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.