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GOP leaders, Dayton representative spar over MNsure performance criticisms

daudt and hann
MinnPost photo by James Nord
“We think that Gov. Dayton needs to take leadership on this issue,” said Senate Minority Leader David Hann, right, during a Monday appearance with House Minority Leader Kurt Daudt.

Republican leaders leveled another round of criticisms at Minnesota’s embattled health insurance exchange on Monday as the deadline for consumers to select coverage looms next week.

GOP legislative leaders said Gov. Mark Dayton, who in part led the effort to bring a state-based exchange to Minnesota, needs to take ownership of MNsure’s failings. They said the governor must address the uncertainty around whether consumers will have health insurance on Jan. 1, when the federal health reform law takes full effect.

The Dayton administration responded with a heavy criticism of the Republican leaders in a release: “The minority leaders are fully aware that that under Minnesota law, MNsure is governed by an independent board. They are also aware that MNsure and other state agencies have been engaged in an around-the-clock effort to ensure that those who need coverage have it on Jan. 1.”

State and MNsure officials — as well as the insurance carriers — have said that Minnesotans who select plans and pay for them by Dec. 23 will have coverage beginning on Jan. 1. They’ve also guaranteed that those enrolling in public health programs who complete the necessary steps will be covered.

But Republican leaders have said there’s uncertainty over whether consumers will have coverage and that no insurance cards have been issued yet. They blasted Dayton for distancing himself from policy failures – the governor was critical of MNsure’s operations last week — and said the governor needs to ensure that the exchange’s basic functions are working.

“We think that Gov. Dayton needs to take leadership on this issue,” Senate Minority Leader David Hann said Monday afternoon at a Capitol press conference. “The bottom line is people need to be insured.”

Eileen Smith, spokeswoman for the Minnesota Council of Health Plans, which represents Minnesota insurance companies, said on Monday the plans are working with MNsure to process enrollment information manually.

“Plans are working with MNsure every day on manually getting enrollment information from MNsure to the health plans,” Smith said in an email.

Consumers enrolling in MNsure can choose to pay online immediately, have MNsure bill them or request their insurance carrier to send an invoice. Smith and MNsure leaders have stressed that Minnesotans should pay online immediately to ensure they get coverage.

“One of the changes to keep the process moving is that MNsure is sending invoices to everyone who asked to be invoiced, even if they asked for the health plan to invoice them,” Smith added. “That way people don’t have to wait for the plans to have the information in order to receive an invoice. So when people receive an invoice, they need to pay it immediately.”

Smith said in an interview that staff from both the public and the private side have been working “around the clock” to sort issues out. She said she’s gotten emails from tech staff in the middle of the night. But, she warned, there will still likely be issues come Jan. 1, although consumers will have coverage.

“What I’ve been told by some of our tech people is that there will be problems, interruptions — there’ll be problems on Jan. 1,” Smith said. “Our goal right now is to minimize them.”

As an example, consumers who go to a pharmacy on Jan. 2 to pick up medication might not be in their insurer’s electronic system, she said. Pharmacists would then have to get in touch with the plans to verify the consumer had insurance, which is an issue that has come up before MNsure.

“Their goal is to not have it happen at all, but they just can’t promise anything at this time,” Smith said.

Republicans at the Capitol on Monday didn’t have concrete solutions to the problems they raised, and instead called on Dayton to end the “uncertainty” that they said consumers are feeling in the final days before health coverage is supposed to take effect.

They positioned themselves as practical critics of a program that should be working for consumers and isn’t — though it’s one they’ve never supported.

When reporters pushed the Republicans on their role in the exchange’s missteps, they demurred. The GOP blocked or ignored exchange legislation during their time in the majority, when Dayton pushed ahead on his own.

“Would I love to repeal this? In a heartbeat,” House Minority Leader Kurt Daudt said, noting that the federal regulatory atmosphere made such a move unlikely.

Dayton called the exchange’s performance “unacceptable” last week. On Monday, his administration was critical of the new GOP attacks.

“No one has ever gotten health care via press conference, so it is unsurprising that today’s round of GOP rhetoric was so unproductive,” Dayton administration Spokesman Matt Swenson said in a press release.

But Swenson also revisited the governor’s criticisms of the exchange, which has faced a bumpy ride since it opened on Oct. 1. Although initial problems plagued the exchange’s launch, it was performing better than the federal exchanges in the ensuing weeks.

But it’s had a series of recent glitches, including the need to review about 30,000 applicants for correct information and difficulties sending enrollment information to the insurance carriers.

“There is understandable frustration with the process thus far — Gov. Dayton has been very clear that the current state of the exchange is unacceptable, which is something he has expressed clearly to the board and to the public,” Swenson said in the statement. “The governor has said, and still believes, that we are in a critical time for the exchange — if changes are needed, they must be made immediately.”

Others have also latched onto an event surrounding MNsure Executive Director April Todd-Malmlov and the Human Services official who oversees the exchange there. KSTP reported on Sunday that Todd-Malmlov and Jim Golden, the state Medicaid director, were vacationing together in Costa Rica around Thanksgiving.

Scott Honour, a Republican running for governor against Dayton in 2014, released a statement on Monday bashing the exchange’s performance. He called for Todd-Malmlov to step down.

“I can’t imagine the head of a company being on vacation during a major product rollout,” Honour said in the statement. “So for the head of MNSure to be on vacation in Costa Rica during the troubled rollout of a government program that affects the lives of almost every Minnesotan is beyond belief.”

Republican leaders declined to directly address the issue at the Monday press conference. Asked afterward, Hann shifted focus back onto the performance issues plaguing the exchange and said he wasn’t familiar with many details of the controversy.

But the GOP leaders did criticize DFL lawmakers for not convening a legislative oversight committee meeting to discuss MNsure’s problems. The committee hasn’t met since September, and its next meeting is in mid-January.

“This oversight committee should be discussing this process,” Hann said.

Rep. Joe Atkins, the architect of the exchange in the House and a co-chair of the committee, said he’s not sure what lawmakers could have done to stop the problems that have arisen.

He said Jan. 9, when the next meeting is scheduled, was the first time lawmakers’ schedules aligned to make a gathering feasible. He added: “I don’t know that we necessarily would have been able to prevent the issues.”

Atkins and Sen. Tony Lourey, who carried the exchange legislation in the Senate, are meeting with MNsure Tuesday. Atkins said he’s been in contact with the exchange a few times a week.

The Democrat from Inver Grove Heights said that he and other lawmakers have shared their concerns with MNsure. But that hasn’t stopped him from worrying about the exchange, though he's glad it's based in Minnesota and not in Washington.

“I feel like a nervous parent who’s given the car keys to their teenage driver,” Atkins said about MNsure. “You turn over the car keys and watch them drive down the road and say a few prayers.”

Atkins said he would be willing to look at Todd-Malmlov and Golden’s vacation if someone could show the move was a conflict or seriously affected their work.

“If they’re not doing their jobs, it does [concern me],” Atkins said. “If she’s still working … I just don’t know enough about it.”

“I guess someone would need to identify where the conflict in that is,” he added, saying that he hoped all state agencies, not just MNsure and DHS, work well together.

“Whether they needed to do it in Costa Rica, I don’t know," he said.

DHS and MNsure put out a joint statement dismissing the issue on Friday. "There is no conflict of interest," the release says. "There is no reporting relationship between them. Mr. Golden is a DHS employee. Ms. Todd-Malmlov works for MNsure."

Still, there are plenty of problems to occupy exchange staff in the weeks before Jan. 1.

In a message to insurance brokers on Monday morning, the exchange outlined its fixes to issues relating tax credit calculations for consumers. It also reminded brokers of the tight deadlines customers face and stressed that the exchange can’t accept paper applications.

Thirty minutes later, another email went out.

“We are currently experiencing problems with plan enrollment for January 1, 2014 coverage and are working to resolve this issue,” the message said. “Please check the website for updates. We apologize for any inconvenience this causes you.”

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Comments (18)

Tsk, those problems

Problems getting MNSure to work perfectly in its first two months, yeah. Okay, SO, now how about the problems with the Jobs bills, the Farm bill, the Immigration bill, and all the rest of the stuff the House GOP has been sitting on while they took 274 days off this year?

Republican criticism of MNSURE, Dayton

This is so tiring. Republican's only intent is to criticise, obfuscate, misinform and delay. Obviously, if they rolled up their sleeves and decided to help implement the health insurance exchanges (a former cornerstone of their own offering of a national health insurance approach) thier criticism would have a little more validity. Otherwise they are an echo chamber of right wing talking points and ideological intolerance. Republicans also mistakenly are trying to link all democrats with the failure of the web sites, a losing strategy. The web site will be fixed, just like the Republican Medicare part D web site rollout was fixed. It's electronic, not political. Once the site functions well and that criticism goes away, the benefits of the ACA and MNSURE will become huge political advantages for democrats. One wonders what genius is guiding the Repubican Party's political strategy. They will appear petty and uncaring as they try to take away millions of new health insurance policies for the poor, entrepeneurs, early retirees and many with pre-existing conditions. They have ostracized huge demographic elements of our population: the poor, minorities, same sex couples, the elderly, young people, unioins and women among others. Their politics have become sick and dysfunctional to the point of embarrasement.

What's Hann holding in his hand?

A list of new Republican ideas?

There's enough room on that card to say this:

You don't expect me to buy your food, clothing or shelter, why do you expect me to buy your health insurance?

Funny Card

People don't go bankrupt from buying a lifetime's worth of food all in one outing to the store.

What???

What are you trying to say?
Your comment doesn't make any sense.
Please make a non-cryptic statement.

Even More Funny

It doesn't make sense if you don't follow the bouncing ball of Dennis' logic. But if you take his statements at face value and translate them into healthcare my line makes perfect sense.

What part of it do you not understand?

Ha!

There's enough room on that list because there are no new Republican ideas. Just old dogma.

Waiting to sign up

Things are too messed up to even waste time trying to sign up now. My employer did put funds in a medical health account since group plans for small businesses were too expensive. That is now going to be illegal to do. The alternative? Still give us that money that did go into the health account AS WAGES. This amount, already minimal, will now be taxed and further reduced. Since I could not afford Obamacare with what was provided, I will be taking money from the food budget to meet increases. I appreciate all the employer has done for us, given the circumstances. However, it is my government that is pushing me closer to poverty by forcing me to by the health equivalent of auto insurance. And that bronze level, with it's high deductables and high co-pay looks so very attractive.

Sign Up

Mark, you just made a very good case for single payer universal health care. No deductible, no co-pay, no lifetime cap. Other countries do it for a fraction of the price we pay and with far better results. Why can't we?

Why can't we?

I think we can explain it quite simply (perhaps you've had similar thoughts) by the following three cases:

1. Corporate executives who feel a sense of kingly entitlement to your wealth. Take the case of former United Health CEO William McGuire, who cleared $1.1 billion before he left the company. As it turns out a huge chunk of that was taken illegally. Families, businesses, entrepreneurs--it doesn't matter who you are or the difficulties of your financial and health situation, executives from these health insurance companies feel entitled to take your hard earned money for their private benefit. Your insurance needs are their golden yellow brick road to wealth and status.
http://en.wikipedia.org/wiki/UnitedHealth_Group#Resignation_of_McGuire

2. Wall Street investors. You and I are viewed as profit centers by these critters. We're not people who need the security that insurance can provide, we're opportunities for financial grifters to line their pockets, plain and simple.

3. Free market ideologues who find no ethical problem with a tiny elite profiting off of your health needs. They're dogmatically committed to "free market" solutions regardless of the evidence, or lack thereof, of their efficacy.

Same story, different day....

It's simple, and we all know it.

When the special interests meet with the politicians, whose parties they donate BILLIONS to, they bring the game book with them, the plan on how a piece of legislation should work so that they still make their profits, if not more. The parties tell their elected and seated members to follow their directions, or no financial support for them for re-election. (Why do you think our elected officials can't find more than two days a week to be in chambers; or, will put their names on a number of amendments to bills; or, will give straight answers to easy, direct questions?

That's how the system works.

There wasn't anything in the ACA or the state exchange to cut insurance cost. Just look at the spreadsheets MNSure provides and see how few of the insurance companies cover most of the counties in the state. Just follow the money.

Because

we supposedly live in a free society where people are expected to pull their own weight.

Free for whom

The rich, big corporations and Wall Street

You are not being realistic

You are in a dream world. Far too simplistic.

I don't think you would make that same statement if tomorrow you were broadsided by a semi-truck, with no fault on your own; and you ended up in a hospital, crippled, for two to three months, then a year of physical therapy, not to mention the rest of your life needing in-home nursing assistance. No matter how much you have in the bank, when you have none coming in, and millions going out every year, you too will not be pulling your own weight.

Don't think it can happen to you? Tens of thousands have it or strokes or Alzheimer' or autism or birth defects to children happen to them every year in this state.

It can happen to your family just as easily.

Come on????

Where is your evidence?

I agree

Without any cost reduction measures in the fed or the state programs, the health insurance companies, all of them, still get what they want: the same premium levels with deductible levels where they have little to no risk. Great scenario for them: Little risk, great income. But then again, we all know who makes the largest political contributions, .... to both sides of the aisle.

All they (read that as the insurance companies and the politicians) had to do was make sure they didn't have to offer all programs at all levels, in each county of the country, across the board. They remained able to pick-n-choose, participating where their data showed the best profits, and avoiding those areas with the highest costs and lowest profitabilities. Worse yet, they listened to some half-baked marketing group tell them that they would get the most participation if they kept the premiums for the youngest at the absolute lowest levels, and balanced the books on the oldest (forced) enrollees. That's not how actuarial tables are suppose to work.

Vermont, in comparison, mandated that the highest premiums paid in their state program would be no higher than 20% higher than the lowest rates paid. Now that's a balanced program. (You don't have to 'market' a healthcare program when you mandate participation. So, why are they playing these ridiculous games with the rates systems? And, why are the board members of MNSure signing off on this non-sense?)

Disaster. The most attractive part of this program is to not enroll, pay the $95 penalty; and if you get hit in an accident or suffer a heart attack or stroke, just show up at the ER. The federal law that mandates hospital care is still in effect. Our state legislators and the board of MNSure missed that one entirely.

This is to be expected

This will end badly like most government interventions into markets. The prices for medical insurance is going to rise, they have been rising exponentially for decades, this will continue. The price for medical services is going to continue to rise as well, it has for decades. The question is, why? What are the key drivers to the cost of goods or services sold within a sector of an economy? While this website roll out is quite funny to watch, it is only small part of the underlying problem of distorted pricing within markets and how to address them. When people start seeing the effects of this massive market intervention and the associated price increases they will reject it.