MNsure: ‘What’s working and what’s not’

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Not long after the start of a MNsure Legislative Oversight Committee hearing Thursday, Sen. Tony Lourey, DFL-Kerrick, committed a social — well, oversight.

Thanking the chairman of the MNsure board for an update on the insurance exchange’s recent progress, Lourey addressed his gratitude to “Chair Beutner.” The reference was a bit outdated, and Lourey soon corrected himself, redirecting his thanks to the new board chair, Peter Benner.

In fact, much had changed for MNsure since the committee’s last meeting before the legislative session. Among the new faces was Rep. Greg Davids, R-Preston, who officially took over as co-chair, the first time a Republican had ever held that post. Also new to the committee was Allison O’Toole, the interim CEO of MNsure, who took over that job following the departure of Scott Leitz in May.

Moments after his error misnaming a testifier, Lourey jokingly introduced O’Toole as “Mr. Leitz.” That line got a laugh, as did a one-liner from Rep. Joe Atkins, DFL-Inver Grove Heights. Atkins, a lead author on the original enacting legislation for MNsure, asked about an IT tool known as a “time machine” might be able to take the exchange back to 2013, before the troubled launch of its website and rounds of disappointing consumer enrollments.

Aside from those moments, the chuckles were few in coming as committee members pressed officials from MNsure and associated state agencies for details on a raft of issues that remain, or that had arisen since last they met.

O’Toole, in her introductory remarks, showed lawmakers an internal MNsure document that captures “what’s working and what’s not,” and said the deficient areas were being addressed by staff within MNsure, the Department of Human Services (DHS) and MN.IT, which has taken authority over MNsure’s Web capabilities and information transfers.

Some 327,000 Minnesotans have registered for coverage through MNsure through Aug. 9, though only about 69,000 did so on the private market. That number is significantly lower than projections from prior to MNsure’s launch, and poses a threat to future budgeting. MNsure is funded through a 3.5 percent “withhold” surcharge on private plans, and supporters will hope there are yet more private insurance consumers who enter the market during the next open enrollment phase, which will run from November through January.

O’Toole told members there were lessons to be learned through the first two enrollment periods.

“The good news is, we have two years of real experience and real data to base our budget on,” she said. “We’re getting smarter.”

Davids, chair of the House Taxes Committee, expressed particular concern about a shortfall of roughly $3.5 million in MNsure’s operating budget. MNsure tapped existing federal grant money to fill that gap. Davids lamented the state’s reliance on federal funds in an amount approaching $200 million, though some core functions were still lagging behind.

Davids said O’Toole’s status update, with its “nice charts and graphs in greens and reds and blues… it looks wonderful,” failed to include the outdated mode of transfer of information to state health insurance companies.

“That’s my big concern, the health plans getting blamed for things they should not be getting blamed for,” Davids said. “It’s MNsure’s ineptitude that is causing problems… $200 million and you’re still getting Xcel spreadsheets. That’s just amazing to me.”

On another point, Sen. Michelle Benson, R-Ham Lake, asked about the authority of the committee itself. Benson observed that the joint House and Senate body had been given an increased statutory role in this year’s health and human services budget, though it was unclear how it would relate to a separate advisory task force, first proposed by Gov. Mark Dayton, that will make recommendations on long-term health care budgeting.

“I would like some understanding as to who’s going to take the lead on evaluating [changing to] a federal exchange, or innovation waivers, structural changes to MNsure,” said Benson, who is also a member of the task force. “I don’t know who owns that, but I’m in both places, and I don’t want it to get missed.”

Lourey responded that the task force, of which he is also a member, has a broader scope, but is also better positioned to push major changes to MNsure, as it was devised specifically to make policy recommendations, unlike the oversight committee. The 27-member task force held a first meeting last month, and Lourey said he hoped it would meet again before summer’s end, and continue working throughout the fall.

“The scope of that work was pretty clear, that they’re supposed to be coming up with … the path forward for health care,” Lourey said. “And I would put MNsure, you know, federal exchange, or partnership model … there’s a lot of options on the table, and I think it’s difficult to parse out a piece and give it to one entity.”