Health insurance exchange, MNsure, moves ahead

by T.W. Budig

ECM Capitol reporter

MNsure Executive Director April Todd-Malmlov, right, watches the unveiling of the new name for the state's insurance exchange at a recent bill signing ceremony. (Photo by T.W. Budig)
MNsure Executive Director April Todd-Malmlov, right, watches the unveiling of the new name for the state’s insurance exchange at a recent bill signing ceremony. (Photo by T.W. Budig)

When Management and Budget Commissioner Jim Schowalter flicked the cloth off a placard bearing the name MNsure, April Todd-Malmlov stood at one side.

She had earned a spot.

“It would have been great to have had it sooner,” said Todd-Malmlov, MNsure executive director, of the state insurance exchange being signed into law. “But it was great to have it,” she said.

Todd-Malmlov, along with the bill authors, was a main character in the speed run the historic exchange legislation took through the State Capitol earlier this session. Other than for a hearing or two when in Washington, Todd-Malmlov, 36, of St. Paul, appeared at nearly all of the 18 hearings for Minnesota’s alternative to a federally run insurance exchange that it cleared before being signed into law by Democratic Gov. Mark Dayton.

The pace, set by the federal government, doesn’t slacken. A summertime media blitz — social media, TV, radio, billboards, State Fair — is planned to educate the public about MNsure, a focus-group tooled name given the exchange.

The exchange board is expected to be appointed by the governor by the end of the month. Rule making is taking place, and qualifications are being set for the brokers and navigators who will guide the public to the best insurance options. Enrollment begins Oct. 1; coverage begins Jan. 1, 2014.

One of the fixed points in the process is the executive director.

Todd-Malmlov, who holds a master’s in public health from the University of Minnesota, was at the Minnesota Health Department when Massachusetts created its insurance exchange. Former Republican Gov. Tim Pawlenty became interested in exchanges, and she was involved in the unsuccessful attempt at moving legislation through the Legislature.

Leaving state government, Todd-Malmlov, with UnitedHealth Group, continued a focus on insurance exchanges, working with officials from a variety of states interested in insurance exchanges.

“I was well over a year working from that side, knee deep in the weeds as the (Affordable Care Act) legislation was playing out at the federal level,” she said.

An economist, Todd-Malmlov eventually returned to the Minnesota Department of Health, her first day back testifying for two hours at a triple-committee legislative hearing on Obamacare.

Shortly after Dayton took office, she stepped into her executive role. She leads an office operating not with microscopes but under one.

Republican exchange opponents blasted the exchange legislation as creating an all-powerful, self-financing board operating outside of legislative constraint. Todd-Malmlov, who expects sharp media and public scrutiny, sees things differently.

“From the very beginning we’ve had a lot of oversight, a lot of scrutiny, from a variety of different places,” she said.

All exchange contracts, reports, reviews are available on its website. There’s an ongoing commitment to transparency, she said.

“We are probably the state with the most oversight compared to other states,” Todd-Malmlov said.

But exactly what is the entity she helps to lead?

“We are not an insurance company. We are not going to have people’s personal medical information. We are not going to be setting rates or anything like an insurance company,” she said.

“What we are doing is facilitate the purchase of insurance and helping people get the information and financial assistance to enroll in the best plan for them,” Todd-Malmlov said.

Under so-called Obamacare, starting Jan. 1, U.S. citizens and legal residents must obtain health insurance coverage. Not having coverage could result in escalating penalties, the penalty next year being the greater of $95 per adult or one percent of taxable income, according to the exchange. More than a million Minnesotans, most of whom are already enrolled in government health care, are expected to use MNsure.

Although portrayed as a virtual online marketplace, which it is, a more accurate picture of MNsure is one of a business, Todd-Malmlov said. Yes, there’s the Internet, but there will also be a call center and possibly offices for insurance-seekers to stop by for assistance.

The “boots on the ground” will be the brokers and navigators working on a community-based level to assistance the public. Some navigators may be members of nonprofits, already engaged in assisting the public. These will not be regular MNsure employees, but contract for services.

“At this point it’s hard to determine exactly how many there will be,” Todd-Malmlov said.

When fully ramped up, the exchange will have a budget of about $60 million a year.

Todd-Malmlov argues the state acted wisely in forming its own exchange rather than accepting a federal exchange.

“If we would have went with the federal exchange, that would have cost us much more,” she said.

The feds would charge at least a 3.5 percent fee on insurance premiums sold through the exchange, while MNsure can charge up to 3.5 percent. Projections suggest MNsure will stay well under that mark, Todd-Malmlov said.

Additionally, there’s the simple comfort and assurance in dealing with fellow Minnesotans.

“Instead of having people have to call a 202 (area code) number in Washington,” she said.

While the political landscape, with Democratic control of the State Capitol, favored passage of insurance exchange legislation, nothing was assured.

“There’s always something in the back of your mind — is this going to pass? Is this not going to pass?” Todd-Malmlov said. “We have a lot of great people who came to work for us during a time of pretty great risk. We didn’t have legislation.”

It was a relief to have that done, she said.


Tim Budig can be reached at [email protected]