While there certainly is room to debate whether MNsure is helping or hurting Minnesotans’ health insurance markets and coverage, there is much less (if any) room to debate the exchange’s functionality, especially as the enrollment deadline nears: It remains a problem.

Witness news reports in December about how call-center wait times ballooned (again) to more than an hour. Look at how deadlines were extended again. And Wednesday, MNsure announced enrollment centers statewide are holding special hours Saturday and Sunday to help any Minnesotans who have not yet enrolled in coverage. The new deadline is Jan. 31.

True, those are not the epic consumer-experience problems seen when MNsure debuted in 2013. But coupled with MNsure’s uncertain fiscal future, they are serious enough to make Minnesotans of all political stripes ask: Is this really what you get for $300 million in public money? (That’s roughly what it cost to build the exchange.) And might it be worth considering replacing MNsure with the federal exchange?

To be sure, MNsure has helped provide more Minnesotans with coverage. But there is no denying MNsure’s operational and budget challenges pose long-term concerns.

Remember, much of the money that built MNsure came through the federal government as the Affordable Care Act took hold. Heading into 2016, though, the federal dollars are largely gone — meaning MNsure will have to pay for itself.

It’s already clear that won’t be easy. Due mostly to lower-than-expected enrollment of private policies, MNsure in March adopted a three-year plan that cuts its budget by $2.5 million. The consumer-level problems experienced in recent weeks can’t be helping matters.

Indeed, the final number of private plans enrolled through MNsure for 2016 will be the biggest indicator yet of whether the state exchange is sustainable or if Minnesota should consider scrapping it.

It’s important to note Minnesota is not alone in this dilemma. According to the Duke Center for Health Policy & Inequalities Research, most state-run exchanges are experiencing similar problems. The center notes Minnesota is one of six it considers financially troubled. Three others are considering shutting down. And four others already have failed.

Many Minnesota legislators are already acutely aware of this. Some asked pointed questions about the enrollment struggles Tuesday at a MNsure oversight committee meeting. Others are raising the predictable, partisan calls for scuttling the exchange immediately.

A more reasonable approach is for the 2016 Legislature to analyze MNsure operations using key recommendations issued in a 2014 Minnesota Legislative Auditor’s Report. Those include:

• The Legislature should amend state law to give the governor, rather than the MNsure Board, authority to appoint the MNsure chief executive officer. In addition, the Legislature should consider whether to retain the MNsure Board as a governing body or to make it purely advisory.

• The Legislature should amend statutes to formally create a governance structure for MNsure’s enrollment system and ensure that MNsure’s future information technology work is subject to oversight from the Office of MN.IT Services.

• MNsure and DHS should ensure that insurance brokers are fairly compensated for enrolling consumers through MNsure.

• MNsure should improve its ability to access and analyze the applicant and enrollee data it collects.

What’s been done? What hasn’t? And in light of MNsure’s current challenges, what proven solutions can be adopted before 2017?

Those answers will go a long way toward determining whether the state exchange is fixable and sustainable for the long term.

 

— St. Cloud Times, Jan. 23