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Progressive Politics in Minnesota, the Nation, and the World

Downey's "Fixes" for MNSure Are More Bunk

Category: Health Care
Posted: 03/01/15 17:36

by Dave Mindeman

I need to respond to an OP-ED in the Star Tribune by Keith Downy, chair of the Minnesota Republican Party and obvious MNsure critic.

It is a bit surprising that Downey and the MN GOP suddenly think of themselves as some kind of "savior" for MNsure - especially when they actively blocked its beginning, did nothing to work on the bill that brought it into being, have not bothered with helping in its evolution, and are still actively seeking to kill it with every opportunity.

So the idea of having the "cure" has to be viewed somewhat skeptically.

But at least, for once, Downey puts forward some actual remedies. Let's take a look....

1. Only 9 percent of MNsure enrollees actually bought the private coverages, and these enrollees don't need MNsure's failed technology to find their insurance. H.F. 5, authored by Rep. Tara Mack, R-Apple Valley, proposes waivers allowing enrollees to take their government subsidy to private-sector insurance exchanges, which already offer Obamacare-compliant private coverages and work perfectly. We should free these MNsure-locked customers to shop wherever they want! Using the federal exchange could also be evaluated.

Private plans have been key to MNsure's viability. And the horrible website has chased away most of the people that wanted to buy a private plan. But there is a flaw in the Mack bill. If we allow the federal subsidies to be used by the private sector, we will have a gigantic privacy issue. The exchanges and Fed website were designed to use data gathered from the IRS to determine those subsidies. One of the problems in forming these exchanges is how to keep that data safe and private. What the Mack bill does is potentially open that income data to insurance carriers, which to me would be a bigger disaster than software problems.

2. The 91 percent enrolled in government's MinnesotaCare and Medicaid programs, which have been available for years, were enrolled through the regular process and systems at the Minnesota Department of Human Services (DHS). They can continue to be. These enrollees do not need MNsure to get their coverage either!

Yes, many of them were eligible before. And many more became eligible with the Medicaid expansion. Except why were they not getting that coverage before? One of the reasons is that they didn't know about the programs or know that they were eligible. The MNsure exchange has been a valuable tool for determining all of that. Granted, the software has still made part of that journey into coverage a little tedious, but the overwhelming numbers of new MNCare and Medicaid recipients means that our overall uninsured rate has dropped by 40%. Would that have happened without MNsure? Maybe some of it - but it is hard to imagine Republicans signing onto new outreach programs to find them.

3.  Shut down the unnecessary MNsure bureaucracy and operations. S.F. 810, authored by Sen. Michelle Benson, R-Ham Lake, proposes an alternative nonprofit structure to manage Obamacare coverages, much like the Minnesota Comprehensive Health Association operated successfully.

I'm not sure how this is worded, but it is hard to imagine that we actually know what is unnecessary at this time. The MN Comprehensive Health Association is a favorite of Republicans because it only provided catastrophic coverage - few prescriptions or any preventive medicine. It was cheap insurance because it covered only the extreme health event. The MN GOP would love to bring that back.

4. Evaluate whether any components of MNsure's technology or operations could be salvaged by the DHS to improve the enrollment process for MinnesotaCare and Medicaid. If not, shut them down altogether.

We do have serious problems coordinating MNsure to our state health programs. Lots of improvement is needed here and they need to "talk" to each other much more efficiently. It might be better to have MNsure determine eligiblity for these plans and then turn over the files to MNCare or Medicaid from there. MNsure seems to have complicated matters with state recipients and that does need to be fixed.

Downey is good at listing complaints about MNsure - GOPers in general have made it a political sport. But his idea of "real" fixes is pretty shallow at best - and will make things more complicated at worst.

I am sure we would all like the MN GOP to be a partner in solving the MNsure problems, but Downey's words are no evidence of that.

Not in the least.
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GOP: It Is Just What They Do

Category: Health Care
Posted: 02/18/15 09:09

by Dave Mindeman

Kinda overhead at the Capitol.....

GOP LEG: Wow, you guys must be in major damage control. Did you see that Auditor report on MNsure? Man, that was bad. Yowser...really bad. Told ya it would be. Told ya so. Hot damn.

DFL LEG: Yeah, It was a tough one. Of course, it was pretty much stuff we already knew. Bad website. Bad management. We covered this pretty thoroughly.

GOP LEG: Yeah, but don't you feel really, really bad? That report was just awful. You guys must be shakin' in your boots. Gotta love a good scathing report like that.

DFL LEG: Well, things are getting better. Wait times were under 3 minutes this time around. And despite the report, over 370,000 Minnesotans got health care and the uninsured rate dropped by 40%. Gotta be happy with that.

GOP LEG: Yadda. Yadda. Yadda. But the report was just sooooo bad. Nothing worked right and wasn't that April Todd-Malmlov a piece of work? Gosh, I'm gonna love the hearings on this. It is going to be great!

DFL LEG: More hearings? I thought the report pretty much said it all don't you? What exactly are hearings going to accomplish?

GOP LEG: Oh, man, really? Hearings are the big chance to go over it all over again. It'll be great! We can call up all the MNsure staff and rake them over the coals. Bring in some of those unhappy callers who had to wait for hours. We can call Todd-Malmlov to testify and she can do her refusal thing. Great stuff. It'll keep the papers busy for weeks.

DFL LEG: Seriously? MNsure is doing much better now. Why bring all that stuff up again? Besides, we've got to get going on transportation. Broadband for rural areas. Debate on Pre-K. College tuition freeze. Maybe even a bonding bill. We have stuff to do.

GOP LEG: Oh heck. We got time for all that. Can't pass up the optics of this really, really bad report. I mean we have to point out how bad it was pretty much every day until the end of session. It was just sooooo bad. I love it. We'll get to that other stuff later....people still want to hear about that really bad auditor report.

DFL LEG: Yeah, well, I guess you do what you gotta do.

GOP LEG: Oh, yeah. That is what we are the best at doing. By the way, how about those Commissioner pay raises? Wasn't that just outrageous? I love it!
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Auditor Report On MNsure - Bad Report But Not Much New

Category: Health Care
Posted: 02/17/15 15:03

by Dave Mindeman

Soon you will be peppered with Republican criticism of MNsure...and Tom Hauser will be certain to lead with MNsure on his At Issue program. The Legislative Auditor's report came out today.

It was very critical. But let's take the summations one by one....

1) MNsure implemented its enrollment website in 2013 with serious technical problems. It did not adequately test the site, and it made insufficient use of state government technology experts.

This was evident from the beginning. There were very, very serious flaws in the technology of the website and manager April Todd-Malmlov hid the problems, didn't allow for adequate testing, and simply botched her job from the beginning. Incidently, she was asked to testify before the Auditor but would only do so IF PAID. She never did testify. Management was a disaster.

2) Federal law imposed an ambitious timeline on states developing exchanges. This challenge was heightened by late federal rules, delays in passing state legislation, and problems with vendor selection and performance.

The emphasis is mine. And it is worth noting that a Republican Legislature during the MNsure discussion refused to act on a bill. They obstructed and delayed and were a large part of the time crunch which forced the Democratic legislature to pull together legislation quickly and for Dayton to try and get implemented on time. This was part of the vendor selection problem as well as there was no time for proper vetting. That is not a good excuse but it was a contributor.

3) MNsure staff withheld information from the MNsure Board and other key officials before the enrollment website was launched.

This put the MNsure board and staff in a real bind. They were never really prepared for the disaster that unfolded when they went live. Another horrible decision from Todd-Malmlov that jeopardized the whole program. If she knew it wasn't ready, then tell everybody.

4) MNsure reported that it met its overall enrollment target in its first open enrollment period, but the target was seriously flawed. The target contained an error that resulted in an unrealistically low estimate.

The Auditor noted that Medical Assistance enrollees had a flawed number, and although this may be true, it doesn't mean they are any less necessary to be enrolled. In fact, more so, because they are more likely to enter emergency rooms with no ability to pay. The goals, flawed or not, were still met - and the uninsured rate dropped 40%. That cannot be a coincidence. The Auditor says expanded Medicaid was a bigger part of the reasoning....but that is still part of the overall ACA law.

5) Many people who bought insurance through MNsure have been satisfied with the products they purchased. But the initial enrollment process was often lengthy, and technical problems frustrated consumers, insurers, and counties.

Yeah, we can rehash the website disaster and yes, because of the disaster, the call center was overwhelmed. But the end goal - the end product - met the needs of the people who got the insurance. That is significant.

6) About 28 percent of MNsure enrollees said they were uninsured immediately before enrolling.

28 percent is still a big number. You have to remember that Minnesota has been a national leader in its low uninsured rate. But to pick up 28% more of the new enrollees is still pretty remarkable. And if the website would work they way it is meant to, then more and more people would use it for the convenience and comparison.

7) During its first year, MNsure failed to provide adequate customer service through its call center. Also, the roles played by consumer assisters were not sufficiently clear, so consumers were often referred back and forth among them.

Again, no argument and well documented. I, personally, was frustrated with trying to use the system. The call times were inexcusable...and the implementation by management was a big part of the problem. This has been largely fixed and the consumer assisters are better defined.


Yes, it was a bad time - and I am sure the House GOP will take up plenty of time to rehash all the bad news. There wasn't a lot of new things in the report but still it was necessary. We can fix this....if we are willing to.

But first, we need to let the Republicans wring out every last drop of political drivel they can find here.

Yes, we must learn from the past - but let's try not to live there. We have other policies to address.
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