Minnesota’s health insurance exchange is a major step closer on the long path to becoming a reality.
The state-based exchange — the linchpin of federal health reform — is on its way to Gov. Mark Dayton for his signature, following Senate approval Monday on the compromise bill.
Major work remains, though, in designing the physical exchange and in working out rules and regulations.
Now it’s time to build the exchange and see if years of labor — both legislative and technical — will work as promised on an effort that advocates call the most sweeping health reform in 50 years.
“First and foremost we’ve got to get a certain signature on the bill, and I don’t take anything for granted,” DFL Rep. Joe Atkins, the exchange’s House author, joked after the Senate vote on Monday.
He’s referring to Gov. Mark Dayton’s sign-off. Luckily, Dayton said on Friday that likely wouldn’t be a problem.
Even as lawmakers cleared political hurdle after political hurdle, exchange staff was working to comply with internal deadlines and federal milestones.
The exchange is expected to serve roughly 1.3 million Minnesotans as an online marketplace where consumers and small businesses can compare and shop for insurance coverage.
Advocates say it will allow Minnesotans to save significantly on premium costs. Opponents, however, criticize it as bloated government bureaucracy that will be detrimental to consumers. In addition, the Minnesota Chamber of Commerce is not happy with the final plan.
Organizations ranging from such progressive grass-roots groups as TakeAction Minnesota to such business interests as the Minnesota Chamber of Commerce worked tirelessly to try to shape the exchange bill to their liking.
Now, they won’t have much downtime as work on the rules, regulations and governance of the exchange are developed.
Lawmakers must now choose who runs the exchange, and rules governing how it works have to be implemented.
And other tasks await:
• The incredibly complex IT infrastructure has to be completed on time.
• Health plans must submit the products they want to sell in the marketplace for regulatory review.
• And the state has to launch a PR blitz explaining to consumers what the exchange can do for them.
Atkins said it reminds him of his teenage children.
“You’ve got to just hope that you’ve done good things and that they’re going to do well on their own,” he said. “That being said, I don’t expect to go quietly into the night.”
There are two important deadlines looming at the end of April.
Lawmakers must finalize the exchange’s seven-person governing board — right now the only member is Human Services Commissioner Lucinda Jesson – and the board, or a state agency, must outline regulations for the people who help consumers shop on the exchange.
The exchange legislation specifies that board members will be selected using the state’s “open appointments” process. Sen. Tony Lourey, the bill’s Senate author, said he expects the job postings to go up this week.
Dayton, with legislative input, will select consumer advocates and health experts to fill the remaining six spots on the board. Lawmakers slightly relaxed conflict-of-interest standards to allow one member of the board to be a provider at an academic institution like the University of Minnesota.
Lourey said his goal was to design an “expert board that really understands the industry and really is watching out that the plans offered on the exchange are in the interests of consumers.”
Board members are eligible for $30,000 salaries during the first two years of the exchange and for per-diem payments and reimbursements after that.
Atkins said on Monday that he received emails every hour from people interested in serving on the board. While he had noted some frontrunners, Atkins said he would leave the appointment process up to the governor and let it work itself out.
“Word is apparently getting out,” he said. “It’s just some phenomenally well-qualified people.”
Rules for “navigators” and “in-person assisters” who will help consumers get insurance are also due at the end of April.
Policymakers need to specify the requirements and training necessary to work in the exchange and outline how those who do so will be compensated, Exchange Director April Todd-Malmlov said in an interview.
Health carriers and the exchange itself have deadlines of their own.
Companies that want to sell products on the exchange must submit them for regulatory review to the departments of Commerce and Health by May 17, she said.
The exchange will be doing public outreach to ensure that people know what sort of products and benefits are available, ranging from federal premium subsidies to eligibility for a state public health program.
“We will be doing quite a bit of public education and outreach into the spring and into the summer months to get people aware of the exchange and what it can do for them,” Malmlov said.
Himle Rapp, a public affairs company, is finishing up a $34,000 public relations and social media strategy contract with the state. Haberman, an advertising firm, is also completing a $162,000 branding contract, Malmlov said.
Rich McCracken, an account director for Haberman, said in an email to expect a formal announcement about the exchange branding once Dayton signs the bill, which will happen this week.
Perhaps the largest obstacle remaining is designing the exchange’s IT infrastructure.
Both Atkins and Lourey, the bill authors, said the technical development is what they’re most concerned about. The massive, complicated project is on a nearly unprecedented timeframe, lawmakers and exchange staff acknowledge.
“The most daunting challenge that lies ahead is making sure that each of the carriers is connected to the marketplace and is able to operate when this thing gets up and running,” Atkins said.
The exchange must be open for enrollment by October and be fully functional by next January. It also faces other federal deadlines.
Malmlov said the exchange would meet the functionality deadlines but at the start might not have all the “bells and whistles” that could be added later.
“It’s a lot to get up and running in this amount of time,” Malmlov said. “When it starts on Day 1, it’s not going to have everything in it that we want to have, and it’s probably not going to be perfect.”
Wait and see
Kate Johansen, a lobbyist with the state Chamber of Commerce, said her group is waiting to see how the exchange will function.
While the political process at the Legislature is over, interest groups will have plenty of opportunity to lobby the exchange board through advisory committees and input on rulemaking as the body gets settled.
Malmlov said she expected such groups as the Chamber and TakeAction to provide input, for example, on the rules for navigators and in-person assisters.
“We have over the course of the exchange discussion focused on engaging members of the public in the exchange conversation and advocating for the well-being of consumers,” TakeAction Associate Director Liz Doyle said in an interview. “As this continues to move forward, we’re going to continue to play the same role.”
But the Chamber may take a different tack.
Johansen said lawmakers could have compromised on a business-friendly, common-sense exchange. Instead, she said, they ignored the thousands of hours of work the Chamber put into shaping the policy over the last two years.
“I think that there would have been a much stronger spirit of collaboration moving forward, and frankly I think there would have been a more pragmatic approach to the marketplace,” Johansen said, if lawmakers had taken some of the business-oriented suggestions.
Johansen said the Chamber would “remain vigilant” and prepare consumers for “premium shock” and other negative outcomes it expects the exchange to produce.
“We spent the last two years trying to help craft a good design,” Johansen said. “Our suggestions were not included in the final bill, and the functionality of the exchange rests entirely with the governor and the Legislature, so at this point it’s totally up to them to make it work.”