Planning for Minnesota’s health insurance exchange at risk of faltering

REUTERS/Jessica Rinaldi
With federal deadlines approaching, political uncertainty surrounds Minnesota's health care exchange planning.

Like many recent ventures in Minnesota politics, planning for the state’s controversial health insurance exchange — a major part of the federal health care law’s implementation — appears at risk of faltering.

As federal deadlines approach, business groups — once-quiet stakeholders in the planning process — have joined conservative Republicans in openly rebuking Gov. Mark Dayton’s administration for what they say is a lack of transparency in outlining the specifics of Minnesota’s developing health exchange.

Mike Rothman

GOP lawmakers, the Minnesota Chamber of Commerce and representatives of health insurance agents have been meeting with Commerce Commissioner Mike Rothman over the summer – most recently last week – to request more information about the exchange and how it will affect businesses in Minnesota.

Health exchanges often are compared to online travel marketplaces, such as Orbitz, where consumers could shop for and compare insurance plans.

The Dayton administration predicts Minnesota’s exchange could serve more than 1 million residents and help cut costs for families when the system is fully implemented in 2014.

In a late-August letter to legislative leaders, Dayton outlined plans to apply for another $42.5 million in federal funds – on top of the roughly $30 million Minnesota has already received to plan the exchange. “We are striving to make this process as transparent as possible and open to all Minnesotans wishing to participate,” the governor wrote.

Waiting for specifics

But the business groups say they’re still waiting for specifics, which, depending on how the exchange is implemented, could bring drastic changes for insurance agents and small businesses. As early as May, they began outlining concerns in letters to Rothman, – whose agency is leading the exchange planning..

The first deadline to submit a blueprint proposal to the federal government is Nov. 16 – two months away.

“We’re obviously having a little disagreement with the commissioner, but, again, it’s not that we think he’s doing anything necessarily wrong,” Chamber of Commerce President David Olson said in an interview. “We just don’t know. That’s the frustration. We have no idea what this thing is going to look like.”

Robert Hanlon, a member of the exchange’s advisory task force representing insurance agents, said his interests sent a letter on May 29 requesting more specifics.

“A critical concern for our members are the questions they raise about their future role, or lack of role, in the exchange and whether they should change their business model, or perhaps even their profession,” the Agents Coalition for Health Care Reform wrote to Rothman.

Industry representatives met with Rothman Tuesday, Hanlon said, to request answers to nine specific concerns before they meet again in the coming weeks.

Rothman has stressed the strength and openness of the exchange planning process — in the form of dozens of public meetings — and said in an interview Tuesday that he believes the department has been transparent.

The commissioner also said he committed to Olson, lawmakers and the agents during meetings to get answers to their questions.

“The commissioner comes off wanting to be transparent, and I just hope that’s how it really is,” Hanlon said, adding that he wants Rothman’s “actions to mirror how the commissioner presents himself.”

Tight deadline

Many are concerned that the timeline is too tight to adequately address the groups’ concerns.

In the same August letter to top lawmakers, Dayton wrote that his administration would continue developing the exchange but would wait until after the Nov. 6 elections to make any final decisions.

Rothman said he wants to “redouble our efforts to communicate” in the coming weeks to prepare for the Nov. 16 deadline, which leaves about 10 days after the election to finalize the early plans before they’re shipped off to the feds.

“You just can’t. This is huge,” Hanlon said of the tight timeframe. “A year’s not enough time to educate people.”

To date, the governor has moved ahead with exchange development without the direct input of the Republican legislative majorities, which declined to become a part of the advisory task force. Exchange legislation the governor supported didn’t move forward in the 2012 legislative session.

In turn, business groups, DFL lawmakers and consumer advocates have criticized the GOP, too.

“The roadblock, quite honestly, became some Republicans in leadership who said, ‘You know, we don’t want to put an exchange together because then it looks like we support the Affordable Care Act, and we’re not going to do that,’ ” Olson said, “and so we kind of swung and missed in the legislative session.”

Political considerations, too

Politics have also managed to creep into the discussion and stir up infighting among current stakeholders.

Phillip Cryan, a member of the advisory task force from SEIU Healthcare Minnesota, agreed the “recalcitrant” Legislature had much to do with delays in the planning process.

But Cryan also criticized groups like the Chamber for stepping forward now to “score political points in the public arena against the administration” and called the exchange planning process open and forthright.

He said waiting until after the elections allows the Dayton administration more leeway to assess its options politically — “given how much the legislative elections will change the dynamics around this, or could change the dynamics around this in the state.”

“Part of the governor is right,” Olson said about that point. “He’s wondering, ‘Am I going to get Tom Bakk and Paul Thissen, and we can go to work right away on this thing, or am I going to get Republican majorities back and then I’m probably going to be doing this thing on my own?’ ”

And if there were to be a President-elect Mitt Romney, Cryan added, “Then we might not care so much about all of these decisions.”

But Hanlon, insisting businesses’ concerns aren’t political, said he and others in the industry are simply working to create a healthy exchange.

“The crescendo and the breadth of concerns about the lack of transparency are, I think, too broad and deep to just write off as people wanting to protect their turf,” said GOP Rep. Steve Gottwalt, a health and human services chairman who opposes an exchange. “Common sense dictates that if you’re going to do something this dramatic, you need to have a conversation with Minnesotans.”

Politics aside, to some, the exchange’s complexity might be enough to derail the whole project before it would start taking enrollment in October 2013.

Dannette Coleman, a member of the task force and a health care expert from Medica, said Minnesota has a “50-50 chance of getting this pulled off” just in terms of the technological development and infrastructure needed.

“Put the politics aside, put the policy aside even as to what you’re building. The ability to technologically build this is being overlooked,” Coleman said. “If you add into that a lack of common ground and continual fighting between these different interest groups, I think that makes it even more difficult to get done.”

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Comments (6)

  1. Submitted by Greg Kapphahn on 09/13/2012 - 08:30 am.

    They’re Just Hoping for President Obama’s Defeat

    I suspect our “conservative” and big medical business friends are dragging their feet because they can’t face the reality that this is actually going to be implemented. They’re desperately hoping that Obama will be defeated and the A.C.A. will be wiped out and they’ll be back to business as usual.

    It seems increasingly unlikely that Obama will be defeated, however, so what they’ll get (and keen and whine and wail about) is a one-size-fits-all federally designed and controlled insurance exchange for Minnesota.

    This will mean that none of the tweaks and fine tuning that would have made Minnesota’s insurance exchange work best for the citizens and existing healthcare entities in Minnesota will be possible and we’ll ALL be doing a bit of teeth grinding at the ways that the universal exchange they forced us to use DOESN’T work well for our state.

    I’m always amazed how, with their absolute unwillingness to compromise with others on any issue, our “conservative” and big money friends consistently create negative outcomes for themselves and the rest of us, too.

    I can only assume that their inability to compromise is not a statement of high moral principles (as they try so hard to convince themselves and the rest of us it is), but a psychological dysfunction,…

    since it so constantly involves figuratively “cutting off their own noses to spite their faces.”

  2. Submitted by Janet Mondloh on 09/13/2012 - 11:05 am.

    Burying their head in the sand

    If Republicans had been willing to help plan the exchange on the chance that it might happen, there would be no need for more transperancy (whether or not the lack of it is real now). Of special note is the “drastic change” agents and small business “depending on how the exchange is implemented.” Isn’t that a compelling reason to participate in the planning?

  3. Submitted by Connie Sullivan on 09/13/2012 - 04:08 pm.

    It’s amazing that the head of the Chamber of Commerce can say that
    “we swung and missed”–refusing to participate at all in planning the MN exchange or even accepting the fact that there would be one under the ACA–during the last legislative session and later, then turn around now and complain that the governor and his administration are making huge strides toward designing an exchange that will be great for MN, without them.

    But like Mitt Romney, they’ve read the polls: the public likes obamacare, once they find out what’s in it. So now they’re running to get on the bus.

    • Submitted by Mark Kulda on 09/17/2012 - 04:44 pm.

      Not sure the public likes Obamacare

      I don’t think you can say the public likes Obamacare. It isn’t implemented yet so nobody knows what it will do.
      They may like some of the benefits that have already been put into place.
      But most people know very little about just how much this system is going to cost or about all the tax increases that will be coming soon to help pay for it….like the 12% increase in the FICA tax all of us will be paying next year or the $10-billion in taxes on health plans starting next year that will all go right to the bottom line of premiums or the medical device tax which will make those products much more expensive and cost job losses (St. Jude Medical already laid off several hundred people so they could pay for their part of the tax). And, many others that haven’t even been figured out yet.
      When people see how much this is going to cost and how the system of health care isn’t really going to change, they may not ‘like’ it as much as you claim.
      High quality affordable health care is different from ‘high quality health care that somebody else pays for.’ The thing that you claim people like is the second option when what this country really needs if the first.

  4. Submitted by Logan Foreman on 09/13/2012 - 09:45 pm.

    Any thought that

    The health insurance industry will help to improve the health care system on its own initiative is purely delusional. The health insurance industry is the main problem for the system that we have today.

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