Posted: 01/30/16 16:41
by Dave Mindeman
MNSure has become a MN GOP punching bag for some time now. The latest legislative audit didn't help matters much as numerous errors were found in regards to the state health programs.
But let's examine some of this from a real world perspective.
Health care has always been a complicated system - the beauty of single payer is its simplicity, but we don't have single payer. We have a myriad of eligibility rules, restrictions, reporting nightmares, and layers upon layers of bureaucracy.
And frankly, a portion of this is a problem that has nothing to do with MNSure. The basic problem for MNSure has been that they have tried to completely automate the system. Where the state programs have files and caseworkers working with clients to figure out where they fit, the exchange tries to shrink all that down into a few facts and figures. That can work for the bulk of health care recipients, but there are still a large number of people who don't fit into a nice neat category.
Yes, the ACA is complicated. It is a product of years of wrangling with insurance companies, health providers, government services, and the layers of vendors who provide that health care. Everybody added their opinion from their own perspective and the end result has layers upon layers of data and forms and rules that are difficult to navigate.
MNSure had no precedent to work with. A new law and new software and new requirements have proven to be inherently flawed. Some of that was to be expected, but obviously, MNSure has had more issues than it should have had.
Some of this is because of the early software failure. The timeline had to be stretched and corners had to be cut. Rules have been modified and major overhauls have improved things immensely, but there are still some basic problems that need to be ironed out.
Republicans want to ditch the whole system and just dump Minnesota into the Federal exchange....at least until the ACA is repealed in their minds. But there is advantages to having our own system. We can better adapt the exchange to meet state health care eligibility and rules. We can make quicker adjustments if the system is our own. We simply have more control. You would think that Republicans would prefer that idea.
The Audit report was pretty critical...and deservedly so. Change and adaptation has been slow, but we have to remember that this new entity is only a few years old. It has already had 3 chief operating officers. It has been wading through regulations that have been constantly shifting. The road to a mature operating entity is going to be slow and rocky.
And it wasn't like some of these problems were not always inherent in our health care system. Anyone who has tried to figure out an insurance bill knows how crazy it can get. The Minnesota state programs have always had eligibility problems to deal with. Even prior to MNSure, people have been placed in the wrong program because lower income people that are close to threshold income levels keep moving in and out of these programs.
And the paper work has been complex. As a pharmacist, I would be spending a lot of time checking on eligibility for patients. Many times they simply missed sending in some information to the state....the requests for data are constant and it is easy to miss those notices. MNSure has been an attempt to automate all of that, and frankly, there just may be too many variables to allow that. It may come to the old system of caseworkers following up with clients to keep up with all the changes.
Yes, the audit report reveals some serious problems, but the real issue is how do we deal with it. Republicans continue to avoid any responsibility to address these issues with fixes. They are great at joining in on the criticism, but in the end, Minnesotans need health care and we need to fix the problems that hinder our methods of providing it.
Audits are necessary and problems need to be identified. But addressing and fixing those problems is the job of our representatives.
The ACA has reduced the uninsured by a huge number. Isn't that what we want? Don't we want health care to work for everybody?
When Republicans have critiqued the audit for whatever political gain they think they can maximize, how about everybody gets to work and fix it.
That would seem to be the real job here.