Posted: 09/02/16 14:51
by Dave Mindeman
We are going to get another round of gleeful criticism of MNSure from the legislative Republicans.
But it is kind of ironic - they don't seem to understand the system well enough to focus on the actual problems.
Let's try to get this right. MNSure is not the reason that insurance premiums are increasing. Got that? MNSure itself has nothing to do with it.
All MNSure does is provide the marketplace for the insurance companies to allow the public to compare what they have decided to charge.
MNSure does have issues. It still has difficulty with technical problems. It has difficulty coordinating with Minnesota Care. It has long wait times to answer questions.
Those things are fixable over time. But insurance premium increases? That is a problem that is still rampant within the insurance system itself.
What did we want the ACA to do? What was its original purpose? It was to reduce the number of people that did not have access to health insurance. To relieve the burden on hospitals to deal with costs of helping those who did not have insurance. To provide government help with affordability.
The ACA is doing those things. I realize affordability has become a bigger issue, but the ACA still provides the subsidies that help the working poor get to affordable options. The ACA is doing its job - the original intent.
But blaming the ACA for having to deal with an insurance based health care system out of control is foolishness.
The biggest change in health care that is causing the current rash of crazy premium increases is the inclusion of people with pre-existing conditions. In the past, the major insurance companies have always developed ways to push them out - to force a government solution to chronic illness. Prior to the ACA, those people went largely uninsured or were thrown into inadequate catastrophic plans that still left them with unaffordable out of pocket expenses.
When the ACA became law, everyone was put on notice that denial of coverage would now be a thing of the past. The insurance companies had plenty of time to prepare and adjust for that coming issue.
But, as usual, they mismanaged it. Some of the companies set up unrealisticly low premiums hoping to capture a bigger share of the market and worry about the cost adjustments later. Some of the companies just completely misinterpreted the new risk pool. Most had the number of new entrants too low - forgetting how many people they had refused to accept.
At the very beginning of creating the new health care law, the ACA made concessions to the insurance companies in exchange for their participation. It was the only way to get such a broad and detailed piece of legislation through Congress.
But the insurance carriers have not held up their part. They refused to let the government negotiate drug prices. They blocked the addition of a public option. They demanded that the government make up the shortfalls.
And now, as everything kicks in, the insurance companies want more concessions.
If the insurance carriers are not going to make a competitive market, then we might as well have the government use a public option to take on what the insurance companies are reluctant to do.
That was the original plan and I suspect that if Democrats win control of the Senate and the Presidency that this will be on the agenda.
But let's get back to MNSure for a minute. The Minnesota Republicans are blaming all the foibles of the insurance market on MNSure. And if we are realistic, that is a stretch. MNSure is not the ACA - it only implements the requirements of the ACA. MNSure does not control the pricing structure - the insurance companies control that. MNSure does not write the policies - they only act as a go between for comparison.
Don't get me wrong - there are plenty of things about MNSure that need fixing, but the MN GOP is not talking about any of those. No, they are pretending that MNSure is to blame for all of our current health care problems - and that is simply not true.
Minnesota started this exchange because we wanted Minnesota to have some control over how Minnesotans would get access. The MNSure system had immediate flaws on technical grounds, but access is improving - although much too slowly.
However, eliminating MNSure would not solve the premium increases and the way the policies themselves are structured. That is outside of MNSure's jurisdiction.
But as far as Republicans are concerned it is a simple easy target. And if they can add confusion and complexity, hey why not.
The GOP is not going to help fix anything.
And quite frankly, that is the main problem here.