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

A survey of 15 states found Minnesota’s offerings about one-third higher than the overall average.

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.
MinnPost file photo by James Nord

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.

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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
AlabamaFederal20,84014,6962,2626245,74011%
AlaskaFederal2,2031,606368531,4004%
ArizonaFederal32,89720,74111,3397397,77010%
ArkansasFederal14,0596,1237,4302503,5707%
CaliforniaState192,48993,66379,51935,36491,00039%
ColoradoState45,57536,335 3,7366,44058%
ConnecticutState18,81512,3256,4904,4182,310191%
District of ColumbiaState 3,0100%
DelawareFederal3,4912,2041,2009756017%
FloridaFederal123,87093,45612,8873,57133,39011%
GeorgiaFederal56,78341,4267,7091,39014,28010%
HawaiiState2,3791,156 6300%
IdahoFederal10,5737,7331,5973382,80012%
IllinoisFederal56,63635,80219,4471,37010,01014%
IndianaFederal31,97919,09311,3057018,7508%
IowaFederal10,8846,1044,4901362,8705%
KansasFederal12,2059,0871,7183713,71010%
KentuckyState76,29439,20728,6765,58615,40036%
LouisianaFederal14,16310,2941,4603876,5806%
MaineFederal6,4975,0616232711,61017%
MarylandState 3,4985,9231,28410,50012%
MassachusettsState 17,5000%
MichiganFederal44,02534,1974,9781,32911,27012%
Minnesota*State31,44724,0379,1664,2794,69091%
MississippiFederal8,2045,8229251484,0604%
MissouriFederal27,91120,1214,1577518,2609%
MontanaFederal5,2053,8154572122,17010%
NebraskaFederal9,9737,4532,2953382,80012%
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%
OhioFederal45,12834,3747,5351,15013,3009%
OklahomaFederal14,1699,9522,4123465,8806%
OregonState 190425 16,5900%
PennsylvaniaFederal57,67443,9663,7882,20714,42015%
Rhode IslandState9,5813,3263,4471,192840142%
South CarolinaFederal20,98015,2573,1125726,4409%
South DakotaFederal3,0812,279525581,3304%
TennesseeFederal33,23024,3344,0899928,61012%
TexasFederal108,41080,96011,6822,99144,0307%
UtahFederal14,5809,3184,8163573,9909%
VermontState5,5403,3411,4111,3253,99033%
VirginiaFederal42,34132,5344,0881,0238,89012%
WashingtonState119,30929,50348,1967,09123,80030%
West VirginiaFederal7,0963,4423,1031741,68010%
WisconsinFederal34,67822,03810,7368775,53016%
WyomingFederal2,6542,040219859109%
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.”