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MNsure stats: State’s deductible highest in study; enrollment misses October target

MinnPost file photo by James Nord
MNsure Executive Director April Todd-Malmlov cautioned that looking at average deductibles doesn't give the full picture of healthcare costs for plans in the MNsure exchange.

Correction: MinnPost used an incorrect statistic from the New York Times in this story about the health insurance marketplace. MNsure says it has actually achieved more than 91 percent of its federal first-month enrollment target.

The original “statistic is not accurate because our number needs to include private enrollment and MinnesotaCare to be comparable,” said MNsure spokeswoman Jenni Bowring-McDonough said in an email pointing out the inaccuracy. “So our number should be 4279, and that is over 91 percent of the target.”

Bowring-McDonough’s figure includes both the 1,774 Minnesotans who had begun enrolling in private insurance as reported on Nov. 6, in addition to the 2,505 people who were determined MinnesotaCare eligible.

For a fuller explanation, see this MinnPost article.

MNsure’s low-cost premiums may have come with a tradeoff.

Minnesota’s health insurance exchange has the plans with the highest average deductibles out of 15 states surveyed by the Robert Wood Johnson Foundation – about one-third higher than the overall average, according to a November report.

In terms of health plans offered on MNsure, the average deductible for a specific set of middle-tier plans was $4,061, compared with an average of $2,763 across the board. It also ranked twice as high as the $2,000 average deductible consumers would face for similar coverage in Maine or Massachusetts.

One expert says that could have something to do with MNsure’s comparably low premium rates, but exchange officials said Wednesday that the issue is too complex to look at just those two factors.

“I think it’s difficult to say because it depends on how the plans are structured,” MNsure Executive Director April Todd-Malmlov said. “There are different ways to structure the plan that relate to premiums. It’s not all related to deductibles.”

But Julie Sonier, deputy director of the State Health Access Data Assistance Center at the University of Minnesota, said “it certainly could be” that the higher deductibles had a factor in Minnesota’s low rates.

“That’s a big difference and that certainly likely explains that difference,” she said.

It’s even unclear what constitutes a “normal” deductible since plans and need vary so much person to person. “It’s all in the eye of the beholder,” she said.

The report surveyed four federally run exchanges and 11 state-based exchanges, including those in California, Kentucky and New York.

National figures released

The federal government’s enrollment data released Wednesday allows a more comprehensive list of states to be compared for the first time. The feds reported about 106,000 enrollments in private coverage across the country in state and federal exchanges, and about 27,000 enrollees in private plans on just those exchanges they run.

MNsure officials had not had an opportunity to review the federal figures after Wednesday’s meeting and didn’t offer much comment. When told that 27,000 people had enrolled in private coverage through federal exchanges, Todd-Malmlov replied, “Interesting,” with a smile.

“To be blunt, I’m less interested in comparing ourselves to other states than what we’re doing in Minnesota. I’d much rather focus on the people who are signing up on MNsure,” governing board Chairman Brian Beutner said. “I don’t care if other states are worse — or other states are better — what I’m most concerned about is what we can do to serve the people of Minnesota through MNsure.”

At least one board member — Minnesota Human Services Commissioner Lucinda Jesson — raised concerns about whether MNsure could adequately serve public program enrollees if some technical upgrades are delayed till next year.

Todd-Malmlov said MNsure’s next IT upgrade will be released in early December.

Affordable Care Act exchange enrollment

StateType# applyingPrivate plan eligibleMedicaid/ CHIP eligible# enrolled in private planPrivate enroll. target% target reached
ColoradoState45,57536,335 3,7366,44058%
District of ColumbiaState 3,0100%
HawaiiState2,3791,156 6300%
MarylandState 3,4985,9231,28410,50012%
MassachusettsState 17,5000%
NevadaState14,819 5,7101,2178,05015%
New HampshireFederal7,8175,7671,6432691,33020%
New JerseyFederal42,37223,98517,4607416,72011%
New MexicoFederal7,5294,2493,5521725,8103%
New YorkState 134,89723,90216,40415,260107%
North CarolinaFederal57,65342,1107,4041,66213,37012%
North DakotaFederal1,8451,180585427705%
OregonState 190425 16,5900%
Rhode IslandState9,5813,3263,4471,192840142%
South CarolinaFederal20,98015,2573,1125726,4409%
South DakotaFederal3,0812,279525581,3304%
West VirginiaFederal7,0963,4423,1031741,68010%
Source: U.S. Department of Health and Human Services
Data represents health exchange enrollments from October 1 to November 2, 2013. Enrollment targets obtained via the New York Times from a September memo from Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, to U.S. Health and Human Services Secretary Kathleen Sebelius.

*Minnesota's number of individuals eligible for private plans and number enrolled in private plans include 2,505 individuals who are eligible for MinnesotaCare.

Some tech upgrades could be delayed

But she said several technical upgrades might be delayed from the end of March until next October. Those changes would allow Medical Assistance, the state’s Medicaid program, and MinnesotaCare enrollees to use MNsure to instantly select coverage electronically.

Right now, once people are determined eligible for Medical Assistance or MinnesotaCare through MNsure, it’s up to the counties or the Department of Human Services to get them into a plan.

Typically the counties actually administer public programs, and some counties only have one public plan option for Medical Assistance or MinnesotaCare. Individuals shopping for private plans can use the MNsure website to select coverage options right away.

“They would be enrolled instantly on MNsure instead of having their plan information sent to them from DHS or the counties,” Todd-Malmlov said, explaining the upgrade.

Jesson said it’s important to think about public program enrollees who would be affected by such a delay when considering how officials want the exchange to run.

“I think the opportunity we really have here — one of the many opportunities we have with MNsure — is to really create a process where we do not have people on public programs who are treated [as] second-class citizens,” she said.

“I just think this is something that deserves further discussion,” she added after the meeting. “I view part of my role on the board is to speak up for people who often don’t have advocates around the table.”

Comments (8)

  1. Submitted by Rebecca Hoover on 11/14/2013 - 12:42 pm.

    All around too pricey for many

    The MnSure program seems too pricey all around for many. Imagine being 60 or over and trying to participate in this program? Most simply will not be able to afford the monthly premiums and very high deductibles. The same is true for most in their 50’s. It’s too bad that Minnesota did not hire managers a bit more in touch with the real world. Perhaps this was deliberate. The politicians and managers of this program seem less concerned with providing universal health care than in maintaining cozy relationships with insurance sellers.

    I have been a supporter of universal health care my entire adult life and this program is far from universal health care. When all is said and done, MnUnsure will expand options for very low income individuals, help younger individuals and leave most in their 50s and 60s out in the cold–more Unsure than ever.

  2. Submitted by Karen Sandness on 11/14/2013 - 02:01 pm.

    Deductibles should be banned, period

    The excuse for them is that they prevent hypochondriacs from running to the doctor for every little sniffle, but really, for most people, sitting in a doctor’s office isn’t their idea of a good time.

    What deductibles ACTUALLY do is keep people from seeking medical attention when they need it. Sure, preventive care is now covered, but I’ve heard people say, “Why should I get screened for cancer when I couldn’t afford the treatment and would leave my family with medical bills if I died?”

    Yes, believe it or not, having to pay a $3000 deductible would bankrupt some households.

  3. Submitted by Dennis Tester on 11/14/2013 - 02:34 pm.

    The purpose of high deductibles

    at least in this insurance model, is to enable insurance companies to recoup their losses.

    When the government is forcing them to cover everybody with pre-existing conditions, include benefits like maternity, substance abuse, etc., for everybody even if you don’t need them, and keep monthly premiums low to give the appearance that it’s “affordable,” they have to make up the difference somewhere. They’re not charitable organizations, you know.

    And if you think health care is expensive now, wait until the democrats get their way and it’s “free.”

    By the way, I discovered this 2007 quote from Hillary Clinton. “If you have a plan you like, you keep it.”

    Expect to see THAT clip a lot on the teevee in 2016.

    • Submitted by Karen Sandness on 11/15/2013 - 12:15 am.

      Is it the insurance companies “recouping their losses” or

      something more self-serving?

      In the early 1990s, I had a no-deductible, small-copay ($10 per office visit or test, $50 a day for hospitalization) policy at an HMO in Portland for $110 a month. But by the time I left in 2003, that policy was $250 a month with larger copays ($25 for each office visit or test, $500 a day for hospitalization). That same HMO now has deductibles.

      While copays are common in other countries, deductibles are unknown, just as they used to be unknown here.

      Yeah, I know, we’re so darn special here in America. We get to have high deductible insurance WITH high premiums, because by gum, that’s the American way, squeezing every dollar out of the customer so that the company’s profits can keep rising. (And even in supposedly non-profit insurance companies, the executives aren’t exactly underpaid.) Because they now have an 80% medical loss ratio enshrined in the ACA, when they used to be happy with 90%.

      Ain’t it grand to be an American and have all those lightly regulated private insurance companies, which love to send out glossy pamphlets telling us how much they care?

      Ain’t it grand that they can–with the blessing of the ACA–retain their practice of price gouging people over 50?

      Ain’t it grand that the private insurance companies now have a guaranteed customer base AND express permission to impose high deductibles? And federal subsidies for covering low-income people? Woohoo! Corporate welfare!

      Yeah, it would be so awful to live in a country where medical expenses were not the most common cause of bankruptcy. It wouldn’t be the American way, of course, and those silly foreigners have nothing to teach us, because the American way is the only way. I heard on AM radio that rich Canadians are practically lined up at the border to pay exorbitant prices for elective surgery instead of waiting their turn in line with their inferiors, because in America, nobody ever waits for elective surgery– (If they can afford it).

      Or so a lot of people seem to believe.

  4. Submitted by Rebecca Hoover on 11/14/2013 - 06:17 pm.

    Big profits for insurance — no ins. for 50 and 60 year olds

    It’s interesting that countries that provide universal health care provide high quality care at a lower cost than the USA profit gouging insurance companies can. And the folks in those countries live longer. Private insurance and politicians are killing us. The next time you see a politician with an honest promise, you will see “Vote for me, vote for private insurance and death.”

  5. Submitted by Richard Callahan on 11/14/2013 - 09:07 pm.

    Just who are they counting?

    My son chose a policy on MNSURE, but went directly to the insurance company’s website to actually purchase it. I doubt he was counted as someone who signed up for “Obamacare”, and there are likely many like him.

  6. Submitted by Carolyn Jones on 11/15/2013 - 06:55 am.

    Low Premiums = lower eligibility for subsidies

    I think this was a deliberate attempt by the Dayton administration to keep down premiums so the Governor could claim credit. Unfortunately for average Minnesotan’s this will mean less people will get subsidy assistance because your subsidy is based on the amount of premium you pay relative to your income. This explains why a family of 4 making $85,000 receives a subsidy of over $6,000 in AK, and that same family receives nothing in MN. Good for campaign literature, but bad for Minnesotans.

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