MNsure has smoothed out many of the kinks in its operations since its launch a month ago, but there are still problems for agents, brokers and health plans that are affecting how the exchange works for consumers.
Minnesota’s health exchange is certainly performing better than its beleaguered national counterpart, which was facing technical issues on Wednesday as Congress grilled federal officials about its botched rollout.
But as many complaints about MNsure’s operations have quieted over the past month, key issues remain, including:
• Minnesota’s health plans are still waiting to receive consumer data from MNsure about who has enrolled in coverage.
• And the state’s agent and broker communities still are waiting for the special system access they need to help people enroll more easily.
Both of those groups agree that the exchange’s consumer experience needs to be improved to ensure that MNsure gets enough people into the marketplace.
“If there’s headaches behind the system, we’ll work those out,” Geoff Bartsh, vice president of public policy and government relations at Medica, said in an interview. “But we want to make sure that the people coming in have as good of an experience as possible. That’s going to help with word of mouth. That’s going to help with retention next year, and those are all really important things.”
If people don’t have a good experience using the exchange, Bartsh added, they could delay enrolling. Likewise, consumers having issues signing up for insurance with an agent may get frustrated and not complete the process.
“You just miss that first chance to get them into the new marketplace,” he said.
Agents, brokers raised concerns early
Minnesota’s agent and broker communities have been raising concerns with the exchange since it was under construction.
One of their main priorities — having dedicated access to the MNsure system to help people enroll — wasn’t available at the rollout and still isn’t there. And there’s no clear timeline when it will be put into place.
“It is frustrating,” said Alycia Riedl, president of the Minnesota Association of Health Underwriters, an agents and brokers group, “mostly because brokers at this point, at some point, are turning people away and saying, “I’m not qualified to help you.’ ”
“Coming out the gate, it’s making it really difficult for people to get good information and get enrolled,” she said.
Riedl said agents and brokers were told they would have special access to MNsure that would allow them to take on consumers’ profiles and help them in a hands-on way.
“There wasn’t a clear communication that came out and said this functionality wasn’t going to be available,” Riedl said. “We’ve kind of been going blind since the beginning.”
Since the exchange was little more than a plan, agents and brokers pushed to have expanded access to the system
Robert Hanlon, president of Corporate Health Systems, led an exchange advisory group that pushed for the access. “The more connectivity we have with the exchange, the better it is,” he said. “We were trying to have a dialogue as much as possible, but not a lot was coming back to us.”
Hanlon brought his issues to the state, but consistently felt rebuffed or ignored. Riedl also criticized MNsure’s priorities and communication.
Now the state is having regular meetings with the agent and broker communities and communication has improved, she said, but there’s still no timeline for when the functionality will come online.
MNsure awaiting federal action
Jenni Bowring-McDonough, a MNsure spokeswoman, said the exchange is waiting for the federal government to roll out a stringent security protocol called “multi-factor authentication” before it opens up special access to the exchange for assisters.
It’s unclear when the feds will roll out the security feature. Representatives of the Centers for Medicare and Medicaid Services (CMS) were unable to provide information about the protocol and its timeline.
But at least two other states, Washington and Kentucky, have pushed forward with dedicated broker access on their own, spokespeople said. Washington put in place the more stringent security requirements at the state-level, as well.
“We have our own process here,” Bethany Frey, a spokeswoman for the Washington Healthplanfinder exchange, said of its dedicated access to the system. “We have some of our methods that go above and beyond some of the CMS requirements.”
Without the access, brokers in Minnesota have had troubles helping people get access to coverage because it’s a clunky process that can really only be done in person, Riedl said. Without improved services for agents and brokers, the process is bad for business and insurance consumers.
“If they can’t in good conscience help somebody, then it’s bad for business,” she said. “It’s definitely bad.”
Update: A CMS representative said in an e-mail that “multi-factor authentication” has been available to states through the federal data hub.
Bowring-McDonough said in an e-mail that the state is happy the feature is available.
“We were told in August that [multi-factor authentication] was not available and that there was no ETA for availability,” she said. “So, we reprioritized our vendors’ work at that time. We only recently found out that it is now available, and we are working through broker/navigator portal implementation as part of upcoming IT releases.”
The MNsure spokeswoman said it’s important to note that the security protocol isn’t a “fix,” but must be “prioritized for an upcoming release.”
The exchange also has struggled to create and test the IT connections between MNsure and the health plans necessary to transmit enrollment data quickly and accurately.
Bartsh, the Medica lobbyist, said it’s unclear when that function will be up and running.
Bowring-McDonough said in an email that MNsure would like it to be available very soon.
There have also been issues transferring that information from the federal exchange.
“MNsure’s aware that we want that information as soon as possible,” Bartsh said. “For us right now, that’s been the biggest challenge.”
Without that information by the enrollment deadline, people might go to an appointment or call their plan with a problem and find “the health plan saying, ‘I don’t know who you are. I have no record of you.’ ”
Bartsh said it’s very important that MNsure’s consumer experience is strong or people could choose to shop on the private market. Without strong enrollment, the exchange’s risk profile could be skewed, driving up costs in the long run.
And costs are almost sure to increase in the coming years, he said, as Minnesota’s high-risk pool closes and federal programs taper out.
“From the health plan perspective, we all sort of took our best shot at what would make sense, given a whole new world where we really didn’t’ know how things would look,” Bartsh said.
“There are some things that are occurring in 2014 that allowed the carriers to come out with a more competitive price that will go away in the future, and the prices in the future will have to reflect the fact that those things are changing.”
New enrollment numbers due
MNsure is set to release new enrollment information on Nov. 6. The last numbers, from Oct. 16, showed that about 3,800 people had begun the process of enrolling.
Observers agree that Minnesota is outperforming the federal government’s exchange, but there are other states that appear to be rising to the top.
Gwenda Bond, a spokeswoman for Kynect, the state-based exchange in Kentucky, acknowledged the national attention her state has received for its work. As of last week, more than 26,000 people had enrolled in coverage there.
“I think it’s been going very well for us. We’ve been pretty pleased,” Bond said in an interview. “We have been surprised at how steady things have stayed.”
Bowring-McDonough said MNsure is communicating with the feds and watching other states, but she cautioned against comparing MNsure to other exchanges and states with different circumstances.
“It’s true that every state is really unique and Minnesota is different from other states,” she said. “Comparing Minnesota’s exchange to other exchanges is not really an apples-to-apples comparison.”