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To MN House GOP, MNSure Is ALWAYS The Problem

Category: Health Care
Posted: 10/13/15 14:50

by Dave Mindeman

MNSure is in the news again. And Republican critics are quick to call for its demise...again. But their is a problem with the definitions. So let's go back to basics.

What is MNSure? MNSure is a health care exchange marketplace. It allows insurance carriers to connect up with health care insurance consumers in a comparison of coverages and prices. It is also the means whereby consumers can obtain subsidies allowed by the ACA.

What isn't MNSure? MNSure is not an insurance carrier. It does not set the coverage or price that an insurance company puts on the exchange. It does not require insurance companies to list on the exchange. It does not set the mandates for coverage (that is done by the ACA for all insurance carriers).

So when insurance companies request premium increases of 50+%, why would this be MNSure's fault? Republicans in the legislature seem to be saying that because insurance companies are raising rates, MNSure should be ended.

If you actually look at facts and not through a political prism, this is totally ridiculous.

The ACA and the exchange method of consumer choice are in their first few years of existence. Insurance companies are still analyzing how the new law affects coverage and how premiums shake out in that context. Companies have made mistakes in marketing strategy. Preferred One attempted a volume pricing method. It did not work. Some set pricing levels that ended up being unsound. But this is an insurance issue, not a MNSure issue.

Now the insurance companies are experimenting with another strategy. They have found a loophole which allows them to capture clients on the exchange, but then for renewal, they take them out of the exchange and into the "off-exchange" market. This saves them the MNSure fee and meets the state requirement of automatic renewal, but it takes away the opportunity for that consumer to be eligible for Federal subsidies.

Health insurers have directed thousands of enrollees off the MNsure exchange by renewing certain policies only in the "off-exchange" market, a practice that threatens to take a bite out of MNsure's revenue.

This saves the 3.5% fee that using the exchange costs the insurer, but leaves the consumer ineligible for subsidies. It also takes needed revenue away from the MNSure exchange that was meant to make it self-sustaining.

This problem has been created by a loophole in the law which allows these renewals without going through the exchange. Other states with exchanges do not allow this and have not had this problem. For some reason, Minnesota decided not to make the requirement....and I suspect that the insurance lobby had a hand in making that happen.

This needs to be fixed and it would be a simple fix.....if not for the probable obstruction of the House GOP. Since they are already calling for a MNSure repeal (even though this problem is not the fault of MNSure), it would seem unlikely that they would be willing to simply change the language and end the problem.

MNSure has had its share of problems, but the software is getting fixed and the number of uninsured has been dramatically reduced. Many new laws need tweaking once they are implemented and fixes can be simple if the lawmakers want to do what is best for the general public.

But when it comes to MNSure, the House GOP isn't interested in fixes. They want the politics. What is foolish about all of this is that getting rid of MNSure won't change the premium prices. It would force MN onto the Federal exchange which eliminates any local control and oversight.

Now, while I would much prefer a single payer system for the state of Minnesota, I do feel that MNSure and the ACA are the best alternative we have until that happens. And it all could be so much simpler if the Republicans wanted to work on that health care system as well.

But they don't....and so we will continue to have to fight for health care in spite of their obstruction.
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Blaming MNSure For Premium Increases Is Simply Wrong

Category: Health Care
Posted: 10/01/15 17:40

by Dave Mindeman

It is worth noting that the GOP has locked in their health care talking points to a critique of MNSure.....not matter what the issue really is.

Today's release of the proposed increases by the insurance carriers gives the MN GOP the perfect opportunity to call for the end of MNSure...again.

But, you know what? It's never that simple.

As we seem to have to explain to the GOP from time to time, MNSure is a market exchange not a price maker. Premiums are determined by the insurers and frankly, they have done a pretty lousy job of establishing the market.

Let's review. The ACA did some very positive things that have greatly reduced the number of uninsured in this country. Greatly reduced! The new law got rid of pre-existing conditions. It allows children to stay on their parents insurance up to age 26. It has mandatory preventive coverages. It eliminated caps on lifetime coverage. It provides subsidies for people who find coverages that take up too much of their income. And it provides an exchange for the consumer to compare prices.

Now several of those benefits cost insurers a significant amount of additional money. Especially in the private market which makes up about 6% of Minnesotans. Prior to the ACA, insurance companies could "pick" their market. They could eliminate sicker clients with pre-existing conditions. They could cap lifetime coverage and disguise what is and isn't covered. And they could make the patient pay for "optional" preventive maintenance.

Those were the basics for insurance premiums before the ACA went into effect. It was a different marketplace going forward and frankly, the insurers misread it badly.

I think their expectation, about how many and what type of people would be added because of the mandate, was pretty much wrong. And the number of people with chronic disease states that were unable to get insurance previously was underestimated.

The pool was different and it will take time for that situation to stabilize. I believe that, as an example, Preferred One entered the marketplace with an expectation that volume would outweigh additional risk. They were wrong. And I suspect very strongly, that these increases that the industry as a whole are now proposing are an overcompensation for previous bad analysis.

This is not MNSure's fault. Putting Minnesota on the Federal exchange doesn't change Minnesota's marketplace. It just takes away local state control.

MNSure still has a lot of work to do to get its operations smoothed out, but what the insurers are charging is not the fault of the exchange.

A lot of the issues with MNSure and the ACA are a direct result of continuing to keep the insurance companies in control of providing health care. They are bad at it....and getting worse.

There is still a simple solution to fix all of it. Single payer.

The MN Health Plan is ready to go...available with a simple waiver. If the Republicans are truly serious about getting rid of MNSure for a better system, the answer is a straightforward single payer plan.

Problem solved.
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House And Senate MN GOP Send Conflicting Messages On Health Care

Category: Health Care
Posted: 07/15/15 23:01, Edited: 07/15/15 23:05

by Dave Mindeman

Minnesota Republicans are so quick to find fault with the ACA and MNSure that they tend to send out conflicting messages - of course, without solutions.

Here are some Twitter critiques from GOP State Senators regarding the Federal Exchange:

Sean Nienow;@SNienow
yaaaaay.... "Healthcare .gov does not appear to be set up to detect fraud, GAO...Seto Bagdoyan said" http://bit.ly/1HvFRak (quote fixed)

Sen. Michelle Benson;@SenatorBenson
HealthCare.gov does not appear to be set up to detect fraud." Pretty basic operations failure. http://bigstory.ap.org/article/2cd1ae9804b545388f993bc0747c441e/apnewsbreak-bogus-enrollees-kept-getting-obamacare#overlay-context=article/week-odd-news-41 ...

Compare that to two days ago on July 13, when there was this story on the MPR website...

Republicans renew calls to dismantle MNsure

In this story we hear this:

Two Republican members of the Minnesota House (Reps. Matt Dean and Greg Davids) on Monday renewed calls to dismantle the state's online health insurance website and send Minnesotans to the federal health insurance exchange.

So in the MN House, GOP representatives want us to get off of MNSure and go on the Federal exchange. In the MN Senate, GOP Senators are complaining that the Federal Exchange has no fraud protection.

So, where in all of these knee jerk criticisms do you see anything that provides a solution or a real fix?

MNSure has had many problems. Some of them have been fixed and yes, there are more that are being fixed or need more work.

But here is the main point. The number of uninsured in Minnesota is at a record low. The number of uninsured in the nation is at a record low. And the enormous ability to lower it even further is totally up to Red State governors who opt for Medicaid expansion.

Another point. The states that have their own exchanges have much more control of the process than the ones who do not. If the Republican Party truly does value "local control", then they should be jumping on board with the MNSure Advisory Task Force and offering real and substantive suggestions for making this exchange better and more efficient.

Whining about it is actually not very constructive.
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