitz and others said the changes wouldn’t have been realized without the coordinated publicity blitz and outreach efforts associated with MNsure. And so far, it appears that businesses haven’t discontinued their own insurance programs because of the reforms, as opponents predicted. In fact, the group market remained stable.

“One of the things that was predicted was that a lot of employers would drop coverage because of the Affordable Care Act, and I don’t think we’ve seen that in Minnesota,” said Julie Brunner, executive director of the Minnesota Council of Health plans, an industry trade group.

So far, 236,745 people have gotten health coverage through the exchange, including 51,500 people who have purchased private insurance, 136,303 Medical Assistance enrollments and 48,942 MinnesotaCare enrollments.

The next sign-up period begins Nov. 15. Those eligible for public programs and individuals with approved life event changes can buy coverage in the meantime.

It’s widely believed in health care circles that rates will jump for next year, and Brunner acknowledged as much, but said it’s unclear how much they’ll rise. This year’s rates were “based on who knows what,” she said, because there was little solid data on which to base rates. “That was just ‘good luck to the health plans.’”

Jesson said she wants to know who makes up the remaining 4.9 percent of uninsured people in the state. Sonier said future research will shed a light on the demographics of those citizens left out of the first wave of enrollment. “I think we have to keep working on the outreach and the community engagement,” Jesson said.

And a significant number of other variables will likely cause shifts before further analysis is undertaken. Brunner said it’s unlikely that a clear picture of what’s happening in the insurance market will emerge until 2016 or 2017.

“Everyone wants to make conclusions today,” Brunner said. “We’re way too early in this process to know what this is going to look like.”

Political repercussions

The Minnesota Jobs Coalition launched a roughly $50,000 ad buy on Thursday targeting Gov. Mark Dayton for his support of the Affordable Care Act. The group, a conservative political committee, has attempted to sink the governor’s electoral bid by casting the weight of MNsure’s perceived failures as concrete boots.

Also updated Thursday was the group’s website, where additional criticisms are leveled at Dayton and MNsure. The coalition’s executive director, John Rouleau, said the group would continue attacking Dayton along those lines.

“MNsure is still far from settled,” Rouleau said. “I think we’re going to continue to hold them accountable.”

But Democrats say they won’t be running from MNsure — especially after this week’s news. TakeAction Minnesota, a progressive grassroots organization that was heavily involved in the legislative incubation of the exchange and continues to offer assistance in enrolling consumers, plans to highlight MNsure during door-knocking and use it as an issue to turn out voters.

“We don’t shy away from that based on the work that we’ve done, so this is obviously a big boost,” TakeAction spokeswoman Greta Bergstrom said.

Likewise, the Dayton campaign said that the governor’s re-election efforts would include promoting the exchange’s benefits to Minnesotans.

“There’s been a lot of good that’s come from the health care law even before the news that Minnesota’s uninsurance rate is at historic lows,” Dayton campaign spokesman Jeremy Drucker said in an email. “[Lt. Gov. candidate] Tina [Smith] has been talking about it on the campaign trail for a couple of months now, especially as she’s heard such great success stories.”

Though Democrats have argued for some time that hundreds of thousands of Minnesotans have managed to get affordable coverage through the exchange, data suggesting that the rate of uninsured Minnesotans has dropped significantly because of the health care law is valuable for campaign purposes, a DFL operative told Capitol Report.

“The Republican obsession with the Affordable Care Act and with MNsure will continue regardless,” the operative said. “I think it’s always been something they’ve wanted to talk about in this campaign.”

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