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MNsure isn’t going away, so how do we fix it?

The following is an editorial from the Rochester Post-Bulletin.

The glee expressed by MNsure critics when PreferredOne announced it would be pulling out of Minnesota’s health insurance exchange was expected, but nonetheless, it’s still disappointing.

The Affordable Care Act isn’t going to go away. Even if the Republicans gain control of the U.S. Senate and maintain their majority in the U.S. House, Congress won’t be able to repeal it because they won’t have a sufficient majority to override President Barack Obama’s veto, something he certainly would use to preserve the signature achievement of his administration. That means we must make MNsure better or default to the federal health exchange as a majority of the states have done.

PreferredOne, the largest provider of coverage during the first year of Minnesota’s health insurance exchange, announced last week it was pulling out of MNsure because it was “not administratively and financially sustainable.” PreferredOne, a small but well-regarded company based in Golden Valley, saw an opportunity to expand its market and took a risk by offering premiums lower than any of its competitors.

Initially, the strategy appeared to work. PreferredOne had 59 percent of the private-plan market for MNsure enrollees through Aug. 6. Blue Cross and Blue Shield of Minnesota had 23 percent, HealthPartners 12 percent, Medica 5 percent and UCare 1 percent. However, PreferredOne concluded it couldn’t maintain its lower premiums as it neared the enrollment deadline for 2015 and chose to leave the health exchange.

Customers can stay with PreferredOne if they choose. The company has to renew existing policies by law, but it has the option of charging more. However, for other customers who qualify for federal tax subsidies, keeping their PreferredOne might not be affordable. The only way to receive the federal subsidies is to enroll in coverage through the state’s insurance exchange, and PreferredOne plans will not be available there. That probably will force some people to switch carriers, leaving the four remaining companies competing for nearly 30,000 people who bought PreferredOne policies when the 2015 open-enrollment period begins on Nov. 15.

Republican gubernatorial candidate Jeff Johnson stepped up his criticism of MNsure on Friday by calling for the state auditor to expand the current investigation into the health exchange’s operations on whether the Commerce Department pressured PreferredOne into offering rates that are unsustainably low. Legislative Auditor James Nobles is in the midst of conducting two audits and a broader evaluation of MNsure after its disastrous rollout last year.

We’ll dismiss Johnson’s charge as campaign hyperbole because accusing Gov. Mark Dayton’s administration of coercion is absurd, especially because he couldn’t offer any hard evidence. However, we believe Johnson’s earlier criticisms of MNsure are worthy of discussion.

Johnson has questioned Dayton for denying waivers to small businesses not in compliance with the federal health-care law. While the Obama administration has offered states more time to get small group plans in compliance, the Dayton administration said no to that option. Dayton defended his decision by saying 75 percent of Minnesota companies already are ACA-compliant and that exempting the other 25 percent would unfairly raise rates for the compliant companies.

Johnson also said he would change the composition of the MNsure board, adding people with experience in the health-care industry. He also has suggested tightening rules around what the MNsure board is authorized to do.

MNsure already was one of the main campaign issues of the gubernatorial and legislation races. Let’s not waste any more breath with the I-told-you-so rhetoric. Instead, let’s return to offering concrete ideas on how to improve MNsure.

Republished with permission.

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Comments (8)

  1. Submitted by Thomas Swift on 09/25/2014 - 09:16 am.

    No, considering the millions of tax dollars wasted already and the millions more MNSure will require next year, some hearty “I told you so is perfectly appropriate.

    Maybe, just maybe, future Governors will listen when industry experts are saying “no” and the majority of Minnesotans are saying “hell no”.

    • Submitted by Hiram Foster on 09/25/2014 - 12:57 pm.

      Telling like it is

      At some point, we became far more immersed in the politics of health care than we did in the policy. Every issue that comes up, instead of giving us a chance to understand and improve the system, instead becomes a target of political opportunity with no effort at all to maintain any underlying policy consistency.

      We decided on a system where private companies would offer insurance in a competitive market place. What happens in a competitive marketplace? Some participants succeed, some participants fail, and some participants just plug along. The above editorial reminds me of a line from a Dylan song to the effect that something is wrong, but no one knows what it is. The editorial writer seems to see the failure of a participant as a failure of the market, and both as problems in need of remedy. But you note, no remedy is offered as the writer wanders off into the thickets of offered political non solutions. What the writer misses isn’t the solution, it’s that this isn’t a problems with the system, rather it’s a natural outcome of the choices we previously made. If we do identify the failure of PreferredOne as a problem in need of a solution, the solution itself is fairly obvious; propping it up with a public subsidy. That works just fine, but what that also is is a rejection of our original competition based model in favor of a de facto, and undoubtedly soon to be de jure policy of single payer.

      • Submitted by Thomas Swift on 09/25/2014 - 04:25 pm.

        No Hiram, “we” didnt decide any such thing; the Democratic party did. The majority of Americans were against Obamacare and most Minnesotans were against MNSure.

        It never had anything to do with health care; it was born of politics. It should die the same way.

      • Submitted by Ron Gotzman on 09/25/2014 - 04:26 pm.

        The Goal of Obamacare was single payer. Obamacare was designed to fail. Even with a DEM house and senate – Obama did not have the guts or the votes to propose single payer. Instead we are slowly moving toward single payer which was the goal in the first place.

        • Submitted by John Ellenbecker on 09/25/2014 - 04:43 pm.

          Lets hope single payer is the outcome

          Single payer is the only logical and by far the most appropriate means of paying for health care – lets hope it is the final outcome.

        • Submitted by Thomas Swift on 09/25/2014 - 07:36 pm.

          Single payer didnt fly because every politician knew supporting it was a career ender. You think the Obamacare fiasco, and the disgraceful VA scandal has made government medicine more attractive?

          Personally, I hope the rump Demicratic caucus makes it a priority after the election.

        • Submitted by Todd Hintz on 09/25/2014 - 09:38 pm.

          Single payer is not enough to get the job done–it also has to be universal, government run, and coupled with results-based compensation reform. Anything less than that is just wasted effort as it doesn’t address any of the core problems we see with the past and current health care system.

  2. Submitted by Hiram Foster on 09/25/2014 - 09:25 am.

    Worthy of discussion?

    This is an editorial which works pretty hard to avoid taking a stand. Initially, a discussion of PreferredOne’s troubles with MnSure, it notes what seems to be true; MnSure provided a market place where Preferred One was able to accumulate a large market share. That market place, which proved so beneficial to Preferred One, by the way, was paid for largely by taxpayers. As problematic as the market place has been for other reasons, for Preferred One, it seems to have served the primary objective of market places anywhere, in that it provided a place for buyers and sellers to meet an do business.

    After touching on, but not really explaining what happened with PreferredOne, and MnSure, the editorial sort of wanders off into a reference to but not an explanation of, various Republican criticisms of MnSure. First, it refers to Dayton’s denial of certain waivers to smaller but not the smallest businesses. Second, it alludes to the composition of MnSure’s board. Are either of these issues relevant to PreferredOne’s problems with MnSure? Presumably the denial of waivers forced more businesses to buy Preferred’s products, not a bad thing for a company, but irrelevant here because selling product wasn’t MnSure’s problem. Would changing the composition of the board have helped? Again, the fact is, MnSure’s market place worked just fine for PreferredOne; their problem seems to be internal, something the board couldn’t really have done much about.

    For whatever reason, we decided to address health care problems by creating a market place where private companies could compete with each other. Well, this is what competition looks like, some folks win, some folks lose. If we don’t like that picture, may be we should switch to something else.

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