State health insurance exchange opens; concerns linger about new system

by T.W. Budig
ECM Capitol Reporter

History kept its appointment last week with the state’s new health insurance exchange opening enrollment for customers.

Despite technical glitches and a battle over the Affordable Care Act, or Obamacare, freezing Congress, MNsure scored an average of 100,000 hits to its website each hour on Oct. 1, the start of enrollment, with about 1,000 phone calls flowing into the Contact Center.

MNsure officials predicted a gradual buildup, but the MNsure website still averaged 30,000 to 50,000 hits each hour Wednesday and Thursday, Oct. 2-3, according to MNsure.

By Friday, Oct. 4, some 4,400 Minnesotans had created accounts with MNsure.

Former Republican U.S. Sen. David Durenberger, a health care expert and long-time advocate of health care reform, offered a simple metric for whether MNsure, one of 16 state health care exchanges, proves a success: “Once it starts being emulated,” he said.

MNsure Executive Director April Todd-Malmlov listens as Chris Buse, the state's chief information security officer, testifies to a MNsure oversight committee on Tuesday, Sept. 24. (Photo by T.W. Budig)
MNsure Executive Director April Todd-Malmlov listens as Chris Buse, the state’s chief information security officer, testifies to a MNsure oversight committee on Sept. 24. (Photo by T.W. Budig)

A recent data privacy foul-up at MNsure and questions of security marked the final days to start of enrollment. Durenberger said he wonders whether deeper issues are being overlooked.

The exchange is part of a transformation of health care delivery in America, Durenberger said. Paying for health care by services provided is shifting to the concept of total cost of care — into “bundles,” said one health care provider.

Durenberger warned that doing nothing to reform the nation’s health care system will result in rising costs crashing it, ushering in undesirable single-payer health care.

“Everybody knows that it can’t go on,” Durenberger said.

Positive signs are already appearing, he said.

“They’re all changing their behavior,” Durenberger said of health care providers. “They’re becoming a lot nicer to the customer.”

As for health care exchanges, the idea has been around for 50 years and has been used to an extent in public and private sectors, Durenberger explained.

“It’s so simple,” he said.

Dale Thompson, president and CEO of Benedictine Health System in Cambridge, while sensing a certain “angst” in the health care industry over Obamacare, also views the status quo as unacceptable.

“In my opinion, doing nothing is not an option,” Thompson said.

Thompson, like Durenberger, views the shift from payment for services to total cost of care as positive. One concern is how young people, a demographic critical to health care insurance stability, will react to Obamacare, he noted.

“I think that’s selling young people really short,” Thompson said of assuming that young people will skirt finding health insurance.

Thompson believes that Americans, in general, will act responsibly.

One criticism of exchanges – that they will drive up insurance rates – is proving to be untrue, Thompson said. Indeed, the health care rates the Benedictine Health System pays to insure its employees can’t match those found on MNsure, he said.

“We would if we could,” Thompson said of shopping on MNsure.

Large businesses may be able to shop for insurance one day on the exchange as small business can do now. Federal and state officials hail the insurance rates on MNsure as the lowest in the country.

Training for insurance brokers and navigators at MNsure will continue through the fall. Navigators help individuals and families enroll in health care plans through MNsure. They are not insurance agents or brokers.

As of the week MNsure opened, it had close to 1,100 brokers and 12 navigators listed on its site. About 2,500 navigators are seeking certification, according to a MNsure official.

In recent legislative hearings, Republicans have expressed dismay regarding levels of training, security polices and other matters at MNsure.

“Republicans will continue to demand accountability from MNsure until we can be sure that Minnesota families will have the peace of mind to know their privacy is protected,” Sen. Michelle Benson, R-Ham Lake, said in a statement.

Sen. Sean Nienow, R-Cambridge, also called for increased privacy controls.

Actual coverage through MNsure begins Jan. 1.

FAQ: Minnesota’s health insurance exchange

Here’s some information about the state’s new insurance exchange, MNsure, online at The MNsure call center is at 855-3MN-SURE (855-366-7873), available 7:30 a.m. to 8 p.m. Monday through Friday and 9 a.m. to 4:30 p.m. Saturdays. The six-month enrollment period began Oct. 1.

•Who will use MNsure? Initially, individuals and families buying their own insurance, looking for better insurance or without insurance, will use MNsure. So will small businesses — those up to 50 employees.

•How long will it take to find insurance? It depends. A person could get through the process in an hour, while others might take more time.

•What do those different color plans mean? Bronze level plans cover about 60 percent of services offered. Silver plans cover about 70 percent of services offered, gold plans about 80 percent and platinum plans about 90 percent.

•What about the federal mandate? Can I get fined? Yes. Under the Federal Affordable Care Act, or Obamacare, most Americans will be required to have health insurance. Starting next year, the penalty for not having coverage will be $95 per adult or 1 percent of taxable income, whichever is greater. The penalty increases: By 2016, the cost of going without health insurance will be $695 per adult or 2.5 percent of taxable income, whichever greater.

Not everyone without insurance will get fined. Poor people, those without coverage for less than three months, American Indians and those with religious objections are exempted.

•Who will be providing insurance on MNsure? Group Health, Blue Cross-Blue Shield, Medica, PreferredOne and UCare. All the insurers will offer plans in the metro area and to the north. Two companies will cover southeast Minnesota, with three in parts of south-central Minnesota.

•When will coverage begin? It begins on Jan. 1.

•Do I have to buy insurance through MNsure? No. But tax credits will be available only through MNsure, open to Minnesota residents.

•How many Minnesotans are expected to use MNsure? More than a million Minnesotans are expected to use the health insurance exchange. Minnesotans in medical assistance and MinnesotaCare will apply for coverage through MNsure.

•What about pre-existing conditions and getting turned down? Under the Affordable Care Act, insurance companies cannot deny an applicant insurance due to pre-existing conditions. They must base their rates on age, geographic area and whether an applicant smokes.

•How many Minnesotans are without health insurance? According to Minnesota Department of Health, in 2011 nearly 490,000 Minnesotans, or 9.1 percent of the population, lacked health insurance.

•Is Obamacare, and the health insurance exchanges under it, controversial? Very much so. In general, Democrats favor Obamacare and Republicans do not.

•How much does MNsure itself cost? When fully ramped up, the exchange will have a budget of about $60 million a year. It is funded by taking a percent of insurance premiums.

Tim Budig can be reached at [email protected].