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

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.

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.”